The medical term for gallstones is cholelithiasis. When these stones manifest as inflammation of the gall bladder, the condition is known as cholecystitis.
The gall bladder is a small organ located behind and underneath the liver. It stores the bile produced by the liver, which is used to breakdown fat into smaller particles, making it easier to digest. As bile is stored by the gall bladder, over time it become concentrated and hence, more effective.
Gallstones are small stones, usually made of cholesterol, that form in the gall bladder. 10 – 15% of the adult population has gallstones; most of the time, they do not cause any symptoms. However, when they become stuck in the neck of the gall bladder, they may cause severe pain and infection, or move out of the gall bladder and get stuck elsewhere in the digestive system, which may lead to a range of symptoms.
Known risk factors of gallstones include age > 40 years, female sex, overweight individuals, and fertility (of women).
SIGNS AND SYMPTOMS
There are 3 major types of gallstones:
Asymptomatic. As is evident by the name, such gallstones exist in the bladder but dont cause any symptoms.
Uncomplicated. These stones usually cause pain when they obstruct the bile duct (narrow tube that leads to the liver, so secretions can be transported). This leads to spasmodic pain which waxes and wanes. Episodes are usually spaced out over a few months.
Complicated disease. This is when gallstones lead to an array of other problems such as inflammation of the bladder. This can be a very severe episode of pain, fever and nausea/vomiting, called cholecystitis. Jaundice may also be present during cholecystitis.
CONDITIONS CAUSED BY GALLSTONES
ACUTE CHOLANGITIS: It refers to infection of bile ducts. If the bile ducts become blocked, they are vulnerable to infection due to stasis of bile. It is a severe infection which may cause pain in upper abdomen, high temperature, jaundice (yellowish tinge of skin), chills, itchy skin, and general unwellness. In some cases, acute cholangitis may lead to altered mental state as well.
ACUTE CHOLECYSTITIS: It is the active infection of gallbaldder, which becomes swollen, irritated and inflamed. Symptoms include pain in right upper abdomen which may radiate towards right shoulder, high temperature and nausea.
Few patients with acute cholecystitis may also experience jaundice.
ACUTE PANCREATITIS: It is the most feared complication of gallstones, which may occur when a gallstone moves out of the gall bladder and blocks the opening of the pancreas, resulting in inflammation of the pancreas. It leads to severe pain in the center of the abdomen, which radiates to the back. Food makes the pain worse. Patients may also experience nausea, vomiting, diarrhea, loss of appetite and high temperature.
DIAGNOSIS OF GALLSTONES:
Majority of gallstones are picked up on routine testing for other reasons. They are commonly detected during blood tests, cholesterol tests, and on ultrasounds. Some gallstones maybe large enough to be picked on an X ray. If picked on any other test, ultrasound is used to confirm the presence of gallstones. Cholangiography (imaging of gallbladder, where dye is injected and special X ray is used for analysis) may then be used fully assess the stone and the gall bladder.
Watchful waiting is recommended for patients with gallstones with no symptoms. Patients are advised to be wary of onset of any of the aforementioned symptoms.
If symptoms occur infrequently, and are mild, surgery is usually not offered. Painkillers are often prescribed to such patients in event of pain.
In patients with frequent and severe symptoms, the best course of action is to remove the gall bladder. Complicated gallstone disease will almost always warrant surgery. Surgery for removal of gall bladder is called cholecystectomy. It has seen many advances in recent times, and is done laproscropically (keyhole surgery – done via 4 small holes in the abdomen only, one of which is through the belly button).
Open cholecystectomy (large incision in abdomen) is done in cases where laproscopic surgery is not advised, such as pregnant patients in 3rd trimester, morbidly obese patients, and patients with blood clotting disorders.
Alternative treatments for gallstones are also available. They are effective in only a small number of patients. Medication is one such alternative. Ursodeoxycholic acid is a chemical agent which dissolves gallstones.
ERCP (Endoscopic Retrograde Cholangio-Pancreatography) is a procedure which also aims to remove gallstones non-surgically. It is similar to cholangiography, but in addition to studying the bile duct system with dye, a small heated wire is also inserted which aims to widen the bile ducts and make the stone pass.