Gallstones (cholelithiasis): symptoms, causes and treatment (2023)

general description

What are gallstones?

Gallstones form in yourgallbladder, the small pear-shaped organ where your body stores bile. They are pebble-like pieces of concentrated bile material. Bile contains cholesterol, bilirubin, bile salts and lecithin. Gallstones are usually made up of cholesterol or bilirubin that builds up in the lower part of the gallbladder until they harden into "stones".

Gallstones can be as small as a grain of sand or as big as a golf ball. They gradually grow as bile continues to bathe them, and they gather additional materials. In reality, it's the smaller stones that cause problems. This is because smaller stones can travel while larger ones tend to stay in place. Wandering gallstones can get stuck somewhere and cause a blockage.

What is cholelithiasis?

Cholelithiasis is the condition of gallstones. Many people have cholelithiasis and don't know it. Gallstones are not necessarily going to cause you problems. If they don't, you can leave them alone. But gallstones can sometimes cause problems by creating a blockage. This causes pain and inflammation in your organs. Left untreated, it can lead to serious complications.

How common are gallstones?

Gallstones are common in developed countries, affecting about 10% of adults and 20% of people over the age of 65. Only 20% of people diagnosed with gallstones need treatment.

How will gallstones (cholelithiasis) affect me?

Your gallbladder is part of your biliary system. It is part of a network of organs that exchange bile with each other. These organs are connected by a series of things called tubesbile ducts. Bile travels through the bile ducts of yourLeberto your gallbladder and from your gallbladder to yourssmall intestine. They arePancreasIt also uses the bile ducts to distribute its own digestive juices.

A gallstone that travels to the mouth of the gallbladder can block the flow of bile. A gallstone that leaves the gallbladder and enters the bile ducts could block the flow of bile through the ducts. This causes bile to build up in nearby organs. When bile builds up, it increases pressure and pain in the organs and bile ducts, causing inflammation.

This can lead to a variety of complications, including:

disease of the gallbladder.Gallstones are the most common cause of gallbladder disease. If they get stuck, they cause bile to build up in the gallbladder and cause itinflammation. Over time, this can cause long-term damage to the gallbladder, scarring the tissue and impairing its function. Stagnant bile flow also increases the likelihood of gallbladder infections.
liver disease. A blockage in any part of the biliary system can cause bile to build up in the liver. This leads to inflammation in the liver, increasing the risk of infection and, over time, long-term scarring (cirrhosis). When your liver stops working properly, your entire biliary system breaks down. You can live without a gallbladder, but not without a liver.
gallstone pancreatitis. A gallstone blocking the pancreatic duct will cause thisInflammation in the pancreas. As with your other organs, temporary inflammation causes pain, and chronic inflammation causes long-term damage that can affect your organ's function.
Cholangitis. Inflammation in the bile ducts can lead to short-term infection and long-term scarring. Scarring of the bile ducts causes narrowing, which leads to narrowingrestricts the flow of bile. This can lead to long-term bile flow problems, even after the blockage has been removed.
jaundice. The accumulated bile enters your bloodstream and makes you sick. Bile carries toxins that your liver has filtered out of your body. The bilirubin content has a yellow color that is visible in the whites of the eyes.
Malabsorption. If bile isn't able to get to the small intestine as expected, you may have a hard time breaking down and absorbing nutrients from food. The bile is particularly important for the breakdown of fats and the absorption of fat-soluble vitamins in the small intestine.

symptoms and causes

What is the main cause of gallstones?

Up to 75% of the gallstones that doctors discover are made up of excess cholesterol. So we could say thatwith excess cholesterol in the bloodIt is the main cause of gallstones. You can have extra cholesterol for a variety of reasons. Some of the more common reasons are metabolic disorders, such asobesityjDiabetes.

High levels of cholesterol in the blood lead to increased levels of cholesterol in the bile. Your liver filters cholesterol from your blood and stores it as a waste product in bile before sending the bile to the gallbladder. The chemicals in bile (lecithin and bile salts) are designed to dissolve cholesterol. But if it's too much, these chemicals may not be up to the task.

What else causes cholelithiasis?

Other factors that contribute to gallstones include:

Excess bilirubin:About 25% of gallstones are made up of excess bilirubin instead of cholesterol. Bilirubin is a by-product produced when the liver breaks down red blood cells. Certain medical disorders can cause your liver to produce extra bilirubin while it is doing its job. Some of these are infections, blood disorders, and liver disorders.
gallbladder congestion:Your small intestine tells your gallbladder to release bile when it has fat to digest. When your gallbladder is healthy, it contracts to efficiently move bile out when needed. However, if your gallbladder doesn't contract enough, some bile may be left behind. This bile gradually concentrates in a kind of sludge at the bottom of the gallbladder, which then crystallizes.

Who Has Gallstones?

Anyone can get gallstones, including children, but they're more common after the age of 40. This is because gallstones grow very slowly. Gallstones can take 10 to 20 years to grow large enough to cause a blockage. They are also more common in people assigned female at birth than at birth, in a 3:1 ratio. This is due to the effect of females.Hormone.

