What Causes Gallstones and How Are They Treated?

Gallstones are stone-like formations that occur in the gallbladder, a small organ located just below your liver. The gallbladder stores bile, a dark green liquid produced by the liver, which aids the digestion and absorption of fats. In some cases, this liquid can turn solid and form gallstones as a result.

Research shows that about one in five Americans will experience gallstones at some point in their lives. The condition is symptomless in about 60% of the cases, so most patients don’t even know that they have it. However, gallstones can often cause pain and may require treatment to avoid complications.

What Causes Gallstones?

Gallstones form when the bile stored in the gallbladder starts to crystallize. Scientists still don’t know exactly what causes gallstones, but they believe it has to do with an imbalance of the chemicals that make up the bile.

In normal conditions, 97% of gallbladder bile is made up of water. The remaining 3% consists of bile salts and inorganic salts (0.7% each), bile pigment (0.2%), cholesterol (0.07%), and a combination of fats and fatty acids.

The salts in the gallbladder bile help dissolve cholesterol and other fats to allow for easier absorption. However, when there is more cholesterol than can be dissolved by these salts, gallstones will form. These yellow cholesterol gallstones are the most common and account for about 80% of all cases.

Bilirubin is another chemical found in the bile. It is released when your liver destroys old red blood cells. Certain blood disorders can stimulate your liver to produce more bilirubin than it normally does, in which case the so-called pigment gallstones will form. These gallstones are typically black or dark brown and account for one in five cases of the condition.

The exact cause of these imbalances is unknown, though it is thought that genetics, weight issues, and insufficient nutrition are all contributing factors. Furthermore, if your gallbladder can’t empty properly, the bile stored inside of it may become too concentrated, thus leading to gallstone formation.

Who Is at Risk for Gallstones?

There are several factors that can put you at a higher risk for gallstones. They include diabetes, high triglyceride levels, rapid weight loss, and obesity. Genetics and age also play a major role, as does your ethnical background. According to research, gallstones are most common in Chile and Scandinavia, as well as among Native Americans.

Studies have also shown that women are up to two or three times more likely to develop gallstones than men. This has to do with the natural effects of two female hormones – estrogen and progesterone. The former increases the level of cholesterol in the bile, while the latter results in slow gallbladder emptying. Both these factors can contribute to the formation of gallstones.

For women, the risk is even higher if they are undergoing estrogen therapy or taking the combined pill. Pregnancy is also considered a risk factor. Namely, the more pregnancies you’ve had, the more likely you are to develop gallstones. Liver-related health problems, gastrointestinal disorders, and family history of the condition can increase the risk of developing gallstones in both men and women.

Women are most at risk by the age of 40. When they enter their fifties, their bodies start producing lower amounts of progesterone and estrogen. Consequently, their risk for gallstones decreases with age. Unlike them, men are up to 10 times more likely to develop gallstones after the age of 60.

What Are the Symptoms of Gallstones?

In most cases, gallstones are completely asymptomatic and don’t cause any complications. Symptoms occur when gallstones are too large to move through the passageway that connects the gallbladder and the small intestine. This creates a blockage and causes a sharp pain in the upper abdomen and upper back. The pain starts abruptly, without any warning signs, and can last for several hours.

Other common symptoms of gallstones include the following:

  • Nausea, burping, and vomiting
  • Bloating and gas
  • Indigestion and heartburn
  • Dark urine and pale stools

Any combination of these symptoms is usually referred to as biliary colic.

What Are the Complications of Untreated Gallstones?

Untreated gallstones can cause cholecystitis, a gallbladder infection that occurs when the duct that removes bile from the gallbladder is blocked. If you ignore the symptoms, the infection could become chronic with frequent bouts of pain.

Gallstones can also cause jaundice, a liver-related symptom that turns your skin or eyes yellowish. They can also cause a bile duct infection known as cholangitis, pancreas inflammation, as well as sepsis. In extreme cases, gallstones can also be the first symptom of gallbladder cancer.

How Are Gallstones Diagnosed?

To diagnose gallstones, your doctor will first check your eyes and your skin for signs of jaundice, which is caused by high levels of bilirubin in the bile. They may also perform an abdominal CT scan to inspect your liver, as well as an ultrasound to check for any visible signs of acute cholecystitis. In some cases, your doctor may also order a blood test to check your bilirubin and cholesterol levels.

Your doctor may inject a small amount a radioactive substance into your veins and track its progress through your liver and your gallbladder to see if there are any signs of infection or bile duct blockage. This procedure is called gallbladder radionuclide scan. They may also use ERCP, a combination of X-rays and cameras, to inspect your abdomen for problems and look for gallstones.

How Are Gallstones Treated?

Asymptomatic gallstones usually don’t require any treatment. They don’t cause any complications and are usually passed with little-to-no discomfort. To decrease the chance of further gallstone complications, your doctor may recommend dietary changes like an increased intake of fiber and a lower intake of fats.

If you’re experiencing pain and can’t pass the gallstone that’s causing it, your doctor may recommend a gallbladder or gallstone removal surgery. This is a routine procedure performed under general anesthesia that often doesn’t require you to stay overnight at the hospital.

Whereas surgery can solve your problem in a matter of days, medication may take years to eliminate your gallstones. For this reason, doctors rarely prescribe medication anymore. However, if for whatever reason your doctor deems that you can’t have surgery, they may prescribe a drug like Actigall or Urso.

The Final Word

No matter what causes gallstones for you, surgery is the only way to prevent their recurrence. There is very little risk involved with the surgery, which is why many doctors recommend it as the go-to treatment method. If you’re taking medication to get rid of gallstones, they may recur as soon as you stop treatment.

Most people can pass gallstones without even noticing them. However, gallstone problems can recur and become even more serious over time if you don’t adopt dietary and lifestyle changes to improve your gallbladder health.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3343155/
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