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Gallstones
(Biliary Colic; Cholecystitis; Cholangitis)

Definition:
Gallstones are pieces of stone-like material that form in the gallbladder. The majority of gallstones are made up of cholesterol. The rest are made up of bilirubin. Bilirubin is a breakdown pigment of the blood product hemoglobin.

Biliary colic is the pain caused by a gallstone stuck in the bile duct, a tube that carries bile to the small intestine. Sometimes, a stone caught in the bile duct causes cholecystitis, which causes inflammation of the gallbladder. Cholangitis is inflammation of the bile duct caused by a gallstone or a bacterial infection.

Causes:
The gallbladder stores bile, which is produced in the liver and used in the small intestine to digest fat. Bile contains cholesterol, water, bilirubin, and bile salts. The bile salts break up fats.

Gallstones can form under the following conditions:

  • Too much absorption of bile salts from the bile
  • Too much absorption of water from the bile
  • Too much cholesterol in the bile
  • Inflammation of the lining of the gallbladder
Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for gallstones include:
  • Age: older than 60 years old
  • Sex: women between 20-60 years old and women with high estrogen levels due to pregnancy, oral contraceptive use, or hormone replacement therapy
  • Obesity
  • Race: Pima Indians and other Native American Indians, Mexican Americans, and Northern Europeans
  • Use of cholesterol-lowering drugs
  • Diabetes
  • Rapid weight loss and fasting
  • Previous gallstones
  • Diseases of the gallbladder and ducts
  • Blood diseases, including sickle-cell anemia
Symptoms:
Many people have gallstones without symptoms. These are called "silent gallstones." While treatment is not required, in some cases it may be recommended.

Gallstones may cause pain in the upper abdomen that is sometimes called an attack because it begins suddenly, often after a fatty meal. The pain is severe and may last for 30 minutes or up to several hours.

Other symptoms include:

  • Intermittent pain on the right below the ribcage
  • Bloating, nausea, and vomiting
  • Belching, gas, and indigestion

If you have the following symptoms, you should see a doctor right away , as they may indicate cholecystitis or cholangitis:

  • Diffuse abdominal pain
  • Sweating
  • Chills
  • Low-grade fever
  • Jaundice (yellowish color of the skin or whites of the eyes)
  • Clay-colored stools
Diagnosis:
The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

X-rays of the Abdomen–about 15% of gallstones can be seen on plain x-rays

Ultrasound–a test that uses sound waves to find gallstones

Magnetic Resonance Cholangiopancreatography (MRCP)–an accurate and non-invasive means of evaluating the pancreas and gallbladder, comparable to ERCP

Endoscopic Retrograde Cholangiopancreatography (ERCP)–a type of x-ray that shows the pancreas after dye has been sent through a tube down the throat and into the gallbladder

Cholecystogram or Cholescintigraphy–x-rays that show movement of the gallbladder and any blockage of the cystic duct that carries bile to the bile duct

Blood Tests–may be used to find an infection, jaundice, pancreatitis, or an obstruction

Treatment:
Surgical Treatments

Laparoscopic Cholecystectomy–removal of the gallbladder through several small incisions in the abdomen. A small, lighted tube with a camera is inserted into one of the incisions to view the gallbladder area and display it on a television screen. Surgical instruments are used to remove the gallbladder through one of the other incisions.

Open Cholecystectomy–removal of the gallbladder through a large incision in the abdomen. This is necessary if there is an infection in the abdomen or a great deal of scar tissue.

Nonsurgical Treatments

Oral Dissolution Therapy–medications taken by mouth to dissolve stones. These drugs are most effective for treating small stones and may take months or years to be effective.

Extracorporeal Shock Wave Lithotripsy (ESWL)–shock waves used to break the stones into pieces small enough to pass through the ducts. This treatment does not have a high success rate and may cause severe pain. Note: This procedure is no longer performed.

Prevention:
To reduce your chance of getting gallstones:
  • Maintain a healthy weight.
  • Avoid rapid weight loss diets.
  • Exercise regularly.
  • Eat a diet low in saturated fat.
  • Eat plenty of fruits, vegetables, and whole grain foods.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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