Gall stones

Content Reviewed by Dr. S. M. Chandramohan MS, MCh, FAICS, Surgical Gastro-enterologist

How do stones form in the gallbladder?

Normally, cholesterol is soluble. But when the amount of cholesterol in bile increases, or the amount of bile salts decreases, cholesterol is precipitated from the bile. When this happens, stones are formed. Other factors causing stone formation are: increased secretion of gallbladder mucus, impaired emptying process, or increased gallbladder volume.

What are the risk factors that increase the possibility of stone formation in the gall bladder?

The words that medical students often learn, to remember the risk factors for gall stone formation are: fat, female, forty, fertile and fair skinned. That is, gall bladder stones are more common among women, obesity is a high risk factor, pregnancy or estrogen therapy can cause gall stone formation and the morbidity increases after middle age.

What are the symptoms produced by stones in the gall bladder?

In most people, the presence of gallstones is diagnosed accidentally during the course of other investigations. The common symptoms are, a feeling of fullness in the abdomen, flatulence, nausea, vomiting and intolerance to food and drinks, particularly to fatty foods and coffee. The symptoms caused by the stones moving through the bile duct or blocking the bile duct are more severe. They are: fever (up to 38°C), biliary colic (acute attacks of pain caused by the blockage of the duct, which prevents transport of material from the gall bladder to the intestine), transient jaundice and sharp, squeezing pain, localized to the right side of the abdomen. Referred pain may be felt in the back and the right shoulder. When the biliary ducts are blocked completely, jaundice with pruritus (itching of the skin) develops. The blockage causes inflammation of the ducts (cholecystitis), which further prevents any drainage of the contents of the gall bladder. This causes an infection of the gall bladder and the duct. The irritation by the stones and the infection cause fever with chills, nausea and vomiting.

What are the complications of inflammation of the bile duct, following blockage by gallstones?

When the cholecystitis becomes more severe, attacks of biliary colic become more frequent. Jaundice develops due to the blockage of the ducts. Cholangitis, or inflammation of the entire biliary tree, with infection, is the result. Acute, septic cholangitis, biliary cirrhosis, pancreatitis and abscesses of the liver may develop.

How does a doctor diagnose stones in the gall bladder?

After knowing the medical history and doing a physical examination, the doctor may ask for some tests to be done. Ultrasonography will reveal the presence of stones. In fact, a doctor will be able to find out whether the stones are present in the gallbladder or in the ducts. Blood tests may show whether an infection is present along with the inflammation.

What is the treatment for Gall stones?

If the cholelithiasis is uncomplicated, then medicines will be given to relieve the pain and the spasm, in case of colic. The person will be put on a liquid diet for at least 24 hours, followed by a diet free of fat and fried foods. If the symptoms are not relieved, the doctor may advise hospitalization. Depending on the severity of the problem and the complications, a decision will be taken to use surgical or non-surgical treatment.

Non-surgical treatment: The stones may be broken by lithotripsy (using sound waves - externally). Substances to dissolve the stones may be administered through the skin. Bile salts may be administered orally. This may benefit people who are slim and have many tiny stones. Non surgical methods cannot prevent a relapse. Surgical Treatment: Surgery is still the best available method to treat cholelithiasis. This may be done by laproscopy or by classical methods. If classical surgery is done, physical effort should be avoided for 6 to 9 months, because post-surgical hernia may develop as a complication.