Gallstones aren’t really stones; they are hardened deposits of digestive fluid that can form in your gallbladder.
Your gallbladder is a small, pear-shaped sac-like organ on the right side of your abdomen, just beneath your liver. The gallbladder holds a digestive fluid called bile, also known as gall (a green-yellow liquid produced by the liver) that's released into your small intestine via the bile ducts (narrow tubes) to facilitate digestion, mainly of fats.
Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.
People who experience symptoms from their gallstones usually require gallbladder removal surgery. Gallstones that don't cause any signs and symptoms typically don't need treatment. You might not even know you have them until they block a bile duct, causing pain that you need to get treated right away.
You might not notice anything, or even know you have gallstones, unless your doctor tells you. But if you do get symptoms, they usually include:
Sudden and rapidly intensifying pain in the upper right portion of your abdomen
Sudden and rapidly intensifying pain in the centre of your abdomen, just below your breastbone
Back pain between your shoulder blades
Pain in your right shoulder
Nausea or vomiting
Other digestive problems, including bloating, indigestion and heartburn, and burping (gas expulsion)
You may also experience:
Gallstone pain may last several minutes to a few hours.
See a doctor immediately if;
these symptoms last more than 1 to 2 hours,
abdominal pain is so intense that you can't sit still or find a comfortable position,
you notice yellowing of your skin and the whites of your eyes,
or you have a fever.
It's not clear what causes gallstones to form. Doctors think gallstones may result when:
The chemicals in the gallbladder, such as cholesterol, calcium bilirubinate, and calcium carbonate are out of balance. Normally, your bile dissolves these produced chemicals in your gallbladder when a meal is ingested, but if there are more excreted chemicals than your bile can dissolve, any of the excess chemicals may form into crystals and eventually into gallstones.
Your gallbladder doesn't empty correctly. If your gallbladder doesn't empty completely or often enough, bile may become very concentrated, contributing to the formation of gallstones.
Types of Gallstones
Types of gallstones that can form in the gallbladder include:
Cholesterol gallstones. They often appear yellow in colour. They're the most common kind, accounting for 80% of gallstones. These gallstones are composed mainly of undissolved cholesterol, but may contain other components.
Pigment gallstones. These are dark brown or black in colour and smaller. They are formed when your bile contains too much bilirubin.
Tests and procedures used to diagnose gallstones include:
Tests to create pictures of your gallbladder. Your doctor may recommend an abdominal ultrasound and a computerized tomography (CT) scan to create pictures of your gallbladder. These images can be analyzed to look for signs of gallstones.
Tests to check your bile ducts for gallstones. A test that uses a special dye to highlight your bile ducts on images may help your doctor determine whether a gallstone is causing a blockage.Tests may include a hepatobiliary iminodiacetic acid (HIDA) scan, magnetic resonance imaging (MRI) or endoscopic retrograde cholangiopancreatography (ERCP). Gallstones discovered using ERCP can be removed during the procedure.
Blood tests to look for complications. Blood tests may reveal an infection, jaundice, pancreatitis or other complications caused by gallstones.
How are Gallstones Treated?
Most of the time, you won’t need treatment for gallstones unless they cause you pain. Sometimes you can pass gallstones without even noticing. If you’re in pain, your doctor will likely recommend surgery. In rare cases, medication may be used.
Your doctor will determine the treatment for gallstones you need based on your symptoms and the results of diagnostic testing.
Treatment options for gallstones include:
Surgery to remove the gallbladder (cholecystectomy). Your doctor may recommend surgery to remove your gallbladder, since gallstones frequently recur. Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder.You don't need your gallbladder to live, and gallbladder removal doesn't affect your ability to digest food, but it can cause diarrhoea, which is usually temporary.If you’re at high risk for surgery complications, a drainage tube may be placed into the gallbladder through the skin. Your surgery may be postponed until your risk is lowered by treating your other medical conditions.
