Understanding Gallstones -- Diagnosis and

Treatment
In this article
 How Do I Know if I Have Gallstones?
 What Are the Treatments for Gallstones?
 Conventional Medicine for Gallstones
 Gallstones and Watchful Waiting
 Nonsurgical Therapy for Gallstones
 Surgery to Remove the Gallbladder

How Do I Know if I Have Gallstones?

If your symptoms suggest a gallstone problem, your doctor might first examine
your skin for jaundice, and then feel your abdomen to check for tenderness. A blood test may
reveal evidence of an obstruction.

Because other digestive problems, such as an infection of the duct, can produce symptoms similar
to those of a gallstone attack, the doctor may also run other tests to determine if gallstones are in
fact the culprit.

The most common technique is an ultrasound exam. This quick, painless procedure uses high-
frequency sound waves to create pictures of the gallbladder, bile duct, and their contents. CT
scans are also sometimes done to look at the anatomy of your internal organs.

A more complicated test may be used if the doctor suspects that a gallstone is lodged in a bile
duct. Commonly known by the acronym ERCP, this test allows the doctor to look at the bile duct
through a small flexible tube called an endoscope. The doctor sprays the back of the patient's
throat with an anesthetic drug to prevent gagging, sedates the patient, and passes the endoscope
into the mouth, through thestomach, and into the area of the small intestine where the bile duct
enters. Dye is injected through the tube and into the bile duct, and then the doctor takes X-rays.
Stone removal can be done during this procedure as well. The procedure takes about an hour.

What Are the Treatments for Gallstones?

In most cases, treatment of gallstones is considered necessary only if you are having symptoms.
Of the various conventional treatments that are available, surgical removal of the gallbladder is the
most widely used. Some alternative treatments have also been found to be effective in alleviating
the symptoms of troublesome gallstones.

Conventional Medicine for Gallstones

When deciding what course of action to take for symptomatic gallstones, doctors usually choose
from among three main treatment options: Watchful waiting, nonsurgical therapy, and surgical
removal of the gallbladder.

Gallstones and Watchful Waiting

Though a gallstone episode can be extremely painful or frightening, almost a third to half of all
people who experience an attack never have a recurrence. In some cases, the stone dissolves or
becomes dislodged and thereby resumes its "silence." Because the problem may solve itself
without intervention, many doctors take a wait-and-see approach following the initial episode.

Even when the patient has had repeated gallstone episodes, the doctor may postpone treatment or
surgery because of other health concerns. If your surgery has been delayed, you should remain
under a doctor's care and report any recurrences of gallstone symptoms immediately.

Understanding Gallstones -- Diagnosis and

Treatment
Nonsurgical Therapy for Gallstones
If you are unable or unwilling to go through surgery for a gallstone problem that requires treatment,
your doctor may recommend one of several noninvasive techniques. Note that though these
methods may destroy symptom-causing gallstones, they can do nothing to prevent others from
forming, and recurrence is common.

Some gallstones can be dissolved through the use of a bile salt, although the procedure can be
used only with stones formed fromcholesterol and not from bile pigments. The
drug Actigall (ursodiol) is taken as a tablet; depending on its size, the gallstone may take months or
even years to go away, and often people need to take this medication indefinitely.

Another nonsurgical technique, shock wave therapy, uses high-frequency sound waves to
fragment the stones. Bile salt is administered afterward to dissolve small pieces.

A method called contact dissolution can also be used to dissolve gallstones. The doctor inserts a
catheter through the abdomen, and then injects a special drug directly into the gallbladder. In many
cases, the stone disappears within a few hours. Contact dissolution and shock wave therapy are
still considered experimental.

Doctors can also attempt to remove gallstones during an ERCP. During the procedure an
instrument is inserted through the endoscope to attempt removal of the stone.

While these therapies may work for some, all of the above nonsurgical therapies are usually
unsuccessful long term (since recurrence is common) and are rarely advised in clinical practice.

Surgery to Remove the Gallbladder

While the gallbladder serves an important function, it is not essential for a normal, healthy life.
When gallstones are persistently troublesome, doctors often recommend removing the organ
entirely. This operation is considered among the safest of all surgical procedures. Each year
approximately 750,000 Americans have their gallbladder removed. It is also the only treatment
method that eliminates the possibility that other gallstones will develop in the future.

