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The Gall of Gallstones

"Gallstones are particles or pieces of solid material that form in the gallbladder. "
By: Gwen Y. Reyes-Amurao, M.D.The Gall of Gallstones

Gallstones are particles or pieces of solid material that form in the gallbladder. These may vary in shape, size, color and texture depending mainly on what they are made of. The two types of gallstones are cholesterol stones and pigment stones. Cholesterol stones develop once there is too much cholesterol in the bile secreted by the liver. Typically, bile is able to dissolve or break down cholesterol. However, once there is too much cholesterol in the blood, bile function is overpowered, leading to stone formation. Stones that are made of cholesterol are usually yellow-green in color and occur very often, accounting for about 80% of gallstones; while pigment stones tend to be smaller and very dark because of its bilirubin content. Bilirubin is a chemical produced when your liver destroys mature red blood cells. Certain conditions may cause an overproduction of bilirubin or production of bile that is highly concentrated, leading to the formation of pigment stones.

Who can develop gallstones?

Sadly, women are more likely to develop gallstones than men, with only 1 man having gallstones for every 4 women who do. The following are also important risk factors for developing gallstones:

  • Obesity or being overweight, According to the Journal of Pediatric Gastroenterology and Nutrition, obese children are at a much higher risk of developing gallstones
  • A high cholesterol or high-fat diet
  • Rapid weight loss in a short amount of time
  • A high fiber diet
  • Diabetes Mellitus
  • Pregnancy
  • Family history of gallstones
  • Age
  • Liver cirrhosis
  • Estrogen intake or women on oral contraceptives or high-dose estrogen therapy

How do I know if I have gallstones?

According to the American College of Gastroenterology, individuals with gallstones often have no observable signs or symptoms. These are called silent gallstones. Once the gallstones block the bile ducts, pressure increases in the gallbladder. This leads to signs and symptoms such as:

  • Pain on the upper right side of the body, just below the ribs
  • Pain radiating to the back or right shoulder
  • Nausea and vomiting
  • Excessive sweating, which may be due to pain
  • Restlessness
  • Jaundice or yellowish discoloration of the skin and eyes
  • Clay-colored stools

What are the stages of Gallbladder Disease?

What is common among all patients who have gallstones is that they tend to experience severe pain especially during the later stage of gallbladder disease. According to the American College of Gastroenterology, this pain is known as the gallbladder attack, wherein extreme pain lasts more than one hour up to a few hours and happens only once the stones block the movement of bile from the gallbladder. The risk of silent gallstones causing a gallbladder attack is 1% annually meaning for every 100 people that have silent gallstones, 10 of those people will experience an attack within the next ten years.

How are gallstones diagnosed?

Although medical history and specific physical examination findings are characteristic of gallstones, some presentations may be mistaken as appendicitis, pancreatitis or gastroesophageal reflux disease or GERD. Doctors may request for specific laboratory procedures in order to reach a definitive diagnosis. Imaging studies such as Ultrasonography, Computerized Tomography (CT) scan and Magnetic Resonance Imaging (MRI) are some of the studies done in order to determine not only presence of gallstones, but also the location of the stones.

How are gallstones treated?

In the first stages of gallbladder disease, gallstones especially cholesterol stones can be treated through nonsurgical on non-invasive procedures. These include:

  • Medications that contain stone-dissolving properties such as Ursodeoxycholic acid and chenodiol, the most effective in dissolving these types of stones by far, although it may take several months for the stones to completely disappear.
  • Shockwave Lithotripsy is a procedure wherein a machine crushes the gallstones into smaller pieces and may be used along with ursodeoxycholic acid.

Treatment for gallstones is usually surgical removal of the gallbladder. This is called cholecystectomy and is one of the most common procedures all over the world. In the past, the gallbladder could only be removed by making an incision through the abdomen, with up to several days of downtime and about a month of no physical activity after. With technology, the gallbladder can now be removed by making several small incisions in the abdomen and inserting a laparoscope, thus its name laparoscopic cholecystectomy.

How can you prevent gallstones?

By identifying the different risk factors, immediately one can assume which preventive measures can be undertaken if one doesn’t want to develop gallstones

  • Diet Modification
    • Reduce intake of fat and avoiding high-fat or high-cholesterol food
    • Limit intake of caffeine, high-fat dairy products and sweets
    • Eat small frequent meals throughout the day
    • Eat a well balanced diet
    • Eat lots of fruits and vegetables
  • Lose weight gradually and properly
  • Drink at least 10 glasses of water
  • Exercise

Although humans can leave without a gallbladder, it is still best to have all your organs intact and properly functioning. Now that you know what leads to gallstone formation, what’s important is to avoid things that lead to stone formation in order to prevent unnecessary pain and surgery in the future.  

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