Definition

Gallstones are pieces of stone-like material that form in the gallbladder. The majority of gallstones are made up of cholesterol. The rest are made up of bilirubin. Bilirubin is a breakdown pigment of the blood product hemoglobin.

Biliary colic is the pain caused by a gallstone stuck in the bile duct, a tube that carries bile to the small intestine. Sometimes, a stone caught in the bile duct causes cholecystitis (inflammation of the gallbladder). Cholangitis is inflammation of the bile duct caused by a gallstone or a bacterial infection.

	Gallstones
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Causes

The gallbladder stores bile, which is produced in the liver and used in the small intestine to digest fat. Bile contains cholesterol, water, bilirubin, and bile salts. The bile salts break up fats.

Gallstones can form under the following conditions:

• Too much absorption of bile salts from the bile
• Too much absorption of water from the bile
• Too much cholesterol in the bile
• Inflammation of the lining of the gallbladder

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors for gallstones include:

• Age: older than 60 years old
• Sex: women between 20-60 years old and women with high estrogen levels due to pregnancy, oral contraceptive use, or hormone replacement therapy
• Obesity
• Race: Pima Indians and other Native American Indians, Mexican Americans, and Northern Europeans
• Use of cholesterol-lowering drugs
• Diabetes
• Rapid weight loss and fasting
• Previous gallstones
• Diseases of the gallbladder and ducts
• Blood diseases, including sickle cell anemia

Symptoms

Many people have gallstones without symptoms. These are called "silent gallstones." While treatment is not required, in some cases it may be recommended.

Gallstones may cause pain in the upper abdomen that is sometimes called an attack because it begins suddenly, often after a fatty meal. The pain is severe and may last for 30 minutes or up to several hours.

Other symptoms include:

• Intermittent pain on the right, below the ribcage
• Bloating, nausea, and vomiting
• Belching, gas, and indigestion

If you have the following symptoms, you should see a doctor right away, as they may indicate cholecystitis or cholangitis:

• Diffuse abdominal pain
• Sweating
• Chills
• Low-grade fever
• Jaundice (yellowish color of the skin or whites of the eyes)
• Clay-colored stools

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

• X-rays of the abdomen—about 15% of gallstones can be seen on plain x-rays.
• Ultrasound —a test that uses sound waves to find gallstones.
• Magnetic resonance cholangiopancreatography (MRCP)—an accurate and non-invasive means of evaluating the pancreas and gallbladder, comparable to ERCP.
• Endoscopic retrograde cholangiopancreatography (ERCP) —a type of x-ray that shows the pancreas after dye has been sent through a tube down the throat and into the gallbladder.
• Cholecystogram or cholescintigraphy—x-rays that show movement of the gallbladder and any blockage of the cystic duct that carries bile to the bile duct.
• Blood tests—may be used to find an infection, jaundice, pancreatitis , or an obstruction.

Treatment

Surgical Treatments

• Laparoscopic cholecystectomy —removal of the gallbladder through several small incisions in the abdomen. A small, lighted tube with a camera is inserted into one of the incisions to view the gallbladder area and display it on a television screen. Surgical instruments are used to remove the gallbladder through one of the other incisions.
• Open Cholecystectomy—removal of the gallbladder through a large incision in the abdomen. This is necessary if there is an infection in the abdomen or a great deal of scar tissue.

Nonsurgical Treatments

Oral dissolution therapy—medications taken by mouth to dissolve stones. These drugs are most effective for treating small stones and may take months or years to be effective.

Prevention

To reduce your chance of getting gallstones:

• Maintain a healthy weight.
• Avoid rapid weight loss diets.
• Exercise regularly.
• Eat a diet low in saturated fat.
• Eat plenty of fruits, vegetables , and whole grain foods .

RESOURCES:

American Liver Foundation
http://www.liverfoundation.org

National Digestive Diseases Information Clearinghouse, National Institutes of Health
http://digestive.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Liver Foundation
http://www.liver.ca/Home.aspx

Health Canada
http://www.hc-sc.gc.ca/index_e.html

References:

National Institute of Diabetes & Digestive & Kidney Diseases website. Available at: http://www.niddk.nih.gov/ .

Allen J, Cuschieri A. Cholelithiasis. Emedicine website. Available at: www.emedicine.com/med/topic836.htm .

Santen S. Cholelithiasis. Emedicine website. Available at: www.emedicine.com/emerg/topic97.htm .

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