What is Cholelithiasis?
Cholelithiasis is the medical term for gallstones. They are hard objects resembling small pebbles, gravel, or sometimes even spherical stones that form in a person's gallbladder or in the bile ducts. The gallbladder is a small pouch beneath the liver that stores bile, which helps to digest fats, oils and fat soluble vitamins such as vitamins A, D, E and K.
What are the Causes of Gallstones?
Gallstones are caused when substances in the bile, which is a fluid, harden and form stones. The stones may be made of:
- Pure cholesterol.
- Bilirubin.
- Cholesterol and bilirubin.
- Minerals, including calcium salts and oxides of aluminum or silicon.
In the United States, most gallstones are made of cholesterol and bilirubin. They form when the bile becomes supersaturated, and a nucleus of the stone is formed. The stone grows by the accumulation of more supersaturated bile. A stone grows at about 2.6 millimeters a year, and people don’t usually begin to feel symptoms until years after the stone starts to form.
What are the Symptoms of Gallstones?
The early symptoms of gallstones are silent. People with numerous or very large gallstones may not have symptoms until contractions of the bladder cause the stones to block the bile ducts. Then, the symptoms may include:
- Pain in the upper right part of the abdomen that may radiate to the right shoulder or the space between the shoulder blades.
- Pain may also be in the mid abdomen or right flank. Rarely, it may even be in the right lower quadrants or the left upper quadrants of the abdomen.
- Nausea and vomiting.
- Bloating.
- Belching.
- Fever, occasionally.
- Jaundice, which is the yellowing of the eyes and the skin.
People with gallstones may also experience indigestion when they eat fatty foods.
How Common is Cholelithiasis?
Gallstones are very common. It’s estimated that about 10 to 15 percent of Americans have gallstones, which is about 25 million people.
How is Cholelithiasis Diagnosed?
Gallstones can be suspected when the patient goes to their doctor complaining of symptoms. To confirm the diagnosis, the doctor will order tests such as blood tests, and imaging such as ultrasound, MRI and CT scans are also used to find gallstones. Other tests include:
Hepatobiliary Iminodiacetic Acid, or HIDA Scan
This is a test that checks the functions of the bladder and bile ducts for problems in the gallbladder, bile ducts and liver. The radiologist injects a radioactive substance into a vein in the patient’s arm that goes to the liver. There, the cells that make bile take it up and it travels to the gallbladder. From there, the bile and the substance pass through the bile ducts into the small intestine. As the radioactive substance travels, a scanner follows it and creates images via computer.
Endoscopic Retrograde Cholangiopancreatography, or ERCP
During this test, the doctor passes an endoscope through the patient’s GI tract and into the bile ducts. A dye is then injected into the ducts, and X-rays are taken to see if there are any stones present. If there are stones in the ducts, the doctor can usually remove them at the time.
How is Cholelithiasis Treated?
Doctors prescribe oral medications such as bile acids to dissolve the gallstones, but these medicines might take years to work, and the gallstones may come back if the medication is stopped. Oral medications are mostly for people who can’t undergo gallbladder surgery.
Surgical Techniques
Surgical techniques involve removing the gallbladder entirely. This is called cholecystectomy. A person can live without their gallbladder, and the liver will simply excreted bile into the intestine. When the gallbladder is removed, a patient's symptoms are usually relieved immediately.
The surgery can be an open surgery or a laparoscopic surgery. In a laparoscopic surgery, the doctor makes small incisions in the abdomen and inserts a tiny camera and special, miniaturized instruments to remove the gallbladder. In open surgery, the doctor makes a longer incision and removes the gallbladder directly.
What are the Complications of Gallstones?
One of the worst complications of gallstones involve the stone becoming lodged in a duct. This can cause an inflammation of the gall bladder, the bile duct, or the pancreas and can even cause an obstruction in the large or small intestine. The symptoms are severe pain in the upper abdomen, nausea, vomiting, fever, and sometimes jaundice. These conditions are medical emergencies.
Expected Recovery Outcomes
People whose gallstones do not cause symptoms may not need treatment. However, the gallstones always have potential to cause a medical emergency in the future if not treated.
Gallstone Treatment Percentage Outcomes
Between 70 and 90 percent of people who have their gallbladder removed get complete relief from their symptoms. Some patients may experience more rapid GI transit times after removal of their gallbladder. This is a minority of patients. However, some patients may experience loose stools or more frequent stools. Some of those affected in this way may experience improvement in pre-existing conditions.
If left untreated, gallstones continue to grow and put the patient at risk for inflammation of the gall bladder, bile and pancreatic ducts. Gallstone pancreatitis continues to be a life threatening complication of gallstones which kills many Americans every year.
Other Key Points About Gallstones
Gallstones can affect people of any age, race and gender, but most often affect women. Some doctors believe this is due to hormonal factors. It’s more common in women of child bearing age, and more common in Native Americans. As much as 60 percent of women with Native American ancestry have gallstones.
Other risk factors for gallstones include being overweight and having diabetes. People who lost weight quickly, such as bariatric surgery patients, are more at risk for gallstones. People who eat a high fat and cholesterol diet and people who are on cholesterol lowering medication are also at higher risk. Interestingly, the body responds to cholesterol lowering drugs by producing more cholesterol in the bile.