Gallstones

What is Gallstone?

A gallstone is a lump of hard material formed inside the gallbladder. Gallstones usually range in size from a grain of sand to 3-4 cms.

Types and Causes of Gallstones

• Cholesterol stones
  
• Pigment stones
  
• Mixed stones

Cholesterol Stones

Gallstones are formed as a result of precipitation of cholesterol and bile salts from the bile. They are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80% of gallstones. 

Scientists believe cholesterol stones form when bile contains 

• too much cholesterol, 
  
• too much bilirubin,
  
• not enough bile salts, or possibly
  
• when the gallbladder does not empty as it should for some other reason.

Pigment Stones

These types of gallstones are small, dark stones made of bilirubin. The exact cause is not known. They tend to develop in people who have 

• cirrhosis, 
  
• biliary tract infections, and 
  
• hereditary blood disorders such as sickle cell anaemia in which too much bilirubin is formed.

Other Causes of Gallstones

As gallstones are related to excess excretion of cholesterol, other risk factors or causes associated with gallstones are:

• Obesity - Especially in women.
  
• Oestrogen - Excess oestrogen from pregnancy, hormone replacement therapy, or birth control pills. Women between 20 and 60 years of age are twice as likely to suffer from gallstones than men.
  
• Cholesterol-lowering drugs.
  
• Diabetes - People with diabetes generally have high levels of fatty acids called triglycerides.
  
• Rapid weight loss - As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile.

Signs of Gallstones

Symptoms may vary and often follow fatty meals, and they may occur during the night. 

Typical symptoms include:

• abdominal bloating and abdominal pain
  
• recurring intolerance of fatty foods
  
• steady pain in the right side of the upper abdomen 
  
• pain in the back between the shoulder blades
  
• pain under the right shoulder
  
• nausea or vomiting
  
• Indigestion and belching

The pain in the upper abdomen may increase and last from 30 minutes to several hours. 

Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called "silent stones." 

Gallstone symptoms can be similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, reflux, pancreatitis, and hepatitis. 

An accurate diagnosis is important.

Diagnosis of Gallstones

To confirm the existence and nature of gallstones various tests may be required. These include:

• Blood Tests - may be used to see signs of infection, obstruction, pancreatitis, or jaundice 
  
• Ultrasound - the most sensitive and specific test for gallstones. 
  
• Computed tomography (CT) - scan to show the gallstones or complications that can result