Everything You Need to Know About Gallstones

Gallstones, which are significant crystalline structures that develop in the gallbladder, are a prevalent and often underestimated health concern. These solid formations, ranging in size from a grain of sand to a golf ball, give off various symptoms and can lead to severe complications. Therefore, it is crucial to have an understanding of their characteristics and implications. Generally, the likelihood of developing gallstones tends to increase with age, with women being more vulnerable than men.

What are Gallstones?

So what are gallstones? Gallstones are particles that form within the gallbladder, which is a small organ located beneath the liver. These particles can comprise cholesterol or bilirubin—a waste product from the liver. Gallstones form from an imbalance in the substances that make up the bile, an essential digestive fluid responsible for breaking down fats. 

Now that you know gallstones’ meaning, let’s look at the types of gallstones.

There are two types of gallstones:

1. Cholesterol Stones: These form when the amount of cholesterol in the bile is excessive.
2. Pigment Stones: These are typically smaller and darker and form when the amount of bilirubin in the bile is more than necessary. 

Symptoms of Gallstones

The symptoms experienced from the presence of gallstones can vary greatly; some individuals may not exhibit any symptoms at all.

However, if the symptoms do manifest, they can be intense and may include:

1. Abdominal Pain: The typical indication of gallstones often surfaces as pain in the right or center of the abdomen. This is called colic pain, which may surge and persist for hours.

2. Pain after Eating: Individuals with gallstones can experience strong discomfort following meals, especially after eating fatty food.

3. Shoulder Pain: The pain may spread towards the back or between the shoulder blades.

4. Nausea and Vomiting: Gallstones can cause nausea and the urge to vomit.

5. Indigestion: Symptoms include bloating and discomfort resembling indigestion.

6. Jaundice: If a gallstone obstructs the bile duct, the result can be jaundice, including yellowing of the skin and eyes.

7. Fever and Chills: In cases where gallstones cause inflammation or infection (cholecystitis), the accompanying symptoms may include fever and chills.

8. Changes in Stool Colour: Gallstones can impact stool colour, making them pale or clay-coloured, given the bile flow.

9. Changes in Urine Colour: Dark urine could be another sign indicating reduced bile flow.

Causes of Gallstones

Gallstones occur when the substances that comprise the bile—a fluid produced by the liver—are imbalanced. While the exact causes of gallstones have not been completely understood, several factors may contribute to their development.

1. Excess Cholesterol in Bile:When the liver produces cholesterol that the bile finds too much to dissolve, it can form crystals and, eventually, gallstones.

2. High Bilirubin Levels: Bilirubin is produced when red blood cells break down. Health conditions such as liver cirrhosis, biliary tract infections, and certain blood disorders can aggravate bilirubin levels, increasing the risk of gallstone formation.

3. Incomplete Gallbladder Emptying:If the gallbladder is not empty enough, it can lead to bile concentration and cause gallstone formation.

4. Gastrointestinal Disorders:Conditions that affect digestive system functioning, such as Crohn’s disease or irritable bowel syndrome (IBS), may be associated with a likelihood of developing gallstones.

While these factors explain how gallstones can form, their exact interaction remains complex and varies from person to person.

Diagnosis of Gallstones

The following methods are commonly used for diagnosing gallstones:

1. Medical History and Physical Examination: Your healthcare provider will enquire about your symptoms, their duration, and if any factors could increase your risk. They may also check for tenderness and signs of jaundice.

2. Ultrasound: Sonography or ultrasound imaging is an invasive procedure that can determine gallstones’ size, number, and location in the gallbladder.

3. CT Scan: A computed tomography (CT) scan may be conducted to procure images of the gallbladder and its surrounding structures to identify gallstones and complications.

4. HIDA Scan: A hepatobiliary iminodiacetic acid (HIDA) scan helps detect blockages or abnormalities in the bile ducts.

5. Endoscopic Retrograde Cholangiopancreatography: ERCP is a procedure that combines endoscopy with X-rays to visualise the bile ducts and identify gallstones, if any. 