When the gallbladder has been removed, bile flows directly from theliver into the small intestine,
and this sometimes leads to diarrhea. Because bile no longer accumulates in the gallbladder,
quantities of the digestive fluid cannot be stored up and used to break down an especially fatty
meal. This condition is not considered serious, however, and can be corrected by simply limiting fat
in the diet.
 Understanding Gallstones -- Diagnosis and
Treatment
Surgery to Remove the Gallbladder continued...
In the past, removal of the gallbladder was done through traditional "open" surgery, which requires
surgeons to make a large incision in the abdomen. Patients faced a two- or three-day hospital stay
plus several weeks of recovery at home.

Today, however, the most commonly used surgical technique is a much simpler approach known
aslaparoscopic cholecystectomy. The doctor makes several small incisions in the abdomen, then
uses special pencil-thin instruments to remove the gallbladder. A tiny microscope and video
camera, snaked through the incision to the site, allow the surgeon to view the operation.

Laparoscopic surgery is highly effective and very safe. It has reduced the hospital stay to a day or
two. Patients report less pain and are generally able to resume a normal lifestyle in a short period
of time. However, people who are obese or who have a severe infection or inflammation in the
gallbladder may still be considered candidates for traditional open surgery.

Gallstones: What You Should Know

In this article
 What Are Gallstones?
 Types
 What Causes Gallstones?
 Am I at Risk?
 What Are the Symptoms?
 How Do Doctors Diagnose Them?
 What’s the Treatment?
 Can You Treat Gallstones Without Surgery?

What Are Gallstones?

They aren’t really stones. They're pieces of solid material that form in the gallbladder, a small
organ located under the liver.

You might not even know you have them until they block a bile duct, causing pain that you need to
get treated right away.

Types
 The two main kinds are:

 Cholesterol stones. These are usually yellow-green in color. They're the most common kind,
accounting for 80% of gallstones.
 Pigment stones. These stones are smaller and darker. They're made up of bilirubin, which comes
from bile, a fluid your liver makes and your gallbladder stores.

What Causes Gallstones?

There may be several reasons, including:

 Your genes
 Your weight
 Problems with your gallbladder
 Diet
Bile can be part of the problem. Your body needs bile, but if
it has too much cholesterol in it, that makes gallstones
more likely.

It can also happen if your gallbladder can’t empty properly.

Pigment stones are more common in people with certain

medical conditions, such as cirrhosis (a liver disease) or blood diseases such as sickle cell anemia.

Am I at Risk?
You're more likely to get gallstones if:

You're obese. This is one of the biggest risk factors. Obesity can raise your cholesterol level and
also make it harder for the gallbladder to empty completely.

You take birth control pills, hormone replacement therapy for menopause symptoms, or are
pregnant. The extra estrogen is the problem. It can increase cholesterol and make it harder for the
gallbladder to empty.

You have diabetes. People with this condition tend to have higher levels of triglycerides (a type
of blood fat), which is a risk factor for gallstones.

You take medicine to lower your cholesterol. Some of these drugs boost the amount of
cholesterol in bile, which may increase your chances of getting cholesterol stones.

You lost weight too quickly. Your liver makes extra cholesterol, which may lead to gallstones.

You’re fasting. Your gallbladder may not squeeze as much.

Gallstones are also more likely if they run in your family, and they're likelier among women, older
people, and some ethnic groups, including Native Americans and Mexican-Americans.

What Are the Symptoms?

You might not notice anything, or even know you have gallstones, unless your doctor tells you. But
if you do get symptoms, they usually include:

 Pain in your upper belly and upper back that can last for several hours
 Nausea
 Vomiting
 Other digestive problems, including bloating, indigestion and heartburn, and gas

How Do Doctors Diagnose Them?

If your doctor thinks you may have gallstones, he'll give you a physical exam. You may also get:

Blood tests to check for signs of infection or obstruction, and to rule out other conditions.

Ultrasound. This quick procedure is done in your doctor’s office, and it makes images of the inside
of your body.

CT scan. Specialized X-rays allow your doctor to see inside your body, including your gallbladder.

Magnetic resonance cholangiopancreatography (MRCP). This test uses a magnetic field and
pulses of radio-wave energy to make pictures of the inside of your body, including the liver and the
gallbladder.

Cholescintigraphy (HIDA scan). This test can check on whether the gallbladder squeezes
correctly. Doctors inject a harmless radioactive material, which makes its way to the organ. The
technician can then watch its movement.

