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What are gallstones?

Gallstones are collections of cholesterol, bile pigment or a combination of the two, which can form in the gallbladder or within the bile ducts of the liver. In the United States, the most common type of gallstones are made of cholesterol. Cholesterol stones form due to an imbalance in the production of cholesterol or the secretion of bile. Pigmented stones are primarily composed of bilirubin, which is a chemical produced as a result of the normal breakdown of red blood cells.

How do gallstones cause problems?

If gallstones form in the biliary system they can cause blockage of the bile ducts, which normally drain bile from the gallbladder and liver. Occasionally the gallstones can also block the flow of digestive enzymes from the pancreas because both the bile ducts and pancreas ducts drain through the same small opening (called the Ampulla of Vater) which is held tight by a small circular muscle (called the Sphincter of Oddi). This results in inflammation of the pancreas and is known as gallstone pancreatitis. Blockage of the bile ducts may cause symptoms such as abdominal pain, nausea and vomiting. If the bile duct remains blocked bile is unable to drain properly, jaundice (yellow discoloration of the eyes and skin) can develop and an infection known as cholangitis may also occur.

What are the symptoms of gallstones?

Gallstones that are not causing symptoms generally do not require further evaluation. Many times gallstones are found by chance on an abdominal x-ray or ultrasound done for other reasons. Unless symptoms of pain, nausea, vomiting or fever are present, no additional testing or intervention may be needed. Symptoms arise when a gallstone blocks the flow of bile out of the gallbladder or through the bile ducts. A gallstone in the common bile duct is called choledocholithiasis and may cause intermittent or constant discomfort. The pain of choledocholithiasis is usually localized in the upper abdomen, and can radiate (be felt in another location) in the right shoulder, may last from 30 minutes to hours, and be associated with sweating, nausea, vomiting, and. Gallstone attacks can produce chest pain that may feel like a heart attack. If a pain is new and different than other pains the symptoms should be discussed with a physician.

An inflamed gallbladder (cholecystitis), infected material trapped within the common bile duct (cholangitis), or a stone blocking outflow of pancreatic juice (gallstone pancreatitis) can result in fever, chills, severe abdominal pain or jaundice. Individuals with these complaints should have an urgent evaluation by a physician.

How do you diagnose and treat gallstones?

The diagnosis of gallstones is suspected when symptoms of right upper quadrant abdominal pain, nausea or vomiting occur. The location, duration and “character” (stabbing, gnawing, cramping) of the pain help to determine the likelihood of gallstone disease. Abdominal tenderness and abnormally high liver function blood tests may be present. An abdominal ultrasound examination is a quick, sensitive, and relatively inexpensive method of detecting gallstones in the gallbladder or common bile duct. This is the test most often used.

The treatment for gallstones that obstruct the common bile duct is endoscopic retrograde cholangiopancreatography (ERCP) or surgery. ERCP involves passage of a thin flexible scope through the mouth and into the duodenum where it is used to evaluate the common bile duct or pancreatic duct. Tiny tubes and instruments may be used to further evaluate the ducts and remove stones if necessary. Gallbladder surgery may be performed if there are stones found in the gallbladder itself, as these cannot be removed by ERCP. This operation, known as cholecystectomy, is frequently done using a laparoscope and is inserted into the abdomen through several small incisions under general anesthesia. If a gallbladder operation is not possible, a medicine known as ursodiol, may be used to dissolve cholesterol gallstones but this can take months, and the stones recur in many people once the treatment is stopped.

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