Why are women at higher risk of developing gallstones?

Estrogenincreases cholesterol and progesterone slows gallbladder contractions. Both hormones are specialAltduring certain periods of their reproductive life, such asMenstruationand pregnancy whenHormone levels begin to dropInMenopause, many people useHormonal therapy (TH)to replace them, which raises them up again.

Women and those identified as female at birth are also more likely to gain and lose body fat. Excess body fat can lead to extra cholesterol in the blood. Obesity increases estrogen. On the other hand, rapid weight loss has a similar effect as weight gain. When you lose a large amount of body fat all at once, you send an unusually large load of cholesterol to the liver for processing, which ends up in the bile.

What are the first signs of gallstones?

You won't notice your gallstones unless one gets lodged somewhere and causes a blockage. When that happens, the most typical symptom is some sort ofstomach pain, in the upper right quadrant of your abdomen, called biliary colic. It occurs in episodes lasting one to several hours, usually after a heavy or heavy meal. Your gallbladder then contracts to send bile to your small intestine for digestion.

If you have occasional biliary spasms, it means a gallstone is causing a partial blockage, but you can't feel it until the gallbladder contracts. The contraction forces pressure through the bile ducts and causes that pressure to build up inside when it meets resistance. This is a warning sign. The stronger the blockage becomes, the stronger your pain will become.

How is gallstone pain?

pain in the gallbladderIt most commonly occurs on the upper right side of your abdomen, below your rib cage where your gallbladder is located. But sometimes it feels looser in your tummy. The pain may also radiate elsewhere, most commonly to the right arm or shoulder blade. It starts out as pain and then steadily increases in intensity for the first hour before receding.

Despite the name, biliary colic is not a "colicky pain" that is sharp and comes in waves. It has a slow, steady arc and is usually blunt but hard. You can take him to the emergency room for relief. You may also notice that your upper right abdomen feels tender. Biliary colic is often accompanied bynausea and vomiting. Also called "gallbladder attack".

Do Gallstones Cause Other Symptoms?

When a gallstone causes persistent obstruction or infection, you have symptoms of acute inflammation. This can include:

Persistent pain.
fever and chills.
accelerations in heart rate.

You may also start showing symptoms of bile buildup in your bloodstream, such as:

jaundice.
hollow eyes
Dark colored urine.

diagnosis and testing

How Are Gallstones Diagnosed?

If you develop symptoms of biliary colic, your doctor will investigate this with blood tests and imaging tests. Blood tests can detect inflammation, infection, or jaundice. They can also give your doctor clues as to which organs are affected. Imaging tests help pinpoint the source of the obstruction. They usually start with aUltrasonic.

What tests are used to diagnose cholelithiasis?

Ultrasonic:Andabdominal ultrasoundIt is a simple and non-invasive test that requires no preparation or medication. This is usually all that is needed to locate gallstones. However, it does not visualize the choledochus very well. If your healthcare provider suspects a gallstone is hiding there, they may need to use a different type of imaging test to find it.

CPRM: Magnetresonanz-Cholangiopankreatographie (MRCP)is kind ofmagnetic resonancewhich specifically makes the bile ducts visible. It is non-invasive and creates very clear images of your biliary system, including the common bile duct. Your doctor may use this test first to find a possible gallstone there. But if you're pretty sure it's there, you can skip it and go straight to an ERCP.

CPRE:ERCP meansEndoscopic retrograde cholangiopancreatography. This test is a bit more invasive, but it's useful for finding gallstones as it can also be used to remove them from the ducts if they're stuck there. It uses a combination of X-rays and endoscopy, which means a tiny camera is passed down your throat at the end of a long tubeupper GI tract. (They will have medication to make it easier.)

When the camera (the endoscope) reaches the top of your small intestine, your healthcare provider will insert another, smaller tube into the first to go further down your bile ducts. They inject a special dye through the tube and then take video X-rays (fluoroscopy) while the dye travels through the channels. They can run tools through the pipe to remove any rocks they find.

_
_Endoscopic retrograde cholangiopancreatography (ERCP) can diagnose and sometimes treat gallstones.

Endoscopic ultrasound enters the common bile duct and gallbladder through the mouth.

management and treatment

Gallstones (cholelithiasis): symptoms, causes and treatment (3)

Does cholelithiasis require surgery?

Most people with gallstones never need treatment. But if your gallstones are causing problems, your doctor will want to remove them. You will usually want to remove all of your gallstones, even if only one of them is currently causing problems. If a crash happens once, it's likely to happen again. It's not worth waiting for the risk.

Since there is no way to access gallstones in the gallbladder without removing them, the standard treatment for problematic gallstones isRemove gallbladdercomplete. This is minor surgery and you can live just fine without a gallbladder. If you have gallstones in your bile ducts, your doctor will need to remove them separately as well.

Can Gallstones Go Away Without Surgery?

Gallstones in the bile ducts that are not blocked can successfully pass through them and enter the intestines. You can run them through your poop. That's a fortunate scenario, but in general you don't want to risk getting gallstones in your bile ducts at all. If they don't come out of you completely, they will only grow over time.

