Gallstones, also known as cholelithiasis, are a condition in which solid particles form in the gallbladder or bile ducts. These stones are usually composed of cholesterol, bilirubin, and calcium, and can cause pain and other symptoms if they block the flow of bile. Cholestasis, which is the obstruction of bile flow, can occur as a result of gallstones or other diseases of the biliary tract.
Symptoms of gallstones
Gallstones are a common condition, occurring in about 10% of the adult population in the Western world. Many people with gallstones have no symptoms, but if the stones cause a blockage, the following symptoms may occur:
- Gallstone attack: Sudden and intense pain in the upper right or middle upper abdomen. The pain may radiate to the back or right shoulder.
- Nausea and vomiting: Especially in connection with fatty foods, which stimulate the gallbladder to empty.
- Jaundice: If the flow of bile is completely blocked, the skin and whites of the eyes may take on a yellowish color.
- Fever and chills: May indicate gallbladder inflammation (cholecystitis) or bile duct infection (cholangitis).
Diagnosis of gallstones
The diagnosis of gallstones is usually made through imaging and blood tests. Ultrasound is the most common method for detecting gallstones in the gallbladder, while magnetic resonance imaging (MRCP) may be used if stones in the bile ducts are suspected. Blood tests may show elevated levels of liver enzymes, bilirubin, and white blood cells in cases of inflammation or blockage, which can provide further guidance in the diagnosis.
- Ultrasound: First-line method for identifying gallstones in the gallbladder.
- Magnetic resonance imaging (MRCP): Used when stones are suspected in the bile ducts.
- Blood tests: May show elevated levels of liver enzymes, bilirubin, and white blood cells in cases of inflammation or blockage.
What can cause gallstones?
Gallstones form when there is an imbalance in the composition of bile, which leads to substances such as cholesterol, bilirubin, and calcium crystallizing and forming stones. This imbalance can be due to several factors, such as altered bile secretion, reduced emptying capacity of the gallbladder, or an increased concentration of substances that promote stone formation. Some common causes and risk factors include:
- Excess cholesterol in bile: Bile cannot dissolve all the cholesterol, leading to the formation of crystals.
- Elevated bilirubin levels: Conditions such as cirrhosis of the liver and hemolytic diseases can lead to increased stone formation.
- Impaired gallbladder emptying: The gallbladder must be emptied regularly to prevent particles from accumulating and forming stones.
Factors that increase the risk of gallstones
Several factors can increase the risk of developing gallstones, either by affecting the composition of bile or the gallbladder's ability to empty it effectively. Some risk factors are genetic or hormonal, while others are linked to lifestyle and health conditions. Listed below are some of the most common factors.
- Gender and age: Women and people over 40 are at higher risk.
- Overweight and rapid weight loss: Can affect the composition of bile and gallbladder function.
- Pregnancy: Increased estrogen can contribute to stone formation.
- Diabetes: Associated with a higher risk of gallstones.
Are gallstones dangerous?
Gallstones themselves are usually harmless and many people have gallstones without experiencing any symptoms. It is only when the stones block the bile ducts or cause inflammation that complications can occur. These can be painful and in some cases serious, which may require medical treatment or surgery. Below are some of the most common complications.
- Acute cholecystitis: Inflammation of the gallbladder, which may require emergency treatment.
- Cholangitis: Infection of the bile ducts, a serious condition that requires prompt treatment with antibiotics.
- Pancreatitis: Gallstones can block the pancreatic duct, which can lead to inflammation of the pancreas.
Treatment and prevention
Treatment depends on whether the patient has symptoms:
- Asymptomatic gallstones: No treatment is required.
- Painful attacks: Painkillers and avoiding fatty foods can relieve symptoms.
- Surgery (cholecystectomy): If gallstone attacks are recurrent, removal of the gallbladder is often recommended.
To reduce the risk of gallstones, the following lifestyle changes may be helpful:
- Eat a balanced diet: Avoid fatty and cholesterol-rich foods.
- Maintain a healthy weight: Avoid rapid weight loss, which can increase the risk of gallstones.
- Regular physical activity: Can help bile circulate better and reduce the risk of stone formation.