For anyone who’s suffered with gallstones, you know they can be a real pain. You’re also in good company — these hardened deposits of cholesterol that can collect in the gallbladder represent one of the most common health complaints affecting Americans. The National Institute of Diabetes and Digestive and Kidney Diseases reports that 10 to 15 percent of the U.S. population, about 25 million people, are affected by gallstones.
Here are answers to nine of the most common questions people ask about gallstones, including:
— What’s the Gallbladder?
— What are gallstones and how do they form?
— What are the signs and symptoms of gallstones?
— How are gallstones treated?
— What happens during gallbladder removal surgery?
— Can gallstones be broken up or removed?
— Who’s most at risk of developing gallstones?
— What are the complications of gallstones?
— How can I prevent gallstones?
1. What’s the Gallbladder?
Any discussion of gallstones needs to begin with some information about the organ in which they reside: the gallbladder. Dr. Timothy Farrell, general surgeon with Geisinger in Danville, Pennsylvania, calls the gallbladder a sort of “cul-de-sac on a street.” The pear-shaped organ sits just under the liver on the right side of the body and connects to the liver on one end and the intestines on the other. It acts as a storage unit for bile, also called gall, a liquid that aids in digestion. “The liver makes a quart of bile per day and your gallbladder holds a shot glass-full of bile” or about an ounce at any one time, Farrell says. It’s typically full and slowly drips bile continuously into the intestines.
“Bile is a soapy liquid basically,” that’s made in the liver and is composed of acids, salts, cholesterol and a variety of other substances, says Dr. Benjamin Poulose, professor of surgery at The Ohio State University Wexner Medical Center. The exact composition of this yellowish-brown liquid “varies from patient to patient,” depending on a number of factors including diet. This could be why some are prone to developing gallstones while others are not. But it’s a substance we all need so that the body can break down and absorb nutrients from fatty foods.
[See: 10 Lessons From Empowered Patients.]
2. What Are Gallstones and How Do They Form?
Sometimes called cholelithiasis, gallstones are “basically what the name implies — they’re little pebbles of gall, which is bile,” Farrell explains. “In some people, cholesterol, which is the main ingredient in bile, will come out of solution as a solid and clump together.” He likens this process to how salad dressing separates. “It’s kind of like if you took a bottle of Italian dressing and shook it up and put it on the counter. The solid stuff would slowly come out of solution and settle on the bottom. That’s the easiest way to understand what a gallstone is — it’s the cholesterol in the liquid bile that then comes out of solution and clumps together as little pebbles of cholesterol.”
Over time these pebbles grow and harden. “What we think happens is small crystals form in the bile and it builds on top of that,” Poulose says. Like a pearl, these stones can take years to grow and develop before you’d even know you had one.
The NIDDK describes two main types of gallstones — cholesterol stones and pigment stones. “Cholesterol stones are usually yellow-green in color and are made of mostly hardened cholesterol.” Pigment stones are darker and composed of bilirubin, an orange-yellow substance that results from the normal breakdown of red blood cells.
A gallstone can be “as small as a grain of sand or it can be as big as an egg, and everywhere in between,” Farrell says. And size doesn’t necessarily correlate to symptoms. “There’s no real connection between number of gallstones and symptoms or size of gallstone. If you have one gallstone and I have 10, it’s not that I have 10 times the symptoms that you do. Or if you have a big one and I have a small one — it’s not that I have small symptoms and you have big symptoms. There’s no real connection between number and size and symptoms.”
While gallstones are very common, “most people don’t have them,” Farrell says. “But there are certainly many people who have gallstones but have no symptoms.” The only way to tell for sure whether you have gallstones is through the use of abdominal imaging, such as an ultrasound. The only time gallstones need to be addressed is if they are causing symptoms.
3. What Are the Signs and Symptoms of Gallstones?
Most commonly patients will complain of pain after eating meals, typically fatty meals, and usually in a specific area of the abdomen. Poulose says some patients may experience more serious issues, such as when a gallstone “blocks the outlet of bile from the gallbladder or blocks the main channel of the bile duct system where bile drains from the liver into the small intestine. And that can lead to more dire consequences,” such as infections and inflammation of the pancreas. These complications need to be treated, as they can be very serious — even life-threatening in some cases.
Farrell describes the primary symptom of gallstones as a “pattern of pain,” on the right side of the upper abdomen, just under the rib cage. In some cases, the pain can radiate through to the right shoulder blade. It tends to come on soon after eating a meal, particularly one that contains fatty components such as dairy products. “We’re looking for that pattern of fatty food intolerance.”
Poulose adds that “if you have these symptoms, seek the attention of your primary doctor or get the opinion of a surgeon, because oftentimes when you don’t treat these gallstones and then you just try to ride it out or take therapies that are unproven, it can lead to further complications that could have been avoided.” Your primary care doctor may refer you to a gastroenterologist for additional testing, but gallbladder surgery is usually performed by a general surgeon.
4. How Are Gallstones Treated?
“In general, this is one particular problem that we have pretty good treatments for,” Poulose says. And for most people who need treatment for gallstones, the preferred treatment is surgery to remove the gallbladder.