Endoscopic ultrasound. This test combines ultrasound and endoscopy to look for gallstones.

Endoscopic retrograde cholangiopancreatography (ERCP). The doctor inserts an endoscope

through your mouth down to the small intestine and injects a dye to allow the bile ducts to be seen.
He can often then remove any gallstones that have moved into the ducts.

What’s the Treatment?

Many people with gallstones get surgery to take out the gallbladder. There are two different kinds
of operations.

Laparoscopic cholecystectomy. This is the more common procedure. The surgeon passes
instruments, a light, and a camera through several small cuts in the belly. He views the inside of
the body on a video monitor. Afterward, you spend the night in the hospital.

Open cholecystectomy. The surgeon makes bigger cuts in the belly to remove the gallbladder.
You stay in the hospital for a few days after the operation.

If gallstones are in your bile ducts, the doctor may use ERCP to find and remove them before or
during gallbladder surgery.

Can You Treat Gallstones Without Surgery?

If you have a medical condition and your doctor feels you shouldn't have an operation, he may
prescribe the medications chenodiol (Chenix), ursodiol (Actigall), or both. These drugs work by
dissolving cholesterol stones. Mild diarrhea can be a side effect.

The downside of using either medication is that you may have to take it for years to completely
dissolve the stones, which may come back after you stop taking the drug.
 Overview
Gallstones can lurk inside your gallbladder. Many people have gallstones and never know it.
Gallstones are hard deposits in your gallbladder, a small organ that stores bile, which is a
digestive fluid made in the liver. Gallstones may consist of cholesterol, salt, or bilirubin, which
is discarded red blood cells. Gallstones range in size. They can be as small as a grain of sand or
as large as an apricot.

Part 2 of 10: Causes

What Causes Gallstones?
The components in bile can crystallize and harden in your gallbladder, leading to gallstones.
According toHarvard Health Publications, 80 percent of gallstones are made of cholesterol. The
other 20 percent of gallstones are made of calcium salts and bilirubin. These are known as
pigment stones.
Cholesterol Stones
Gallstones may develop when there is too much cholesterol in the bile secreted by your liver.
Bile usually dissolves or breaks down cholesterol. However, if your liver makes more
cholesterol than your bile can dissolve, hard stones may develop.
Bilirubin
Bilirubin is a chemical produced when your liver destroys old red blood cells. Some conditions,
such as cirrhosis of the liver and certain blood disorders, cause your liver to produce more
bilirubin than it should. Stones form when your gallbladder cannot break down the excess
bilirubin. These hard substances are also called pigmented stones.
Concentrated Bile
Your gallbladder needs to empty bile to be healthy and function properly. If it fails to empty its
bile content, the bile becomes overly concentrated, which causes stones to form.

Part 3 of 10: Risk Factors

Who Is at Risk for Gallstones?

While your body produces cholesterol naturally, you can also take in excess cholesterol through
your diet.
Many risk factors for gallstones are related to diet. These include:
being overweight or obese
eating a diet that’s high in fat or cholesterol
rapid weight loss within a short period of time
eating diet that’s high in fiber
having diabetes mellitus
Other risk factors include:
being female
being of American Indian or Mexican-American descent
being pregnant
 having a family history of gallstones
 being age 60 or older
 having cirrhosis of the liver
 taking certain medications for lowering cholesterol
 taking medications that have a high estrogen content
Don’t stop taking any medicines unless you have discussed it with your doctor.
 Part 4 of 10: Symptoms

What Are the Symptoms of Gallstones?

You may not experience any symptoms if you have gallstones. According to the American
College of Gastroenterology (ACG), 80 percent of people who have gallstones don’t have any
pain at all. These are called “silent” gallstones. Your doctor may find these stones in your
gallbladder from X-rays or performing surgery on your abdomen.
Some people do have gallstone symptoms. The most common symptom of gallstones is pain in
the right upper quadrant of your abdomen. The pain often radiates to your back or right
shoulder or shoulder blade.

Other symptoms include:

 fever
 a yellowish tint in your skin or eyes, which can indicate jaundice
 nausea or vomiting
 clay-colored stools

Part 5 of 10: Stages

What Are the Stages of Gallbladder Disease?
Extreme gallstone pain is known as a “gallbladder attack.” This extreme pain lasts more than
one to two hours. Gallstones themselves don’t cause this pain. It occurs when the gallstones
block the movement of bile from the gallbladder. This doesn’t usually happen overnight.
Instead, there are three stages that lead to the attack.

