You might have no symptoms at all and still have gallstones. What are those stones and how do they get into your gallbladder? How can you prevent them?
By Dona Suri
If there’s something strange in your duodenum …
You could have … GALLSTONES.
Gallstones produce five typical symptoms:
Pain in right upper or middle upper abdomen for at least 30 minutes
Skin and whites of the eyes look yellow
Poop is light brown
Vomiting, nausea
Fever
The abdominal pain happens when a large stone blocks the duct that drains the gallbladder. It goes away once the stone passes into the small intestine
Of course, you might have no symptoms at all and still have gallstones. Often, stones are discovered in the course of a routine x-ray or ultrasound, abdominal surgery, or other medical procedure.
Symptomatic or silent, either way, you can impress your friends by referring to your condition as cholelithiasis.
(kow-leh-lih-thai-uh-suhs. Greek; chole means bile, lith– means stone, iasis means process.)
Let’s look at the mechanics:
The gallbladder is a small organ located just beneath the liver. It holds a digestive fluid known as bile.
The gallbladder also sits right next to the duodenum (first part of the small intestine, where food continues to be digested). The duodenum not only digests food, it secretes three hormones: gastric inhibitory peptide, secretin and cholecystokinin (CCK).
Cholecystokinin is also produced by some neurons in the brain. Cholecystokinin acts on two types of receptors found throughout the gut and central nervous system. This hormone stimulates the gallbladder. Result: gallbladder contracts, pushing bile through the cystic duct and into the common bile duct. Simultaneously, the Sphincter of Oddi relaxes, permitting bile to enter the duodenal lumen (small intestine).
Bile acts like a detergent making the fat droplets smaller so that enzymes can easily break them down. Cholecystokinin also increases the release of fluid and enzymes from the pancreas to break down fats, proteins and carbohydrates.
(Cholecystokinin may have a role in anxiety and panic disorders. This is an effect of cholecystokinin released in the brain, not an effect of secretion from other parts of the body.)
Gallstones are crystalline deposits in the gallbladder. Normally, your bile contains enough chemicals to dissolve cholesterol excreted by your liver, but if your liver excretes more cholesterol than your bile can dissolve, the excess cholesterol forms into crystals and they build up and become stones.
While cholesterol-derived stones are the most common type, there are also stones that form because the bile contains too much bilirubin. Bilrubin is a waste product of expired red blood cells. These cells are strained out in the liver and excreted in the bile. The orange-yellow color makes bilirubin easy to spot. On its way out, bilrubin acts as an antioxidant that helps protect against cardiovascular disease. When too much bilirubin gets into the bile, the excess hardens into pigment stones.
The type of person most likely to suffer from gallstones is fat, female, 40 (plus) and fertile. Native Americans and Hispanics are at greater risk than Whites and Blacks. Other family members with gallstones also points toward a predisposition.
Risk increases if the person has …
Had bone marrow or solid organ transplant
Is diabetic
Suffers from fatty liver or biliary tract infection
Suffers from hemolytic anemia (disorder in which red blood cells are destroyed faster than they can be made)
Has been on intravenous feeding for a long time
Has lost weight very rapidly, or has had weight-loss surgery
Is taking birth control pills
Has a complication of pregnancy — failure of the gallbladder to empty bile
Liver cirrhosis and biliary tract infections (pigmented stones)
Medical condition that causes too many red blood cells to be destroyed
Typically, gallstones are treated only if they cause symptoms. For recurrent gallbladder attacks, the most effective treatment is surgical removal of the gallbladder, or cholecystectomy. This used to mean a five-inch incision and a hospital stay of up to a week. Now, this kind of surgery is laparoscopic: instruments are inserted through small incisions and the gallbladder is removed. The patient is in the hospital overnight and then goes home to recover over the course of a week. Risk of injuring the bile ducts is very slight and chance of symptoms or complications from gallstone surgery is low. Nearly all people who have their gallbladder taken out by surgery remain symptom free thereafter. Only in a very few complicated cases, surgeons opt for open surgery.
The liver produces enough bile for digestion and this bile can flow directly into the small intestine through the common bile duct. The gallbladder is not strictly necessary – you can live without it.
Gallstones can also be treated with ursodiol, a naturally occurring bile acid that dissolves gallstones made of cholesterol. Ursodial is a liquid; the patient takes a spoonful two to four times a day. It’s not an instant stone-killer. Expect to be stone-free only after several months.
Ursodial is also used to prevent the formation of gallstones in people who are losing weight quickly.
The ursodial treatment is usually speeded up by combining it with lithotripsy. Sound waves from outside the body are used to pulverize gallstones into pieces small enough to safely pass through the bile duct. Lithotripsy is not used as often as it once was because gallstones often come back
ERCP and a procedure called a sphincterotomy may be done to find or treat gallstones in the common bile duct. Rarely, chemicals are passed into the gallbladder through a catheter. The chemical rapidly dissolves cholesterol stones. This treatment is hard to perform, so it is not done very often. The chemicals used can be toxic, and the gallstones may return.
According to the National Institutes of Health there is no proven way to prevent gallstones but you can lower your risk of gallstones by maintaining a healthy weight, getting regular exercise and eating sensibly.