Medications to dissolve gallstones. Medications you take by mouth may help dissolve gallstones. But it may take months or years of treatment to dissolve your gallstones in this way and gallstones will likely form again if treatment is stopped.While medications can increase your risk of gallstones to recur, don’t stop taking them unless you have discussed it with your doctor and have their approval.Sometimes medications don't work. Medications for gallstones aren't commonly used and are reserved for people who can't undergo surgery.
Tips For Gallbladder Health
Maintain a healthy weight.
Avoid rapid weight loss.
Eat an anti-inflammatory diet.
Get regular exercise.
Take supplements as approved by your doctor.
Some nutritional supplements you can take include vitamin C, iron, and lecithin. One review found that vitamin C and lecithin can decrease the risk of gallstones. Talk to your doctor about the appropriate dosage of these supplements.
Some people recommend a gallbladder flush, which involves fasting and then taking olive oil and lemon juice to help pass gallstones. There is no evidence that this works, and it may even cause gallstones to become trapped in the bile duct.
Foods to avoid
To help improve your condition and reduce your risk of gallstones, try these tips:
Reduce your intake of fats and choose low-fat foods whenever possible. Avoid high-fat, greasy, and fried foods.
Add fibre to your diet to make your bowel movements more solid. Try to add only a serving of fibre at a time to prevent gas that can occur from eating excess fibre.
Avoid foods and drinks known to cause diarrhoea, including caffeinated drinks, high-fat dairy products, and very sweet foods.
Eat several small meals per day. Smaller meals are easier for the body to digest.
Drink a sufficient amount of water. This is about 6 to 8 glasses per day.
Gallstones and Diet
The role of diet in the formation of gallstones is not clear.
We do know that anything that increases the level of cholesterol in the blood increases the risk of gallstones.
It is reasonable to assume that a diet with large amounts of cholesterol and other fats increases the risk of gallstones, but it is also important to remember that the amount of cholesterol in your bile has no relationship to your blood cholesterol.
Losing weight rapidly seems to increase the risk of gallstones and so does skipping meals.
Obesity is a risk factor for gallstones.
Eating a fatty or greasy meal can precipitate the symptoms of gallstones.
If you need surgery to remove your gallbladder or any stones in your gallbladder, the outlook is often positive. In most cases of stone removal, stones don’t return.
But if you don’t have surgery, the gallstones can return. This is true even when you’ve taken medication to dissolve the gallstones.
You won’t need treatment if your gallstones don’t cause symptoms. Still, you may want to make lifestyle changes to prevent them from getting bigger and causing problems.
Complications of gallstones may include:
Inflammation of the gallbladder. A gallstone that becomes lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain and fever.
Blockage of the common bile duct. Gallstones can block the tubes (ducts) through which bile flows from your gallbladder or liver to your small intestine. Jaundice and bile duct infection can result.
Blockage of the pancreatic duct. The pancreatic duct is a tube that runs from the pancreas to the common bile duct. Pancreatic juices, which aid in digestion, flow through the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.
Gallbladder cancer. People with a history of gallstones have an increased risk of gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of cancer is elevated, the likelihood of gallbladder cancer is still very small.
Factors that may increase your risk of gallstones include:
Being age 40 or older, the risk increases as you get older
Being a Native American
Being a Mexican-American
Being overweight or obese
Eating a high-fat diet
Eating a high-cholesterol diet
Eating a low-fibre diet
Having a family history of gallstones
Losing weight very quickly
Taking medications that contain oestrogen, such as oral contraceptives or hormone therapy drugs
Having liver disease
There is no sure way to prevent gallstones. But you can reduce your risk of forming gallstones that can cause symptoms.
You can reduce your risk of gallstones if you:
Don't skip meals. Try to stick to your usual mealtimes each day. Skipping meals or fasting can increase the risk of gallstones.
Lose weight slowly. If you need to lose weight, go slow. Rapid weight loss can increase the risk of gallstones. Aim to lose 1 or 2 pounds (about 0.5 to 1 kilogram) a week.
Maintain a healthy weight. Obesity and being overweight increase the risk of gallstones. Work to achieve a healthy weight by reducing the number of calories you eat and increasing the amount of physical activity you get. Once you achieve a healthy weight, work to maintain that weight by continuing your healthy diet and continuing to exercise.