 In stage 1, gallstones form in the gallbladder. Usually, there’s no pain in this stage.
 In stage 2, you start to experience gallbladder pain from time to time. You may notice this when
you eat foods that are high in fat, such as fried foods. The pain doesn’t usually extend past a
few hours. Other symptoms can include stomach pain, burping, diarrhea, nausea, and
indigestion.
 In stage 3, a gallstone blocks the duct where bile moves from the gallbladder, a gallbladder
attack occurs. This stage is a medical emergency. Symptoms can include intense stomach or
back pain, fever, chills, or appetite loss.
According to the American College of Gastroenterology (ACG), the risk of silent gallstones
causing a gallbladder attack is 1 percent annually. For every 100 people that have silent
gallstones, 10 of those people will have an attack within a decade.

Part 6 of 10: Diagnosis

How Are Gallstones Diagnosed?
Your doctor will perform a physical examination that includes checking your eyes and skin for
visible changes in color. A yellowish tint in your skin or eyes may be signs of jaundice. Too
much bilirubin in your body causes jaundice.

The examination may involve using diagnostic testing to see inside your body. These tests include:

Ultrasound

Ultrasound tests produce images of your abdomen. This is the preferred imaging method to initially confirm
that you have gallstone disease.

Abdominal CT Scan

This is an imaging test that takes pictures of your liver and abdominal region.

Gallbladder Radionuclide Scan

This is a very important scan that takes about one hour to complete. A specialist injects a radioactive
substance into your veins. The substance travels through your blood to the liver and gallbladder. It
highlights any infection or blockages in these organs.

Blood Tests

Your doctor may order blood tests that measure the amount of bilirubin in your blood. The tests also help
determine how well your liver is functioning.

Part 7 of 10: Treatment

How Are Gallstones Treated?
Your doctor may use any of several treatment options to remove stones or improve your
condition.

Surgery

Surgery is often the first option if you have significant symptoms.

Your doctor may need to perform a laparoscopic gallbladder removal, which is a common
surgery. General anesthesia is usually required for gallbladder removal. The surgeon will
usually make three or four incisions on your abdomen. Your surgeon will insert a small, lighted
device into one of the incisions and carefully remove your gallbladder.

You usually go home on the day of the procedure if you have no complications.

Medications
 Drugs that dissolve gallstones caused by cholesterol are an option if you cannot undergo
surgery. These medications may take several years to eliminate the gallstones.

Part 8 of 10: Lifestyle Changes

Lifestyle Changes After Gallbladder Removal
Much like an appendix, a gallbladder isn’t necessary for a person to live a full and healthy life.
However, you may have loose or watery stools after gallbladder removal.

This diarrhea occurs because removing a gallbladder involves rerouting the bile from the liver
to the small intestine. Bile no longer goes through the gallbladder after surgery and it becomes
less concentrated. The result is a laxative effect that causes diarrhea. If you eat a diet lower in
fats, less bile will be released. Examples of dietary steps you can take include:

 Reduce your intake of fats. Choose low-fat foods whenever possible. Avoid high-fat, greasy,
and fried foods.
 Add fiber to your diet. Extra fiber can make your bowel movements less liquid. Try to add only
a serving of fiber at a time to prevent gas that can occur from eating excess fiber.
 Avoid foods and drinks known to cause diarrhea, such as caffeine, high-fat dairy products, and
very sweet foods.
 Eat several small meals per day instead of large meals. Smaller meals are easier for the body to
digest.
Part 9 of 10: Prevention
Can I Prevent Gallstones?
You can’t prevent gallstones, but you can reduce your risk with lifestyle strategies. Eat a
balanced diet. Don’t skip meals. Drink sufficient amounts of water each day to keep your body
hydrated. If you plan to lose weight, do it slowly. Aim to lose no more than two pounds per
week. Rapid weight loss may increase your risk of gallstones and other health problems.

Part 10 of 10: Outlook

What Can I Expect in the Long Term?
Surgery to remove your gallbladder or any stones in your gallbladder is often successful. In
most cases, stones don’t return. However, if you don’t have surgery, the gallstones can return.
This is true even when you’ve taken medicines to dissolve the gallstones.