It might sound dire to remove a whole body part, but Farrell says the biliary system — the tract includes the gallbladder and bile ducts inside and outside the liver — has enough redundancy that most people have no problems living a full and healthy life without a gallbladder. “I tell patients that by the time you are having symptoms, you’re already living without the gallbladder because it’s filled with stones or a large stone. So, it’s not holding that much bile and you’re already living without its proper function.” Unlike the appendix, “which has no known function in humans,” the gallbladder does have a very definite function, he says. But “when it’s diseased you can live a long and healthy life without it.”
[See: How Often Should I Poop, and Other Toilet Topics.]
5. What Happens During Gallbladder Removal Surgery?
Surgery to remove the gallbladder, also called a cholecystectomy, is one of the most common surgeries in the U.S. today. The NIDDK reports that “about a quarter of the nearly 1 million people diagnosed with gallstones each year will need to be treated, usually with surgery.” The American Gastroenterological Association reports that 90 percent of these surgeries are performed laparoscopically, or with minimally invasive techniques.
This laparoscopic approach usually involves “three or four small incisions made around the belly,” through which the surgeon can reach in and remove the gallbladder, Poulose says. The surgery usually takes one to two hours depending on the complexity of the case, and patients are typically discharged the same day. “The recovery time is three or four days, but some people need a little longer than that,” he says.
The bile system continues to function in the absence of the gallbladder, and Poulose says that “over time, we’ve found that the bile duct system starts taking over some functions of the gallbladder. We’re designed to be pretty resilient.”
6. Can Gallstones Be Broken Up or Removed?
Farrell says many patients ask whether the stones can be broken up, such as is often done with kidney stones using a technology called lithotripsy. This technique uses sound waves to break up kidney stones, which can then be passed more easily through the urinary system. “It’s not quite the same with gallstones. That technology has not been shown to be helpful for patients with gallbladder disease,” because gallstones are fundamentally different from kidney stones.
He says patients also ask frequently whether the stones can just be removed and the gallbladder left in place. “The problem with that is the people who make gallstones will continue to make gallstones. They’re likely to re-form their gallstones and become symptomatic again. That’s why the standard treatment would be to remove the whole gallbladder, because it’s very uncommon to make gallstones once the gallbladder has been removed.”
7. Who’s Most at Risk of Developing Gallstones?
While anyone can develop gallstones at pretty much any time in their life, Farrell says women tend to get them more often than men. “They’re more common in women who’ve had pregnancies, but we see certainly see many women who haven’t had pregnancies develop gallstones, and we certainly see men with them, so it’s not a 100 percent sort of thing.”
Farrell says female hormones and the hormones of pregnancy can slow down the movement of bile, which provides a greater opportunity for stones to form. “Female hormones cause cholestasis, which is sluggish flow of bile. If your bile is not flowing, it has a longer time to come out of solution and make stones.”
The Mayo Clinic reports that being over age 40 is a risk factor for developing gallstones. Being sedentary, overweight or obese, having diabetes or liver disease, and having Native American or Mexican-American heritage may also increase your risk.
Poulose says no one’s certain yet whether there’s a hereditary or genetic component to why some people develop gallstones while others don’t. “We do see a pattern in some patients that kind of tracks with families, but we don’t know for sure if that’s genetic or if it’s just related to your diet — a lot of times we eat the same things our parents eat and they eat the same things their parents eat.”
8. What Are the Complications of Gallstones?
Poulose says if gallstones aren’t treated, they can lead to serious complications. “Sometimes patients will experience bad infections of the gallbladder that can lead to emergency surgery. Other times, if the stones travel down the tree of the bile duct system, they could potentially block the bile duct system itself, causing a backup of bile into the liver which could also lead to more serious infections and inflammation of the pancreas, which could be potentially life threatening.” Therefore, if you’re having symptoms of gallstones, it’s important to get it checked out. Your doctor will likely perform an ultrasound test to get images of what’s going on in the abdomen that will show whether you have gallstones and how inflamed the gallbladder is. This can guide treatment options.
If you’re too sick to undergo gallbladder removal surgery, your doctor may opt instead to “insert a tube into the gallbladder to act as a pop-off valve,” to relieve pressure from a blocked duct, Poulose says. And if you have a gallstone that’s moved out of the gallbladder and into the bile duct system, that may need to be removed. “When the stones travel down the common channel of the bile duct system, typically we handle that by endoscopy,” Poulose says. In this procedure, the doctor inserts a tube with a camera in it into the mouth and threads it down to where the stone is to help guide its removal. “It’s actually a little easier to access the bile duct system from that route, and we’ll remove the stone that way.”
[See: 10 Questions Doctors Wish Their Patients Would Ask.]
9. How Can I Prevent Gallstones?
Unfortunately, there’s no simple way to prevent gallstones from forming, and science doesn’t yet have a great answer for why some people seem more prone to developing them than other people. “I think there’s some dietary component to it because we seem to be seeing more gallbladder disease in younger people as the general trend to obesity in this country continues,” Farrell says. “We’re certainly seeing more younger people than we did 20 years ago.”
Because bile reacts to fatty foods, there is a theory that eating a low-fat diet may be helpful in reducing the chances of developing gallstones. “A low-fat diet is helpful for prevention of heart disease more so than gallbladder disease,” Farrell says, but eating healthfully is important, as well as getting plenty of exercise. “The same things that help everything in the body will help the gallbladder as well.”
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Your Guide to Gallstones originally appeared on usnews.com
