The gallbladder is located just beneath the liver at the upper right side of the abdomen. If you are having sudden pain in the upper or right part of your abdomen, consult a doctor now to check if you’re suffering from gallstones or cholelithiasis.
Gallstones are hardened deposits of bile that form in the gallbladder. Bile, a digestive fluid synthesised by the liver, is stored in the gallbladder and released into the small intestines after meals to aid in fat digestion.
Gallstones can be as small as a grain of sand or as big as a golf ball. Some people may have just a single stone or multiple stones. Symptoms may vary — some patients may experience no discomfort while others suffer excruciating pain. If you are having sudden pain in the upper or right part of your abdomen, consult a doctor now to check if you are suffering from gallstones or cholelithiasis.
How Do Gallstones Form?
It is not clear how gallstones form. Scientists think they can be formed through the following:
High cholesterol levels secreted by the liver Normally, cholesterol secreted by the liver is digested by the bile, but the bile cannot digest large amounts of cholesterol when too much cholesterol is dumped into the gallbladder. The excess cholesterol forms into gallstones.
High levels of bilirubin This can occur when red blood cells break down at an accelerated rate, as seen in blood disorders or biliary tract infections. The increased bilirubin levels can contribute to gallstone formation.
Gallbladder not emptying properly When the gallbladder does not empty completely, bile can become overly concentrated, which may lead to the hardening of bile into stones.
There are usually three types of stones. The most common stones in the Asian population are dark-coloured pigment stones, which can be brown or black and are made up of bilirubin. Secondly, they can be yellow cholesterol stones made up of cholesterol, which is more common in the Western population. Finally, they can be mixed stones with pigment and cholesterol stones.
What Are the Common Symptoms of Gallstones?
Most people with gallstones are asymptomatic. Others feel a sudden pain that lasts several minutes to a few hours.
The symptoms of gallstone disease can be the following:
- Abdominal bloating, which is typically worse after meals or at night
- Sudden onset of pain in the right upper part of the abdomen
- Sudden onset of pain at the epigastric area or the centre of the abdomen below the breastbone.
- Pain from the abdomen going to the back
- Pain in the right shoulder
- Nausea and vomiting
- Severe abdominal pain, fever, or jaundice can signify complications arising from gallstones
How Are Gallbladder Stones Diagnosed?
To diagnose gallstones, doctors will utilise the following methods:
Ultrasound visualises the gallstones, their location, and their number.
CT or MRI scans are used to help exclude other causes of abdominal pain and may be used to diagnose complicated gallstone disease.
Blood tests determine concomitant infections, obstruction, pancreatitis, and jaundice
Endoscopic ultrasound (EUS) involves inserting an endoscope into the stomach and the duodenum (first part of the intestine) to locate stones in the bile duct.
Endoscopic retrograde cholangiopancreatography (ERCP) can be used to remove stones in the bile duct once their presence is confirmed.
What Are the Treatment Modalities?
The treatment of gallstones depends on the patient’s symptoms. For those who are asymptomatic but have gallstones detected through an ultrasound, surgery is generally not required. Removal of the gallbladder, called cholecystectomy, is typically recommended for people with haemolytic anaemia or who are at risk for gallbladder cancer.
In cases where painful symptoms are present, cholecystectomy is advised. The gallbladder is not essential for survival since it only stores bile (which is not a vital function). It is the liver that produces the bile which will flow directly into your small intestines.
People with symptoms can have their surgery scheduled at their convenience. Cholecystectomy is almost always done as a laparoscopic procedure (keyhole surgical technique). This is done as a day procedure or an overnight stay at the hospital. The open technique with a long incision may be used for complicated cases, and this will require a longer hospital stay.
What Are the Complications of Gallstones?
Gallstones with complications are usually treated as emergency cases. The following are complications:
Bile duct obstruction and cholangitis visualises the gallstones, their location, and their number.
CT or MRI scans Gallstones have blocked the bile duct, which empties bile into the duodenum, causing excruciating pain. In addition to the blockage, the bile duct may become inflamed, which is called cholangitis. The doctor will administer intravenous antibiotics, and the obstruction is usually relieved through endoscopy (ERCP). Once the condition stabilises, the gallbladder will be removed.
Acute gallstone pancreatitis Acute pancreatitis can cause sudden severe abdominal pain. It is also potentially life-threatening when it is a severe attack. When symptoms of pancreatitis have abated, early laparoscopic removal of the gallbladder is advised to prevent the recurrence of pancreatitis.
Acute cholecystitis Infection within the gallbladder can result in right abdominal pain and fever. In diabetic patients, gangrene of the gallbladder wall can set in quickly if left untreated. Early laparoscopic removal of the gallbladder is advised to treat this condition.
There is no reliable medication that can help dissolve your gallstones. Cholesterol stones may respond to dissolution therapy, but this takes a long time and they can form again once the medications are stopped.
What Are the Preventative Measures?
The risk of gallstone formation can be reduced by maintaining a healthy diet. Crash diets and losing weight quickly increase the risk of gallstones. Obesity is associated with increased gallstone formation, thus maintaining a healthy weight is important.