There are somemedicationwhich can help dissolve smaller gallstones. These take many months to take effect, so they're not the most practical option for people with symptoms. But they offer an alternative for people who may not be in a safe medical condition for surgery. They can also be helpful for people who have gallstones but don't have symptoms yet.

How are gallstones removed?

There are several ways to remove gallstones.

endoscopy

Gallstones in the bile ducts are removed endoscopically (CPRE). This does not require an incision. The gallstones will exit through the long tube that has been passed down your throat. Gallstones in the gallbladder are removed by removal of the gallbladder (cholecystectomy). This can usually be done throughLaparoscopy, a minimally invasive surgical technique.

Laparoscopy

Alaparoscopic cholecystectomyuses small "keyhole-shaped incisions" in the abdomen to operate using a small camera called a laparoscope. Your surgeon inserts the laparoscope through one keyhole and removes your gallbladder through another. The smaller incisions result in less postoperative pain and faster recovery time than traditional "open" surgeries.

open surgery

Some people may have more complicated conditions that require open surgery to be treated. If you have open surgery then you will have a longer hospital stay and longer recovery at home for your larger incision. Some laparoscopic cholecystectomies may need to be converted to open surgery if your surgeon has complications during the procedure.

What are the complications or side effects of gallstone surgery?

Afterlaparoscopic surgery,You may have some absgas and gas pain. You can also have this after ERCP. Both methods pump gas into your organs to expand them and make them appear better on pictures. It will pass in a day or so. Complications during surgery are rare but include bleeding, infection, and injury to nearby organs.

How long does recovery take after gallstone surgery?

If you have a laparoscopic cholecystectomy, you can be home in 24 hours. You can recover in about two weeks. If you have open surgery, you will need to stay in the hospital for three to five days afterwards. Your recovery at home will take six to eight weeks. Your digestive system may take two to eight weeks to adjust after surgery.

What happens when you no longer have a gallbladder?

They aredigestive systemit can still function without a gallbladder. Your gallbladder is primarily a storage location for the bile that your liver produces. It transports bile to the small intestine to aid in digestion. When your surgeon removes your gallbladder, he or she will reroute your bile ducts so bile can flow directly from your liver to your small intestine.

Do I have to change my diet after gallstone surgery?

Your digestive system may take a few weeks to adjust to not having a gallbladder. Some people can experienceindigestionÖDiarrheaduring the transition period. Your doctor will advise you not to eat anything too rich or greasy during recovery. Most people can return to a normal (but reasonably healthy) diet after a few weeks.

prevention

Can Diet Prevent Gallstones?

You can reduce your risk of cholesterol gallstones, which are the most common type, by:lower cholesterol in your diet. Here are some quick tips:

Limit fried and fast foods.These foods are typically deep fried in saturated fat, which promotes LDL cholesterol (the "bad" kind). When cooking with oil, choose vegetable oils over animal fats.
Replace fish with red meat.Red meat is high in saturated fat, while fish is high in omega-3 fatty acids.fatty acidsthat boost HDL cholesterol (the "good" kind). The good helps to balance the bad.
Eat more plants.Fiber-rich fruits, vegetables, and whole grains help remove excess cholesterol from the body. Eating more plants can also help you keep your overall weight down.
Gradually decrease.A weight loss diet can help lower blood cholesterol levels. But it's best to lose weight at a slow and steady rate of one to two pounds a week. Rapid weight loss can stimulate gallstones.

Outlook / Forecast

What is my prognosis for gallstones (cholelithiasis)?

If you have gallstones but they haven't caused any problems yet, they probably never will. About 2% of asymptomatic gallstones become symptomatic each year. Once they start causing symptoms, they likely will continue to do so. About 2% of people with symptomatic gallstones develop complications such as acute inflammation and infection each year.

Cholecystectomy is a definitive treatment for most gallstones, and most people recover quickly and completely. Some people may still have gallstones in their bile ducts afterwards. These can be treated endoscopically. Using medication to dissolve gallstones works about 75% of the time, but gallstones often come back.

to live with

When should I get treatment for gallstones?

If you're experiencing something like biliary spasms, seek help right away. Biliary pain is dull and persistent, increasing for about 20 minutes and lasting one to several hours. It's usually located in the upper-right quadrant of your abdomen, but sometimes it's related to a different part. It is often accompanied by nausea and vomiting, but vomiting does not relieve it.

A note from the Cleveland Clinic

Gallstones are common and most people are never bothered by them. If they stay in your gallbladder, you'll probably never know they're there. But once they move, they become dangerous. These small pebble-like pieces can do a lot of damage if they get into the tight spaces of your delicate biliary system.

A gallbladder attack can be intense and scary, especially if you didn't know you had gallstones to begin with. It can be alarming to learn that the recommended treatment is surgery. However, laparoscopic removal of the gallbladder is a common procedure with an excellent prognosis. Your entire ordeal can be over within hours of your first symptoms.