6. Blood Tests: These tests may be done to check for levels of liver enzymes that could indicate inflammation or blockage caused by gallstones.

7. MRI: Magnetic Resonance Imaging (MRI) can provide images of the gallbladder and its surrounding structures, assisting in diagnosing gallstones.

8. Percutaneous Transhepatic Cholangiography: PTC is an imaging procedure in which a dye is injected into the bile ducts through the skin. X-rays are then taken to identify any abnormalities, including gallstones.

Treatment of Gallstones

The treatment approach for gallstones depends on many factors, including symptom severity, complications, and overall health condition. 

1. Pain Management: In mild symptoms, pain can be managed with over-the-counter or prescription pain medications during gallstone attacks.

1. Medications: Ursodeoxycholic acid (ursodiol) is a medication that can dissolve certain types of cholesterol-based gallstones. It is often prescribed for individuals who are not candidates for surgery.

1. Extracorporeal Shock Wave Lithotripsy: This non-invasive procedure uses shock waves to break down gallstones into pieces, facilitating their passage. ESWL is more commonly used for kidney stones and not for treating gallstones.

1. Endoscopic Retrograde Cholangiopancreatography: ERCP can be leveraged to extract gallstones from the bile duct. This procedure is often carried out alongside a sphincterotomy.

1. Surgery (Cholecystectomy): The surgical elimination of the gallbladder, referred to as cholecystectomy, is an effective treatment for gallstones. It is commonly recommended for recurring gallstones and is typically performed using minimally invasive laparoscopic techniques.

1. Percutaneous Transhepatic Cholangiography: When ERCP is not particularly feasible, PTC may drain the bile and eliminate gallstones.

Risk Factors Associated With Gallstones

The factors that can enhance the likelihood of developing gallstones include:

• Being a female
• Being 40 years old or older
• Having Native American or Hispanic of Mexican heritage
• Being overweight or obese
• Leading a sedentary lifestyle
• Undergoing pregnancy
• Consuming a high-fat diet
• Consuming a high-cholesterol diet
• Following a low-fibre diet 
• Having a family history of gallstones 
• Having diabetes 
• Blood disorders such as sickle cell anaemia or leukaemia 
• Undergoing rapid weight loss 
• Using estrogen-containing medications such as oral contraceptives or hormone therapy 
• Having liver disease

How Can Gallstones Be Prevented?

While it may not be possible to prevent all cases of gallstones, specific strategies can help reduce the likelihood of their development:

1. Aim for a steady weight loss instead of rapid weight loss, as rapid weight loss can increase the risk of gallstones.
2. Limit the consumption of foods rich in fat and cholesterol.
3. Drink an adequate amount of water to prevent the formation of gallstones.
4. Avoid crash diets or extreme measures for weight loss, as these can potentially raise the risk of developing gallstones.
5. Increase foods in your diet that are high in fibre, such as fruits, vegetables, and whole grains.
6. Take smaller and more frequent meals rather than large meals. This can aid in regulating the functioning of the gallbladder.
7. Engage in physical activity daily to lower the risk of developing gallstones. Make a goal of moderate-intensity exercise for 150 minutes per week.
8.  If possible, consider contraceptive methods that do not contain oestrogen, as certain medications containing oestrogen can enhance the risk of developing gallstones.
9.  If you have conditions such as diabetes or liver disease, it is important to seek your doctor’s guidance in effectively managing them.

Conclusion

Gallstones are quite common, and if left untreated, they can cause discomfort and complications. Understanding the factors that increase the risk, such as age, gender, and lifestyle choices, empowers people to maintain a healthy weight, have a balanced diet, and stay physically active. Regular medical checkups and promptly addressing any symptoms are crucial in managing gallstones. You can handle the challenges of gallstones by having a comprehensive approach that includes awareness, preventive measures, and timely medical intervention. Always prioritise your overall health and well-being! Having health insurance ensures access to timely diagnosis and treatment, providing financial support for managing gallstones effectively and maintaining your health.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. Please consult your general physician or another certified medical professional for any questions regarding a medical condition. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.