Dear Dr. Crutchfield: My uncle tells me he suffered with gallstones. What are gallstones?
Let’s first discuss the gallbladder, then gallstones. The gallbladder is a small, sack-like structure that is part of the digestive system. Technically, it is called a storage organ. It is about the size of a large plum.
The gallbladder is full before meals and usually empty and flat after meals. It is located just beneath the liver on the right side of the upper abdomen. The gallbladder stores a green liquid called bile (made in the liver) and other substances that are used in digestion.
The role of the gallbladder is to constrict after eating, and the contained bile and other substances are squeezed into the small intestine through a special tube/duct. The bile and other substances will help emulsify a fatty meal, which breaks down fat and helps the body to absorb it more easily.
The gallbladder is not essential for life. If diseased or problematic, the gallbladder can be removed without significant long-term consequences. Patients may have problems with temporary diarrhea or difficulty absorbing fats. The bile will flow from the liver directly into the small intestine.
- Gallstones: This is the most common problem seen with gallbladder disease and will be the focus of this article. For unknown reasons, the bile forms crystals which grow and become stones. Some of the conditions that cause gallstones are too much bilirubin in the bile (bilirubin comes from the liver’s breakdown of old red blood cells) or from too much cholesterol.
Gallstones can also occur if the gallbladder does not empty properly and the crystals remain and grow. The medical term for gallstones is cholelithiasis.
- Gallstone pancreatitis: Because the duct that transports bile into the small intestine is shared with the pancreas, a gallstone can block the duct and also the contents of the pancreas. This blockage can be extremely painful, and if it occurs chronically, surgery may be required for treatment.
- Cholecystitis: This is the medical term for inflammation of the gallbladder. Cholecystitis is most commonly a result of an irritating gallstone. This situation can cause pain and nausea.
- Gallbladder cancer: This is a very rare condition, but the symptoms of pain and nausea are the same as seen with gallstones and cholecystitis (inflammation of the gallbladder), so the doctor will always keep this in mind during an evaluation, especially if there is a family history of gallbladder cancer.
Some gallstones produce little or no symptoms at all. Some are quite painful. Often gallstones are associated with abdominal pain and severe nausea and vomiting, especially after eating.
The pain is a bit perplexing, as it may occur in the upper right abdomen, central abdomen, in the back between the shoulder blades, or in the right shoulder. The symptoms can last a few minutes or several hours.
Gallstone risk factors:
- Family history of gallstones
- Repeated fasting
- High fat diets
- Rapid weight loss
- Being pregnant
- Being overweight
- Being Native American-Indian or of Mexican heritage
Gallstones can be diagnosed using medical imaging studies including ultrasound, special X-rays using dyes, special MRI scans, or with direct visualization using a tube that is inserted in the mouth that travels in the digestive system for viewing (endoscopy, ERCP). Sometimes a combination of imaging and endoscopic tests are used to make the diagnosis of gallstones.
- Medical treatments: These are usually reserved for patients who can’t undergo surgical treatment of gallstones. A medication (ursodeoxycholic acid) is used to dissolve gallstones, but it may take weeks or even years to work successfully.
- Shock treatments: High-intensity shock waves are directed into the area where the stones are to break them up. This works best if the stones are few and small.
- Surgery: This is the treatment of choice. The entire gallbladder is removed (cholecystectomy). This is usually done with a series of small incisions and done using a device called a laparoscope. Sometimes this minimal surgery is not appropriate, and a traditional open surgery (called laparotomy) is required.
If you are experiencing stomach nausea or pain, especially after eating, see your doctor. It could be gallstones and, as discussed here, there are many very good treatments. Most patients receive a great deal of relief from having their gallbladder removed if chronic gallstones are a culprit. As always, be sure to have a general medical, eye, and dental exam yearly unless directed otherwise by your doctor.