It is estimated that around 20 million Americans suffer from gallstones, which are stones or lumps that form in the gallbladder. Gallstones have many different causes, and there are several different types that occur for different reasons. While a Western, high-cholesterol diet is associated with the formation of certain types of gallstones, they can have other causes, making prevention a bit tricky. Read on to learn more about gallstones, what their cause is, when you should seek medical help, and what viable treatments are available.
Gallstones: What You Should Know
Gallstones form in the gallbladder, a tiny organ that is located under the liver. They are different than kidney stones, which form directly in the liver. While kidney stones are formed by uric acid and other chemicals related to urine, gallstones are formed by a chemical imbalance in the gallbladder. This imbalance is caused by bile cholesterol as well as a substance called bilirubin, which is a waste product of the breakdown of blood cells that occurs in the liver.
The gallbladder itself is part of the digestive system known as the biliary system. The biliary system’s main function is to transport bile and digestive enzymes. Bile is a fluid produced by the liver to help the body digest fats, and bile contains both bilirubin and cholesterol. Bile is not stored in the stomach, but actually in the gallbladder. It makes an appearance when a patient eats a high-cholesterol or high-fat meal, and its function is to assist in the digestive process of that meal, via the bile duct and the small intestine. When there is simply a cholesterol and bilirubin imbalance in the gallbladder, stones can form.
What Causes Gallstones?
There are two distinct types of gallstones, and they have varied causes: cholesterol stones and pigment stones. As the name suggests, cholesterol stones are exacerbated by eating unhealthy, high-cholesterol meals, so prevention of these types of stones is thought to be possible. However, pigment stones are caused by excess bilirubin, not excess cholesterol, so prevention of these is a little more tricky.
Cholesterol stones comprise 80 percent of the cases of gallstones in America and are directly related to having too much cholesterol in the diet. Researchers believe that a low-fat, high-fiber diet can help in the prevention of gallstones, particularly this type. It is also believed that those who are overweight and obese are more likely to have gallstones form.
Pigment stones are smaller, darker, and are comprised of bilirubin. Instead of cholesterol, those who suffer from these types of stones may also have comorbid medical problems, such as cirrhosis, or inherited diseases like sickle cell anemia. It is thought that genetics plays a much larger role in the formation of pigment stones than cholesterol stones.
There are also other causes of both types of gallstones. Patients may be more at risk if:
- They are fasting. The gallbladder must be able to “squeeze” as part of its function. If you are fasting, this directly affects this function.
- They lose weight too fast. Rapid weight loss has the same effect on the gallbladder as fasting does.
- They take cholesterol-lowering medication. It might seem as if taking medication to lower cholesterol would reduce the risk for gallstones, but it actually has the opposite effect.
- They are diabetic. Diabetes (both type 1 and type 2) and gallstones have a strong correlation.
- They are taking birth control or hormone replacement therapy. Too much estrogen is also associated with the formation of gallstones. In addition, those who are pregnant are more at risk of developing gallstones.
- There is a family history of gallstones.
In addition, certain ethnic groups are at higher risk for gallstones. Native Americans are at the highest risk of developing gallstones, based on ethnicity and genetics, followed by Mexican-Americans. Because of the correlation between high levels of estrogen and the development of gallstones, women also carry a higher risk. As with other health concerns, those over 60 are more at risk of developing gallstones as well.
When to Seek Medical Care for Gallstones
Many patients who have gallstones actually don’t notice symptoms at all, and gallstones are discovered while patients are undergoing testing for other medical conditions (such as liver problems). However, other patients experience painful and noticeable symptoms. If symptoms are noticeable, then it is definitely time to seek medical care because at the point gallstones become symptomatic, there may be other issues, such as cholecystitis, or inflammation of the gallbladder. Common symptoms of gallstones may include:
- Nausea and vomiting
- Pain in the upper back, right shoulder, or abdomen
- Indigestion, heartburn, bloating, and gas
Unfortunately, gallstones symptoms also mimic many other symptoms of conditions that indicate GI distress, so it may be hard to tell. Of course, most patients aren’t going to rush to their MD after an evening of heartburn and belly pain. However, if the pain persists for hours or even days, you should be checked out as soon as possible—not only to rule out gallstones but also to rule out other possible gastrointestinal conditions.
What Procedures and Tests Do Doctors Use to Diagnose Gallstones?
As previously mentioned, gallstones are often found by accident as doctors are testing for other gastrointestinal or liver conditions. However, there are certain tests and procedures that doctors use specifically to test for gallstones, the first being a simple blood test. A blood test can let the doctor know of infection in the blood or possible obstruction. It can also let the physician rule out other possible causes of pain or irritation. Ultrasound, X-ray, and CT scan are also often utilized for checking for gallstones. However, one of the most common tests used to detect gallstones is known as endoscopic retrograde cholangiopancreatography (ERCP). As this is a more invasive test, your doctor will likely suspect gallstones before the ordering of this procedure. During an ERCP, an endoscope is inserted through the mouth to the small intestine and dye is injected so that the doctor can see the bile ducts. This will give the physician a good idea of whether there are gallstones in the bile ducts.
Once gallstones are inside of the gallbladder, they cannot be removed. They do not “pass,” like kidney stones have an ability to do. Because of this, treatment is limited when it comes to gallstones. As the body can easily live and thrive without the gallbladder, the most common treatment for gallstones is its removal, which is also known as a cholecystectomy. There are two types of surgeries that can be performed, laparoscopic cholecystectomy and open cholecystectomy. The laparoscopic type is less invasive, as several small cuts are made in the abdomen. This procedure usually allows you to go home the same day. An open surgery is a complete removal of the gallbladder with a deeper cut. Sometimes ERCP is also used as a treatment, but that is to remove gallstones from the bile ducts. Gallstones may be removed from bile ducts; they cannot be removed from the gallbladder. If you need more information about gallstones, suspect you have them, or wish to be seen by a physician, request an appointment with Dr. Sameer Islam, MD today. Our office is a caring and nurturing environment that offers patients the best of care through any condition.