Gallstones are usually found on a routine ultrasound scan of the abdomen. But should you worry about them?
If you have been subject to a scan of the abdomen, you may notice the term ‘few gall bladder calculi’ or ‘cholelithiasis’ in your report.
Fear not, these are just small gall stones in your gall bladder. They are quite a common finding in most people across India.
But what do you do it you have stones in the gall bladder? Here, I shall discuss this in detail and hopefully guide you on how it is managed.
The Gall Bladder
Before we discuss what gall stones are and the problems they cause, let us first see what the gall bladder is.
The gall bladder is a small balloon shaped structure that is located just below the liver. It serves the purpose of secreting enzymes that help in digesting fat.
The enzymes the gall bladder secretes is collectively called bile. Bile is essential to breakdown the fat we consume into a product that can absorbed into the blood stream.
Bile is generally quite a thick substance. The balance of chemicals and enzymes within it is what gives it this consistency.
If this balance is disrupted due to some reason, then gall stones can form.
What Are Gallstones?
Gallstones, also called gall bladder stones or cholelithiasis in the medical world, are small stone like structures that can form in the gall bladder.
In reality, they are not stones. They are only called so because of the way they look.
They are actually collection of different compounds. Cholesterol is also a compound seen in gall bladder stones.
Gallstones are of 2 types – cholesterol stones and pigment stones. Cholesterol stones are the most common type, and tend to be larger than pigment stones.
Who Is At Risk of Gallstones?
In my medical days, our professor told us that gall stones are seen in ‘fat, fair, fertile females of forty’.
In other words, gall stones are seen in overweight women who are above the age of forty years. That being said, they can be seen in men as well.
Those who have previously had problems with their gall bladder are also at risk. If you follow an unhealthy diet that is full of fried and fatty foods, then you could increase your risk of developing gall stones.
There may be a genetic component to the development of stones in the gall bladder. If a family member has stones, then there is a chance that you will have it too.
Symptoms Of Gallstones
How do I know if I have gallstones?
Many a times, people do not know that they have gallstones in the gallbladder. This is because the stones are small and do not cause any trouble while sitting in that organ.
However, there are certain times when the gallbladder stone attempts to come out of the gallbladder and can get stuck in the neck. This can cause a variety of symptoms.
The most common symptom that is associated with a gallstone that is stuck is pain in the upper abdomen just below the right rib cage. This pain can radiate to the back and can be quite excruciating. The pain often lasts for hours.
Associated with this pain can be the feeling of nausea and vomiting.
Individuals who have gallstones that are not causing pain may experience bloating, indigestion and a burning sensation in the chest due to heart burn. Excessive belching or passing gas from the bottom may also be experienced.
Diagnosis Of Gallstones
How do I know if I have gallstones?
You may not even realise that you have gallstones. Furthermore, the clinical examination can be normal.
However, if the gallstones are stuck in the gallbladder neck then you may feel a sharp pain in the upper right abdomen when it is pressed upon.
If a diagnosis of gallstones or infection of the gallbladder is suspected, your doctor may subject you to a few tests.
One of the initial tests that is performed is a simple blood test that can help determine the presence of an infection and also the involvement of the liver. Your liver function may be abnormal.
Following this, an ultrasound scan of the abdomen may be arranged. This will help visualise the gallbladder, view the stones in the gallbladder and determine if the stones are causing any blockage of the neck of the gallbladder.
Usually, further investigations are not really necessary though in some cases an MRI scan of the abdomen may be performed. An MRI scan to look at the gallbladder stones is called a magnetic resonance cholangiopancreatography test (MRCP). It is radiation free and safe.
A CT scan may also be conducted though some radiologists are of the opinion that a CT scan does not help visualise gallstones very clearly.
Additional investigations such as an endoscopy may also be performed in case the stone used to be removed. This procedure is called an endoscopic retrograde cholangiopancreatography or ERCP.
Treatment Of Gallstones
So how are gallstones treated?
If you have gallstones in your gallbladder and are not experiencing any symptoms, then you may not require any treatment at all. However, some surgeons are of the opinion that the gallbladder needs to be removed if gallstones are present.
Gallbladder stones are only treated surgically through removal of the gallbladder. This can be achieved either through a laparoscopic cholecystectomy where the camera is inserted into the abdomen through a small incision and the gallbladder is removed with another instrument.
Here is a video explaining how the surgery is done.
Sometimes, if laparoscopic cholecystectomy is going to be difficult, and open surgery is performed to remove the gallbladder.
There is no specific medical therapy that can help dissolve gallstones completely. This is because gallstones may either be pigment stones or cholesterol stones.
Cholesterol stones can be dissolved to some extent with medications such as ursodeoxycholic acid. However, some patients experience bloating and diarrhoea with this tablet.
Taking medication does not guarantee that the stones and completely disappear. Furthermore, you the stones to disappear, there is a high chance of recurrence again in the future.
Can gallstones be prevented?
There is nothing concrete regarding preventative strategies for gallstones. Maintaining a healthy body weight, reducing fat intake, lowering your cholesterol and exercising regularly may all work.
Gallbladder stones are very common problem and are usually found incidentally during a routine health checkup. Many of them do not require any treatment but gallbladder stones that get stuck and cause gallbladder infections require stone removal and gallbladder removal as well.