Tuesday, January 8, 2013

Gallstones In Depth

Gallstones are hard, pebble-like deposits that form inside the gallbladder.  Gallstones may be as small as a grain of sand or as large as a golf ball.  The cause of gallstones vary.  There are 2 main types of gallstones: 

  • Stones made of cholesterol, which by far are the most common type.  Cholesterol gallstones have nothing to do with cholesterol levels in the blood. 
  • Stones made of bilirubin, which can occur when red blood cells are being destroyed (hemolysis).  This leads to too much bilirubin in the bile, these are called pigment stones.

Gallstones are more common in women, Native Americans, Hispanics, and people over the age of 40.  Gallstones also run in families.  The following also makes you more likely to develop gallstones:

  • Bone marrow or solid organ transplant
  • Diabetes
  • Failure of the gallbladder to empty properly (this is more likely to happen during pregnancy)
  • Liver cirrhosis and biliary tract infections (pigmented stones)
  • Medical conditions that cause the liver to make to much bilirubin, such as hemolytic anemia, including sickle cell anemia
  • Rapid weight loss from eating a very low-calorie diet or after bariatric surgery
  • Receiving nutrition through a vein for a long period of time (intravenous feedings)

Many people with gallstones have never had any symptoms.  The gallstones are often found during a routine X-ray, abdominal surgery, or other medical procedure.  However, if a large stone blocks either a cystic duct or a common bile duct (called choledocholithiasis), you may have a cramping pain in the middle to the right upper abdomen, this is biliary colic.  The pain goes away if the stone passes into the first part of the small intestine (duodenum).  Symptoms that may occur include: 

  • Pain in the right upper or middle upper abdomen:
    • May be constant
    • May be sharp, cramping, or dull
    • May spread to the back or below the right shoulder blade
  • Fever
  • Yellowing of the skin and whites of the eyes (jaundice) 

Other symptoms that may occur with this disease include:
  • Clay-colored stools
  • Nausea and vomiting
It is very important to seek medical attention if you have the symptoms of gallstones.  Tests used to detect gallstones or gallbladder inflammation include:

  • Abdominal ultrasound
  • Abdominal CT scan
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Gallbladder radionuclide scan
  • Endoscopic ultrasound
  • Magnetic resonance cholangiopancreatography (MRCP)
  • Percutaneous transhepatic cholangiogram (PTCA) 

Your physician may order the following blood tests: 
  • Bilirubin
  • Liver function tests
  • Pancreatic enzymes

The treatment for gallstones is normally surgery to remove them or the gallbladder, because you can live normally without your gallbladder.  It can be done with one large cut.  But now they have a new surgical technique (not just used to remove the gallbladder), laparoscopic, where they cut you in 3 places very small cuts, about an inch in length.  They go into each with a different tool.  One a camera, one to cut out the gallbladder, and one used to pull the gallbladder out of the body.  They also have medication that can dissolve gallstones, but it can take up to 2 years to work, and they can still come back.  Stay Informed! 

1 comment:

  1. I worked in Pathology for many years. I've seen some gallstones and I've seen some GALLSTONES. Some of them are actually quite pretty, difficult as that might be to believe. That leads me to the subject of my comment. A patient once came to the lab some days after her surgery and asked for her stones. In those days, it was fairly common for patients to ask for them, as well as kidney stones. I often wondered why someone would want such a thing, but this woman gave me at least one answer. Because of the size and coloring of the stones (they were quite large) she planned to have them made into jewellery!! She came back, as I requested, to visit us a few months later. She was sporting a necklace that had the largest stone (~4cm diameter as I remember) and a pair of earrings with a couple of the smaller ones dangling from them. It was an amazing thing to see!