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Gallstones are deposits in the gallbladder, which can be small like sands or big like eggs. (see picture at right, a gallstone retracted by ERCP) There are three types of gallstones: 1. cholesterol stones are formed from cholesterol, which are the most common type; 2. Pigment stones are made from bilirubin. 3. Mixed stones that are made from both cholesterol and bilirubin. The major problems caused by gallstones are: 1. Infection of the gallbladder, also called cholecystitis, is caused by large stone(s) blocking the gallbladder duct, also called cystic duct; 2. Obstruction in the common bile duct, also called choledocholithiasis, results in acute pancreatitis, jaundice, hepatitis, cholangitis, etc, by impairing the draining system; 3. A gallstone blocking the intestine, is known as gallstone ileus. 4. Increased risk of gallbladder polyps and cancer.
Common Causes and Risk Factors:
- Female gender
- Age 40 and above
- Obesity
- High cholesterol diet
- Native Americans and Hispanics
- Family history of gallstones
- Diabetes
- Pregnancy
- Liver cirrhosis and biliary tract infections
- Hemolytic anemia
- Sickle cell anemia
- Rapid weight loss
- Total parenteral nutrition use
Symptoms and signs
Many people with gallstones may not have any symptoms and the gallstones are just found accidently by x-ray, ultrasound, or CT scan for other reasons. Depending on the location of the stones, patient may have the following signs and symptoms:
- Intermittent abdominal discomfort or pain especially after a fatty meal
- Cramping pain
- Sharp pain spread to the back or the right shoulder
- Nausea and vomiting
- Jaundice
- Fever
- Right upper abdomen tender to touch
- Distended belly
- Light colored stools
Some patients may become very sick with severe symptoms if necrotizing pancreatitis, cholangitis, perforated gallbladder or small bowel, etc, develop. This is an medical emergency, which requires admission to the hospital and immediate medical treatment.
Diagnosis and Treatment
Diagnosis is based on the risk factors, symptoms, signs, etc. One or more of the follow tests maybe needed for the diagnosis:
- Abdominal ultrasound
- Abdominal CT scan
- Gallbladder radionuclide scan
- Endoscopy (EGD)
- Magnetic resonance cholangiopancreatography (MRCP)
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Endoscopic ultrasound (EUS) (see picture at lower right)
- Percutaneous transhepatic cholangiogram (PTCA)
Treatment is based on the symptoms and signs, physical examination, and test findings. Asymptomatic patient without organ damage may not need any special treatment except close observation. Depending on the presentation, one or more of the following modalities maybe the choice of treatment:
- Medication therapy
- Surgery
- Lithotripsy
- Endoscopy (EGD)
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Endoscopic ultrasound (EUS)
References:
- PubMed Health.
- Wikipedia.
- Mayo clinic online health information.
- Sleisenger and Fordtran's Gastrointestinal and Liver Disease- by Mark Feldman MD, et al.
- The Little Black Book of Gastroenterology-by David W. Hay.
- Principles of Clinical Gastroenterology by Tadataka Yamada, et al.
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