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    Gallstones

    Cholelithiasis; Gallbladder attack; Biliary colic; Gallstone attack; Biliary calculus

    Gallstones are hard, pebble-like deposits that form inside the gallbladder. Gallstones may be as small as a grain of sand or as large as a golf ball.

    Causes

    The cause of gallstones varies. There are two main types of gallstones:

    • Stones made of cholesterol, which are by far the most common type. Cholesterol gallstones have nothing to do with cholesterol levels in the blood.
    • Stones made of bilirubin, which can occur when red blood cells are being destroyed (hemolysis). This leads to too much bilirubin in the bile. These stones are called pigment stones.

    Gallstones are more common in women, Native Americans, Hispanics, and people over age 40. Gallstones may also run in families.

    The following also make you more likely to develop gallstones:

    • Bone marrow or solid organ transplant
    • Diabetes
    • Failure of the gallbladder to empty bile properly (this is more likely to happen during pregnancy)
    • Liver cirrhosis and biliary tract infections (pigmented stones)
    • Medical conditions that cause the liver to make too much bilirubin, such as chronic hemolytic anemia, including sickle cell anemia
    • Rapid weight loss from eating a very low-calorie diet, or after bariatric surgery
    • Receiving nutrition through a vein for a long period of time (intravenous feedings)

    Symptoms

    Many people with gallstones have never had any symptoms. The gallstones are often found during a routine x-ray, abdominal surgery, or other medical procedure.

    However, if a large stone blocks either the cystic duct or common bile duct (called choledocholithiasis), you may have a cramping pain in the middle to right upper abdomen. This is known as biliary colic. The pain goes away if the stone passes into the first part of the small intestine (the duodenum).

    Symptoms that may occur include:

    • Pain in the right upper or middle upper abdomen:
      • May be constant
      • May be sharp, cramping, or dull
      • May spread to the back or below the right shoulder blade
    • Fever
    • Yellowing of skin and whites of the eyes (jaundice)

    Other symptoms that may occur with this disease include:

    • Clay-colored stools
    • Nausea and vomiting

    It is important to see a doctor if you have symptoms of gallstones.

    Exams and Tests

    Tests used to detect gallstones or gallbladder inflammation include:

    • Abdominal ultrasound
    • Abdominal CT scan
    • Endoscopic retrograde cholangiopancreatography (ERCP)
    • Gallbladder radionuclide scan
    • Endoscopic ultrasound
    • Magnetic resonance cholangiopancreatography (MRCP)
    • Percutaneous transhepatic cholangiogram (PTCA)

    Your doctor may order the following blood tests:

    • Bilirubin
    • Liver function tests
    • Pancreatic enzymes

    Treatment

    SURGERY

    Some people have gallstones and have never had any symptoms. The gallstones may not be found until an ultrasound is done for another reason. Surgery is usually not needed unless symptoms begin. One exception is in patients who have weight-loss surgery.

    In general, patients who have symptoms will need surgery either right away, or after a short period of time.

    • A technique called laparoscopic cholecystectomy is most commonly used now. This procedure uses smaller surgical cuts, which allow for a faster recovery. Patients are often sent home from the hospital on the same day as surgery, or the next morning.
    • In the past, open cholecystectomy (gallbladder removal) was the usual procedure for uncomplicated cases. However, this is done less often now.

    Endoscopic retrograde cholangiopancreatography (ERCP) and a procedure called a sphincterotomy may be done to find or treat gallstones in the common bile duct.

    MEDICATION

    Medicines called chenodeoxycholic acids (CDCA) or ursodeoxycholic acid (UDCA, ursodiol) may be given in pill form to dissolve cholesterol gallstones. However, they may take 2 years or longer to work, and the stones may return after treatment ends.

    Rarely, chemicals are passed into the gallbladder through a catheter. The chemical rapidly dissolves cholesterol stones. This treatment is not used very often, because it is difficult to perform, the chemicals can be toxic, and the gallstones may return.

    LITHOTRIPSY

    Electrohydraulic shock wave lithotripsy (ESWL) of the gallbladder has also been used for certain patients who cannot have surgery. Because gallstones often come back in many patients, this treatment is not used very often anymore.

    Outlook (Prognosis)

    Gallstones develop in many people without causing symptoms. The chance of symptoms or complications from gallstones is low. Nearly all patients who have gallbladder surgery do not have their symptoms return (if the symptoms were actually caused by gallstones).

    Possible Complications

    Blockage of the cystic duct or common bile duct by gallstones may cause the following problems:

    • Acute cholecystitis
    • Cholangitis
    • Cholecystitis - chronic
    • Choledocholithiasis
    • Pancreatitis

    When to Contact a Medical Professional

    Call for an appointment with your health care provider if you have:

    • Pain in the upper part of your abdomen
    • Yellowing of the skin or whites of the eyes

    Prevention

    In most people, gallstones cannot be prevented. In people who are obese, avoiding rapid weight loss could prevent gallstones.

    References

    Siddiqui T. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg. 2008;195(1):40-47.

    Chari RS, Shah SA. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2007:chap. 54.

    Wang DQH, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 65.

    Glasgow RE, Mulvihill SJ. Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 66.

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    A Closer Look

    Self Care

      Tests for Gallstones

        Review Date: 8/11/2011

        Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

        The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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