What are gallstones?
Bile is composed of various components, and their concentration remains balanced at a certain equilibrium. When there is an imbalance in this equilibrium (for example, in conditions of excess cholesterol or bilirubin) hard deposits called "gallstones" are formed.
Gallstones can be present in the gallbladder or the bile ducts themselves, obstructing the flow of bile from the liver to the intestine. Since the bile ducts are narrower, stones in the bile ducts can obstruct bile outflow, leading to pain, fever, jaundice, and infections.
What causes gallstones?
Cholesterol stones are formed when the bile contains an excess of cholesterol or bilirubin, insufficient bile salts, or when the gallbladder does not empty properly. Pigment stones are formed in patients with liver disease, infections of the bile ducts, and individuals with hereditary hematological disorders such as sickle cell anemia.
Risk factors for gallstones:
• Obesity
• Increased cholesterol level in the bile or reduced gallbladder motility, often influenced by the hormone estrogen. Increased estrogen levels can occur due to various reasons, with common examples being pregnancy, hormonal therapies, and the use of birth control pills.
• Women have a twofold higher tendency to develop gallstones compared to men.
• Individuals over the age of 60.
• Medications that lower blood cholesterol levels can increase cholesterol levels in the bile.
• Diabetes
• Rapid weight loss
• Fasting
What are the symptoms of gallstones?
Often, gallstones in the gallbladder do not cause any symptoms, and many patients are unaware of their presence unless they undergo imaging tests such as ultrasound or CT scans.
Symptoms usually occur when the gallbladder outlet or bile ducts are obstructed, or when the common bile duct is blocked. The most common symptom is a pain in the upper right quadrant of the abdomen, especially after meals, although the pain can also occur in other areas of the body, such as the right shoulder or between the shoulder blades. The pain can last for several hours. In addition, there may be nausea, fever, chills, and jaundice, depending on the severity of the condition.
How are gallstones diagnosed?
• Ultrasound - primarily used to diagnose gallstones in the gallbladder. The imaging is less accurate when it comes to stones in the bile ducts.
• CT scan
• MRCP
• ERCP - an endoscopic procedure used to visualize the bile ducts.
How are gallstones treated?
Diagnosis of gallstones in the gallbladder in asymptomatic individuals who do not belong to high-risk populations usually does not require treatment. A treatment plan is typically determined when there are symptoms or when the patient is classified as a high-risk population. The decision is made based on the physician's judgment and in consultation with the patient.
Possible treatments:
• Cholecystectomy - removal of the gallbladder when gallstones are symptomatic. After cholecystectomy, bile flows directly from the liver to the small intestine. Possible side effects include diarrhea since bile is no longer stored in the gallbladder.
• Dissolution of gallstones. Oral medical treatment that reduces the formation of gallstones may have side effects and require regular use.
• Extracorporeal Shock Wave Lithotripsy and clearance of residual stones through the bile ducts without causing obstruction. This treatment is mainly accepted when there are large stones in the bile ducts and not in the gallbladder.