Dr. Jeremy Albin: Anatomy of a Gallstone
Dr. Jeremy Albin: Anatomy of a Gallstone
Do you know it’s possible to have gallstones and not know it? They can lie dormant for years without causing problems. However, they become symptomatic when they start causing severe pain. Understanding what gallstones are and knowing the symptoms of a gallstone attack can be very important.
The gallbladder is a small, pear-shaped organ that is part of the digestive system. It’s located on the right side of the abdomen below your liver. The gallbladder stores and secretes bile, which is made by the liver, into the small intestine during digestion. Bile, a yellow-brownish fluid, helps digest fats in food. Gallstones form when substances in the bile crystallize, or harden. There are two types of gallstones:
• Cholesterol gallstones—Made mostly of cholesterol, these yellow-green stones comprise about 80 percent of gallstones.
• Pigment gallstones—Made mostly of bilirubin and calcium salts, these smaller and darker stones account for the remaining 20 percent of gallstones.
Gallstones can be as small as a grain of sand, or as large as a golf ball, though smaller gallstones are much more common. Symptoms may begin to appear when the stones get too large, or leave the gallbladder and get lodged in a duct.
Factors that Contribute to Gallstones:
Although there is not an exact cause for gallstones, a number of factors are known to contribute to their formation:
• Body chemistry—Bile that contains too high a concentration of cholesterol and too low a concentration of bile salts.
• Reduced efficiency—Refers to how good your gallbladder is at contracting and flushing bile into the intestine.
• Proteins —An improper balance of different types of proteins in the liver or bile.
• Obesity —Excess weight may be linked to a decrease in bile salts and an increase in cholesterol production by the liver.
• Rapid weight loss—Causes an increase in cholesterol in the bile.
Anyone can develop gallstones, but some people are more susceptible than others.
People may be more susceptible if they:
• Have a family history of gallbladder problems
• Are women
• Are over 40 years old
• Are Native Americans and Hispanics of Mexican origin
• Have certain health conditions
• Are obese
• Follow certain diets
Symptoms and Complications:
If you experience a gallstone attack, the symptoms can be severe, and sometimes dangerous. Usually experienced as severe pain in the upper abdomen, upper back between the shoulder blades, or right shoulder, gallstone attacks can last anywhere from 20 minutes to hours. If you have gallbladder symptoms, seek medical help. Often times, gallbladder attacks are recurrent or will not go away on their own.
If gallstones are suspected, images of the abdomen are taken to confirm the diagnosis. These tests may include abdominal ultrasound, hepatobiliary scintigraphy (HIDA) scan, or magnetic resonance cholangiopancreatography (MRCP). An endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy and x-ray. It may also be done to diagnose gallstones. Certain stones can be removed during an ERCP exam.
Gallstone Treatment Options:
Keep in mind that gallstones that do not create symptoms are usually not treated. Once gallstones become symptomatic and are diagnosed, they can be treated in a number of ways.
One treatment for gallstones is surgery to remove the gallbladder. Surgery is the most effective method of treating gallstones. Most commonly, the gallbladder is removed with laparoscopy (multiple small incisions) to shorten recovery time. It is often done as an outpatient or day surgery. This can also be done as an open surgery, where a large incision is made into the abdomen.
There are also nonsurgical methods available to treat gallstones, such as oral dissolution therapy and contact dissolution therapy. However, the long-term efficacy of these methods have not been proven and may only be indicated in extreme cases.
Life Without a Gallbladder:
Yes, you can live without a gallbladder, as it functions as a storage area for bile. Without a gallbladder, bile simply drains directly into the small intestines from the liver at a steady rate all day. Some people may have softer and more frequent stools as a result.
People with gallstones that are not causing symptoms need to carefully weigh the risks of gallbladder removal surgery against potential complications that could occur if the gallbladder is not removed. These include eventually developing a painful complication of gallstones such as a blockage of the liver or pancreas.
Talk with your doctor to learn more about gallstones and for the best treatment plan for you.
Dr. Jeremy Albin is a general surgeon with Columbus General Surgery.