Gallstones

About

Gallstones are small, hard stones typically made up of cholesterol, bile pigments, and calcium. They can form in the gallbladder or in the bile ducts, which are channels that connect the gallbladder to the small intestine. Gallstones can block the bile ducts, leading to a wide range of problems, such as jaundice, abdominal pain, and nausea. If left untreated, some gallstones can result in infection and inflammation of the gallbladder, known as cholecystitis. Gallstones can be treated through medications, dietary changes, and in some cases, surgery.

Symptoms

The most common symptom of gallstones is pain in the upper right abdomen; however, other common symptoms include indigestion, nausea, vomiting, bloating, extreme fatigue, abdominal pain that comes and goes, pain between the shoulder blades or in the right shoulder, and chills. In some cases, gallstones can cause a fever or jaundice.

Causes

The most common known cause of gallstones is an imbalance of substances found in bile, such as cholesterol or bilirubin. Other possible causes include obesity, diabetes, poor diet, using certain medications, liver disease, and genetic predisposition. Pregnancy and rapid weight loss can also increase the risk of developing gallstones.

Risk factors

Gallstone formation is usually associated with several risk factors such as:

Age – over 60
Gender – women are more likely to suffer from gallstones than men
Pregnancy – women who are pregnant are at higher risk of developing gallstones
High cholesterol levels – excess cholesterol can increase the risk of gallstone formation
Obesity – being overweight increases the risk of developing gallstones
Family history – those with a family history of gallstones are more likely to develop them
Rapid weight loss – rapid weight loss through diets or bariatric surgery can increase the risk of developing gallstones
Diabetes – diabetics are more likely to develop gallstones
Ethnicity – those of Native American, Mexican or Hispanic descent are more likely to develop gallstones
Medications – certain medications including estrogens, diuretics, and some cholesterol-lowering medications may increase the risk of developing gallstones
Malabsorption – certain conditions that affect the ability to absorb fats and cholesterol can increase the risk of gallstone formation.

Diagnosis

Gallstones are typically diagnosed using an abdominal ultrasound, which is a non-invasive imaging test that uses sound waves to produce images of the gallbladder and related organs. A doctor may also order a CT scan, MRI or abdominal X-ray if further details are needed. Blood tests for liver function may also be ordered to check for signs of gallbladder disease.

Sub-types

Gallstones are solidified deposits of bile within the gallbladder. There are two main types of gallstones: cholesterol stones and pigment stones. Cholesterol stones are the most common type, accounting for around 80% of all gallstones. These stones are yellow-green and consist mainly of hardened cholesterol. Pigment stones are smaller and darker in color, and are made up of bilirubin, calcium, and other substances. They tend to form when there is an imbalance of these substances in the bile.

Treatments

The treatment options for gallstones depend on the size, number and type of gallstones. Common treatment options include:

Medications like bile acid tablets or ursodeoxycholic acid (UDCA) to dissolve gallstones less than 5 millimeters in size.
Shock wave lithotripsy (ESWL), a procedure that uses shock waves to break up gallstones into smaller pieces, which can be passed in the stool.
Laparoscopic cholecystectomy, a procedure to remove the gallbladder when complications arise or the gallstones cannot be treated with medications or shock wave lithotripsy.
Other surgical procedures, such as open cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) to remove larger or impacted gallstones.

Your doctor will recommend the best treatment option based on the size, number, and type of your gallstones.

Prevention

To reduce the risk of developing gallstones, people can adopt a few lifestyle changes. These include:

Maintaining a healthy, balanced diet – Eating a diet rich in fruits, vegetables and whole grains, and low in processed foods, can help to reduce the risk of gallstone formation.
Avoiding excessive intake of fatty or sugary food – Eating too much fatty or sugary food can increase the risk of gallstone formation.
Maintaining a healthy weight – Maintaining a healthy weight can help ensure that bile is at the right consistency, reducing the chances of gallstones forming.
Avoiding crash diets – Restrictive diets can disrupt the balance of bile in the body, leading to gallstones forming.
Regular physical activity – Physical activity can help to keep the body healthy and prevent gallstone formation.
Drinking plenty of fluids – Drinking at least six to eight glasses of water a day can help keep the bile in the gallbladder more diluted, reducing the risk of gallstone formation.

Gender differences?

Yes there are gender-specific differences in the presentation and management of Gallstones. Women are more likely to present with biliary pain, nausea, and vomiting, while men are more likely to present with symptoms of abdominal discomfort, poor appetite, and bloating. Women are also more likely to be diagnosed with gallstone pancreatitis, while men tend to experience cholelithiasis complications more often.

In terms of management, hormone replacement therapy is often used to reduce the risk of gallstones in post-menopausal women. Men, on the other hand, may require more aggressive treatment such as lithotripsy or cholecystectomy. Medical management of gallstones may also differ between the sexes, with studies suggesting that women may require higher doses of ursodeoxycholic acid than men.

Nutrition

Nutrition plays an integral role in the management of gallstones. Eating healthy foods such as fruits, vegetables, wholegrain carbohydrates, and lean proteins can help reduce the risk of developing gallstones in the first place. Eating a diet low in saturated fat, total fat, and cholesterol, and ensuring adequate intake of fibre, can help to keep gallstones from forming. In addition, maintaining a healthy, steady weight—not under or over-eating—can reduce the risk of gallstone formation, as well as reduce the risk of recurrence if gallstones have already formed. Regular exercise and staying active can also help to prevent gallstones by promoting regular digestion and preventing bile from becoming too concentrated and forming stones.

Physical Activity

Physical activity can reduce the risk of developing gallstones by helping to maintain a healthy weight. Additionally, physical activity helps to stimulate the contraction of the gallbladder, which helps to move gallstones out of the gallbladder and into the intestines. Regular physical activity may also reduce cholesterol levels, which can help to reduce the risk of gallstone formation.