Gallstones

Gallstones are crystal-like or pebble-like deposits that form in the gallbladder. The gallbladder is an organ that stores bile produced by the liver. Bile is released when certain foods, particularly those containing fat, enter the digestive tract. Bile consists, among other things, of cholesterol, bile salts, bile pigments and mineral salts.

Gallstones can vary in size and shape from as small as a grain of sand to as large as a ping-pong ball. In most cases, gallstones are composed of crystallized cholesterol. Generally speaking, gallstones are not life-threatening and cause no symptoms. In some cases however, gallstones can block the ducts that carry bile to the liver or intestines, causing severe abdominal pain. This is known as biliary colic or hepatic colic and must be addressed.

Causes

The most common causes of gallstones are:

• Too much cholesterol in the bile
• Insufficient amount of bile salts in the bile
• Poor contractility of the gallbladder

Risk factors that may increase one's chances of developing gallstones include:

• Being obese or overweight
• Being female (women are 2 to 3 times more likely to develop gallstones)
• Being elderly (10 to 15% of men, and 25 to 30% of women are over the age of 70 years)
• Having Crohn's disease or ulcerative colitis
• Having undergone bariatric surgery
• Having lost weight very quickly
• Being of American Indian or Hispanic ancestry
• Taking hormone replacement therapy or hormonal contraceptives

Symptoms

Gallstones do not always cause symptoms. Oftentimes, individuals have no idea they have gallstones. Others however, will present the following symptoms, especially in the event of hepatic colic:

• Vomiting and nausea
• Intense pain in the upper right part of the abdomen
• Diarrhea
• Fever

The pain associated with an episode of hepatic colic can last from 30 minutes to several hours, and is caused when the gallbladder contracts to release bile. As it contracts, the gallbladder pushes the stone into the duct where it lodges itself and causes an obstruction. The pain eases once the stone is dislodged from the duct.

Diagnosis

An abdominal ultrasound is used to confirm the presence of gallstones.

Complications

If a duct is obstructed and the condition is left untreated, certain complications could arise. These include: acute cholecystitis (inflammation of the gallbladder), acute cholangitis (inflammation of the bile ducts) and acute pancreatitis.

Treatment

If the gallstone is not obstructing a duct, no treatment is required. However, if a duct is obstructed, several treatment options are available.

A drug known as ursodiol can be used to dissolve gallstones. Its effect however, is not immediate. It can take 6 months to 2 years before the stones are dissolved.

Surgery is another treatment that can be considered if the frequency of gallstones is an issue. It should be noted that 70% of those who have had gallstones are likely to develop more. The surgery, which is performed laparoscopically (small incisions in the abdomen), involves the removal of the gallbladder and is not associated with any negative long-term effects.

Prevention

You can lower your risk of developing gallstones by adopting healthy eating and lifestyle habits. Increasing your intake of fiber and keeping a healthy weight are highly recommended.

If you have any questions, don't hesitate to speak to your pharmacist.