Gallstones: The stone story

Here are some basics about gallstones, what causes them and how they are treated

What are gallstones?

Pain in abdomenThey are stones formed in the gallbladder due to the excess accumulation of bile. Bile is the fluid produced in the liver and stored in the gall bladder. It contains water, fats, cholesterol, bile salts, proteins, and bilirubin. Stones are formed when there is excess cholesterol, bile salts, or bilirubin in the bile.

Gallstones are of two types: cholesterol and pigment stones. Cholesterol stones are yellow-green in colour and are made of hardened cholesterol. About 80 per cent of gallstones are of the cholesterol type. On the other hand, pigment stones are small, dark and are made of bilirubin.

The size of the stones vary—they can be as small as a grain or as large as a golf ball. One can develop either one large or many tiny stones or even a combination of both.

If you have gallstones, you will experience severe abdominal pain due to inflammation of the gall bladder [a condition called cholecystitis]. The stones can also obstruct the other parts of the biliary duct, thus causing infection [a condition called cholangitis or pancreatitis]. Both these conditions need immediate medical attention.

What causes them?

The exact cause of either cholesterol stones or pigment stones is still undiscovered. Some scientists believe that having too much cholesterol or bilirubin in the body leads to the formation of cholesterol stones. But why these imbalances occur, is still a mystery. Pigment stones are commonly found in those suffering from liver cirrhosis, biliary tract infections or blood disorders.These conditions increase one's risk of developing gallstones.

Apart from these, there are other factors that may contribute to the formation of gallstones, especially cholesterol stones. These include:

  • Sex. Women are more likely [almost twice] than men to develop gallstones. Also chances of getting gallstones is high during pregnancy or when on birth control pills.
  • Weight. A clinical study shows that people who are even moderately overweight are at a higher risk of developing gallstones.
  • Diet. A diet high in fat and cholesterol and low in fibre increases the risk of gallstones.
  • Rapid weight loss. When the body is subjected to prolonged fasting or rapid weight loss, the liver produces more cholesterol into the bile, which may cause gallstones.
  • Age. People above the age of 60 are more likely to develop gallstones.
  • Cholesterol-lowering drugs. Certain drugs that are used to reduce cholesterol levels in the blood actually increase the amount of cholesterol in the bile. This in turn increases the risk of gallstones.
  • Diabetes. Diabetics usually are seen to have higher levels of fatty acids called triglycerides, which increases the risk of gallstones.

How to diagnose them?

Gallstones can be diagnosed with the help of signs and symptoms and tests.

A classic symptom of gallstones is the occurrence of intense pain in the upper right side of the abdomen, followed by nausea and vomiting. This may last for approximately 30 minutes.

Sometimes, it may even last for hours. In most cases, symptoms appear after a heavy meal and at night. Other symptoms include bloating, intolerance of fatty foods, and indigestion.

There are some gallstones that remain asymptomatic for several years and do not require treatment till they cause discomfort. They are thus called “silent stones”. Symptoms may appear when the stone size or the number of stones increases.

The best and easiest way to diagnose gallstones is using ultrasonography. Although sometimes standard computerised tomography [CT or CAT scan] and magnetic resonance imaging [MRI] may detect gallstones; but they are not as effective as ultrasonography.

How are they treated?

There are two approaches for their treatment:

Non-surgical: Doctors opt for these only in case of cholesterol stones, when the patient has a serious medical condition and cannot undergo surgery. Stones removed non-surgically tend to recur within five years.

Common non-surgical treatments methods are oral dissolution therapy and contact dissolution therapy. In oral therapy, a drug is used to dissolve the stones, while in contact therapy; a drug is injected directly into the gall bladder.

Surgical: Removing the gall bladder surgically [laparoscopic cholecystectomy] reduces the occurrence by 99 per cent. This works best in patients who show clear symptoms of the disease.

What happens when the gall bladder is removed?

The absence of a gall bladder has no negative side-effects. We can live without a gall bladder. Our liver is capable of producing enough bile to digest our regular diet. When the gallbladder is removed, the bile produced by the liver flows directly into the small intestine, instead of being stored in the gall bladder. This sometimes causes the person to pass softer and more frequent stools. But this is only temporary and occurs in only one per cent patients.

Difference between Gallstones and kidney stones

Gallstones are mostly made of cholesterol and are soft in nature. They are not seen on X-rays and do not respond to lithotripsy [physical destruction of stones].

Kidney stones are mostly made of calcium salts and are hard. They are detected on an X-ray and respond well to lithotripsy.

Ways to prevent gallstones

Diet

A fibre-rich diet keeps your weight in check and this in turn may prevent gallstones. Include whole-grain breads, nuts, cereals, fruits and vegetables in your diet.

Our body converts the carbohydrates we eat to sugar. Consuming excess sugar increases our risk of gallstones. So, avoid eating pasta, rice, muffins, white bread, and other carbohydrate-rich foods in excess.

Regular exercise will keep your weight in check, which may prevent gallstones. Experts recommend about 30 minutes of exercise five times a week to make the difference.

It is prudent to keep a check on our fat intake since saturated fats like butter and the ones found in meat increase our risk of gallstones. Choose healthier options like lean chicken, skimmed milk and low-fat yoghurt.

Hormone therapy

Hormone replacement therapy [HRT] increases a woman's risk of developing gallstones. This is because the oestrogen triggers the body to produce more cholesterol.

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