Gallstones: Symptoms and Causes

Aug 12, 2019

Gallstones, solid pieces of cholesterol that form over time, are the most prevalent problem that occurs in the gallbladder. Part of the function of the gallbladder is to transport bile through the digestive system. Because of different factors, too much cholesterol and bilirubin form to make hard stones, which can be painful and cause other medical problems. There are several different causes of gallstones, as well as other risk factors. Treatment also varies, dependent on the severity of the problem. Read on to learn more about gallstones, their risk factors, treatment such as cholecystectomy, and how to avoid gallstones in the first place.

What Causes Gallstones?

To understand what causes gallstones, it’s wise to know the different functions of the gallbladder. Essentially, bile is fluid constructed by the liver and resides in the gallbladder until it is needed. The gallbladder is home to several different substances, with the means of transporting them when they are necessary, such as bile, bilirubin, and cholesterol. Bilirubin is different from bile and is a waste product of blood cells in the liver.

When a patient eats a meal that is high in cholesterol, it is the gallbladder’s function to contract and then excrete bile into the liver via the small intestine. If there is too much cholesterol in the diet, such as in a Western (American) diet, gallstones are much more prevalent. Other common causes of gallstones include having too much bilirubin in the digestive system and not enough bile salts available. It is also important to know that there are two types of gallstones.

Overconsumption of cholesterol and excess bilirubin contribute to cholesterol gallstones, which are much more common in Americans. However, there is another type of gallstone known as a pigment stone. Doctors and researchers are unsure what the root cause is of this type of stone. However, these pigment stones are much more common in these types of patients:

those who have a bile duct infection or biliary tract infection
those who have liver disease, such as cirrhosis
those who have hereditary blood disorders, like sickle cell anemia

Very often, gallstones may not cause any symptoms at all. However, in some patients, symptoms are painful, and several affect quality of life.

What Are the Symptoms of Gallstones?

Some patients may experience no symptoms of gallstones at all, and gallstones are often discovered by accident when doctors are trying to diagnose or treat another issue. However, other patients experience myriad symptoms of gallstones as they grow. Common symptoms of gallstones include:

pain between the shoulder blades
pain in the upper quadrant of the abdomen
nausea and vomiting
right shoulder pain
chills
jaundice (yellowing of skin and/or eyes)
low-grade fever

It’s best to be seen by a medical health professional immediately if you notice jaundice, chills, sweating, fever, or if you experience pain for more than five hours. This could be indicative of a gallbladder attack, which requires immediate intervention. However, it is very common to have gallstones that do not have symptoms. Many patients are not aware of the fact that they have gallstones at all.

Who Is at Risk for Gallstones?

While diet is strongly associated with cholesterol gallstones, there are several ethnic groups as well as risk factors that can place patients at a higher risk. Eating a high cholesterol diet and being overweight or obese certainly tops the list; however, having too much estrogen in the body can also contribute to gallstones, as well as fasting, rapid weight loss, and diabetes. Surprisingly, taking medications that are meant to lower cholesterol can also contribute to the formulation of gallstones. While these medications can help your heart health, they in turn increase the amount of cholesterol that is found in the bile and bile duct, which causes stones.

Women, Mexican-Americans, Native Americans, those over the age of 60, and those with a family history of gallstones are also more predisposed to their formation. For reasons unknown, Native Americans (studied as an ethnic group) have more cholesterol in their bile than any other ethnicity and should be aware of the likelihood of gallstones. Mexican-Americans also have an exceedingly high rate of gallstones statistically, and should likely be evaluated more often than other ethnic groups. Because excess estrogen is associated with gallstone formation, women should be checked regularly as well, particularly ones who are obese, over the age of 60, or who have a family history of gallstones.

Diagnosis of Gallstones

Gallstones are often diagnosed while doctors are running tests regarding a separate medical condition. Many patients don’t realize they have gallstones as they are not in pain. However, if you are in pain and suspect gallstones, your doctor may run specific tests, including:

ultrasound
ERCP (endoscopic retrograde cholangiopancreatography), which uses X-ray technology as well as a lighted tube that is inserted into your esophagus
blood tests
CT scan
MRCP (magnetic resonance cholangiopancreatography), which is a special type of MRI
HIDA scan (hepatobiliary scintigraphy or cholescintigraphy), which uses radiation injection

It very much depends on the size and severity of the gallstones with regard to treatment. Doctors may not always elect to treat gallstones if there is no pain, they are insignificant, and are not affecting patient quality of life.

How Are Gallstones Treated?

If gallstones are painful or are interfering with quality of life, there are several treatment options. Your physician may opt to try less invasive treatments at first to see if this relieves the problem; however, one of the most common treatments for gallstones is the complete removal of the gallbladder. Once stones are in the gallbladder, they cannot be removed. If you are experiencing inflammation of the gallbladder (cholecystitis), then more treatment options are available.

Your doctor may elect to use ERCP, which not only detects gallstones but can treat them. Oral dissolution therapy, methyl-tert-butyl ether, and percutaneous drainage/cholecystostomy are also options. Percutaneous drainage/cholecystostomy is often used for those who cannot undergo full surgery. A drainage tube is inserted into the gallbladder, which can remove blockages and infection. Other patients who do not want to undergo surgery may opt for medications that help dissolve gallstones over time. However, this may take months to years to be successful, and if there is an immediate problem, such as a gallbladder attack that presents with pain, this may not be an option. Also, this type of medication works best only for cholesterol stones, not pigment stones.

For those who elect cholecystectomy, there are two options: open removal and laparoscopic removal. It is fortunate that the body can live without a gallbladder, and post-surgery, a change in diet is not required. Laparoscopic cholecystectomy is less painful than open surgery and is a more popular option. Both surgeries are complete in 20 to 90 minutes, however, laparoscopic cholecystectomy has a much faster recovery time. In this procedure, small instruments remove the gallbladder through a few small cuts in the abdomen. Open removal requires a 3-to-6-inch incision cut in the upper abdomen and necessitates a longer recovery time. Both procedures require the patient to be under general anesthesia as well as an outpatient operating room visit.

To learn more about gallstones, or to be seen by a physician if you are in pain, book an appointment at Carolina Digestive Health Associates today. We offer eight different office locations for your convenience as well as five endoscopy centers.