Gallstones

What are gallstones?

A small pebble-like substance that develop in the gallbladder is called gallstone. The gallbladder is located below the liver in the right upper abdomen. It is a small, pear-shaped sac that stores bile, a liquid that helps the body to digest fats.When the liquid stored in the gallbladder hardens it forms into pieces of materials called stones.


Composition of Bile

Bile is a golden yellow or greenish fluid poured into the digestive tract along with the pancreatic juice. This helps in the digestion and absorption of lipids. The contents of bile are:

1. Water

2. Cholesterol

3. Fats

4. Bile salts

5. Proteins

6. Bilirubin

Bile salts are nothing but sodium and potassium salts of bile acids conjugated either with glycine or taurine. They are needed for the solubilisation of fats. Bilirubin is the excretory product of bile and is the important bile pigment which is responsible for the yellowish-brown color of the faeces. If enormous amounts of bilirubin, bile salts and cholesterol are present it hardens and this forms gallstones.


Types of gallstones

1. Cholesterol stones

They are usually yellow-green and are the primary content is cholesterol, which is hardened. About 80 percent of gallstones are cholesterol stones.

2. Pigment stones

They are small and dark stones made only of bilirubin.


Size of gallstones

The size of the gallstone may be as small as a grain of sand or as large as a golf ball. The gallbladder can develop into

a. one large stone

b. hundreds of tiny stones

c. a combination of the two


Causes for the formation of gallstones

Stones develop in people with liver cirrhosis, biliary tract infections, or hereditary blood disorders because bilirubin is formed in large quantities in these conditions.


Factors that contribute to the formation of gallstones

Sex

Women are more prone to develop gallstones when compared to men. This is due to excess estrogen production due to pregnancy and hormone replacement therapy, which increases the cholesterol levels in bile and thus leads to gallstones.

Family history

Gallstones often develop in families as a genetic link.

Weight

Obese persons are more prone to get gallstones due to increased cholesterol levels.

Diet

A Diet high in fat and cholesterol and low in fiber can increase the risk of gallstones.

Age

People who are above 60 are more likely to develop gallstones than younger people. The body tends to secrete more cholesterol into bile as the age increases.

Cholesterol-lowering drugs

Some drugs that are used to lower cholesterol levels in the blood may increase the amount of cholesterol secreted into bile thus increasing the risk of gallstone formation.

Diabetes

Diabetic individuals usually have high levels of fatty acids called triglycerides which may increase the risk of gallstones.


Symptoms of gallstones

Gallstones move from the gallbladder and lodge in any of the ducts such as hepatic duct, cystic duct and common bile duct and thus causes blockage of bile flow. A gallbladder attack may occur suddenly following a fatty meal due to this blockage particularly during night time.

1. Steady pain in the right upper abdomen.

2. Pain in the back between the shoulder blades

3. Pain under the right shoulder

4. Prolonged pain lasting for more than 5 hours

5. Nausea and vomiting

6. Fever

7. Yellowish color of the skin or white layer of the eyes

8. Clay-colored stools


Diagnosis of gallstones

1. Computerized tomography (CT) scan

2. Cholescintigraphy (HIDA scan)