Introduction
Gallstones are hardened deposits of bile (digestive fluid) that can form in your gallbladder. Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.
People who experience symptoms from their gallstones usually require gallbladder removal surgery. Gallstones that do not cause any signs and symptoms typically don’t need treatment.
Causes
It is not clear what causes gallstones to form. Possible causes include:
- If the bile contains too much cholesterol
- If the bile contains too much bilirubin
- If gallbladder does not empty correctly
Symptoms
- Sudden and rapidly intensifying pain in the center or upper right portion of the abdomen
- Pain in your right shoulder
- Nausea or vomiting, especially after a fatty or heavy meal
Risks
Factors that may increase your risk of gallstones include:
- Being female
- Being age 40 or older
- Being overweight or obese
- Being sedentary
- Being pregnant
- Eating a high-fat diet, high-cholesterol and low fiber diet
- Having a family history of gallstones
- Having diabetes
- Having certain blood disorders, such as sickle cell anemia or leukemia
- Losing weight very quickly
- Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugs
- Having liver disease
Complications
Complications of gallstones may include:
- Inflammation of the gallbladder. A gallstone that becomes lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain and fever.
- Blockage of the common bile duct: Gallstones can block the tubes (ducts) through which bile flows to the intestine
- Blockage of the pancreatic duct: A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.
- Gallbladder cancer. People with a history of gallstones have an increased risk of gallbladder cancer.
Diagnosis Tests
- Abdominal ultrasound: This test is the one most commonly used to look for signs of gallstones.
- Endoscopic ultrasound (EUS): This procedure can help identify smaller stones that may be missed on an abdominal ultrasound. During EUS your doctor passes a thin, flexible tube (endoscope) through your mouth and through your digestive tract.
- Other imaging tests: Additional tests may include oral cholecystography, a hepatobiliary iminodiacetic acid (HIDA) scan, computerized tomography (CT), magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP). Gallstones discovered using ERCP can be removed during the procedure.
- Blood tests. Blood tests may reveal infection, jaundice, pancreatitis or other complications caused by gallstones.
Treatments
Laparoscopic cholecystectomy
Most people with gallstones that don’t cause symptoms will never need treatment. Your doctor will determine if treatment for gallstones is indicated based on your symptoms and the results of diagnostic testing.
Your doctor may recommend that you be alert for symptoms of gallstone complications, such as intensifying pain in your upper right abdomen. If gallstone signs and symptoms occur in the future, you can have treatment.
Treatment options for gallstones include:
Surgery to remove the gallbladder (cholecystectomy). This is done laparoscopically.
Laparoscopic gallbladder surgery (cholecystectomy) removes the gallbladder and gallstones through several small cuts (incisions) in the abdomen. The surgeon inflates your abdomen with air or carbon dioxide to see clearly. The surgeon inserts a lighted scope attached to a video camera (laparoscope) into one incision near the belly button. The surgeon then uses a video monitor as a guide while inserting surgical instruments into the other incisions to remove your gallbladder. You may have gallbladder surgery as an outpatient, or you may stay 1 or 2 days in the hospital. Most people can return to their normal activities in 7 to 10 days.
Advantages of laparoscopic cholecystectomy over open procedure
- The hospital stay after laparoscopic surgery is shorter than after open surgery. People generally go home the same day or the next day, compared with 2 to 4 days or longer for open surgery.
- Recovery is faster after laparoscopic surgery.
- You will spend less time away from work and other activities after laparoscopic surgery (about 7 to 10 days compared with 4 to 6 weeks).
