Gallstones and its Cause, Symptoms, Diagnoses and Treatment

Gallstones are stones of various sizes and composition that usually occur in the gallbladder.

Gallstones are formed from bile, a digestive liquid produced by the liver and stored in the gallbladder. Most gallstones do not cause symptoms. Gallstones occur in about 1 in 10 people over age 40, with twice as many women as men being affected. The typical patient is described as “female, fair, fat and forty”. Gallstones may run in families, and are more common in Native American and Hispanic people for reasons that are not fully understood.

Bile, the liquid from which gallstones are formed, is made up mainly of the fatty substance cholesterol, pigments and various salts. A change in the composition of bile may trigger stone formation. Most gallstones are a mixture of cholesterol and pigments. In about
1 in 5 cases stones consist of cholesterol only, and in about 1 in 20 cases stones consist of pigment only. Often, there are many stones, and some can reach the size of a golf ball.

Cause for Gallstones

Gallstones form within the gall bladder as a result of precipitation of cholesterol and bile salts from the bile. Women are twice as likely as men to get them, but in later life there is a roughly equal chance of gallstones.

Most bile is formed by the liver from cholesterol. It mixes with yellow and green pigments derived from the breakdown within the liver of old blood cells. Bile makes fat soluble, which is an important step in the absorption of fat from the intestinal tract. The liver secretes* a remarkable 1 litre/ VA pints a day of bile, half of which is stored temporarily in the gall bladder, the rest going directly into the duodenum via a network of ducts from the liver.

There are a few rare conditions where an excessive load of bile pigments increases the risk of gallstones, for example certain types of anaemia. Gallstones are extremely common: 10-20% of the adult population have them, and only a fraction cause symptoms.

Symptoms of Gallstones

Many gallstones are silent. They lie within the gall bladder and are simply a chance finding on investigation for other abdominal symptoms. However, symptoms may occur if one or more stones block the cystic duct (the exit tube from the gallbladder) or the common bile duct (the main bile duct from the liver to the duodenum). A stone that partially or completely blocks the flow of bile will cause attacks known as biliary colic, which cause symptoms that include:

• very severe upper abdominal pain
• nausea and vomiting.

Episodes are normally brief and typically occur following a fatty meal, which causes the gallbladder to contract.

Complications of Gallstones

Stones that remain lodged in the bile ducts block the release of bile, causing severe inflammation or infection of the gallbladder and bile ducts. Blocked bile ducts may also cause jaundice, a condition in which the skin and whites of the eyes become yellow. In addition to jaundice, blockage of the common bile duct may cause inflammation of the pancreas (pancreatitis).

Diagnoses of Gallstones

Most people only become aware that they have gallstones by chance when an unrelated condition is being investigated.

• If your doctor suspects from your symptoms that you have gallstones, you may have blood tests to check your red blood cell count and cholesterol levels.
• You may also have imaging tests, such as ultrasound scanning.
• If a bile duct is found to be blocked, the exact position of the gallstones may be located using a specialized imaging procedure called ERCP, in which an endoscope is used to inject a contrast medium into the bile ducts prior to X-rays being taken.

Treatment of Gallstones

• Gallstones that do not cause symptoms need no treatment.
• If you have mild or infrequent symptoms, adopting a diet that is low in fat may prevent further discomfort.
• If your symptoms are persistent or become worse, you may have your gallbladder removed by conventional (open) surgery or by endoscopic (keyhole) surgery (see box, left). Removal of the gallbladder usually cures the problem. The absence of a gallbladder does not usually cause any health problems, and the bile simply drains continuously through a duct directly into the intestines.
• In very rare cases, the stones re-form in the bile duct and may need to be removed by open surgery or during endoscopic examination.
• Drugs are available that dissolve gallstones made of pure cholesterol, but it may take months or years for the stones to dissolve completely.
• Alternatively, you may be treated with ultrasonic shock waves (lithotripsy), which shatter the stones into tiny pieces so that they pass painlessly into the small intestine and are excreted in the faeces.

Use of drugs or ultrasonic shock waves avoids the need for surgery. However, because the gallbladder is still present there is an ongoing risk that further gallstones will form.

Surgery for gallstones

The usual procedure is laparoscopic removal of the gall bladder. Occasionally the older-type operation has to be performed, which involves a long incision under the ribs and from which it takes several weeks to recover.

Gallstones lodged in the duct between the gall bladder and duodenum can be removed by endoscopy.

Complementary Treatment

Diet – gallstones are linked with the consumption of too much fat and sugar; a nutritional therapist or naturopath will be able to provide a diet programme.

Chakra balancing helps reduce pain attacks and supports orthodox therapies; postoperatively it aids relaxation and promotes healing of wounds.

Hypnotherapy can lessen anxiety and so promote the free flow of enzymes, reducing problems. Other therapies to try: tai chi /chi kung.