All about Gallstones
Gallstones are common, and most people will never be bothered by them. At least 10% of U.S. adults have gallstones, and up to 75% of them are women. But only 20% of those diagnosed will ever have symptoms or need treatment. In northern India these are in about 5% of the population.If they stay put, one may never know they’re there. But once they begin to move, they become dangerous. These tiny, pebble-like pieces can do a lot of damage when they get into tight spaces in one’s delicate biliary system.
Risk factors that contribute to gallstone formation include (i) Family History: If you have a family history of gallstones, you may be more likely to develop them, regardless of your racial heritage. (ii) Age: Gallstones take time to develop and grow large enough to cause an obstruction. Men and people assigned male at birth (AMAB) are more likely to get them after age 60. Women and people AFAB are more likely to get them during their fertile years, roughly between the ages of 20 and 50. (iii) Hormones: Women and people AFAB are three times more likely to get gallstones than men and people AMAB.
Their risk peaks and declines with their estrogen and progesterone levels. Estrogen increases cholesterol levels, while progesterone slows your gallbladder from emptying (iv) Weight: Body fat releases estrogen, so having more of it raises your estrogen levels and your cholesterol levels. On the other hand, rapid weight loss, like after weight loss surgery can also cause gallstones. Losing body fat quickly releases large loads of cholesterol into the bile and (v) Genetics: The genetic profile of Native Americans or people of Mexican descent, makes them more prone to higher cholesterol levels in the bile, leading to gallstones.
A gallstone attack is an awful way to find out that you have gallstones. You might be even more alarmed to learn that the recommended treatment is surgery. But gallbladder removal is a common procedure with an excellent prognosis. Your whole ordeal could be over within hours of your first symptoms. Gall bladder is a pear-shaped organ located beneath the liver on the right side of the abdomen. It stores bile, concentrates it and readies it for supply to the intestine for digestion. Bile is synthesized in the liver; gall bladder only stores it. Ducts from liver and gallbladder combine to form common bile duct (CBD), which then combines with pancreatic duct to open into the intestine.
Bile is composed of water, cholesterol, bile pigments and bile salts. When the equilibrium between the water and other bile components is disrupted, the bile becomes very thick known as sludge. When bile pigments/cholesterol crystallise with external covering of calcium salts, gallstones get formed. Gall bladder is an extra storage for bile; one can live without gallbladder.
As said earlier gallstones generally don’t cause symptoms unless they get stuck and create a blockage. This blockage causes symptoms, most commonly upper abdominal pain and nausea. The pain may come and go, or it may stay. One might develop other symptoms if the blockage is severe or lasts a long time, like: sweating, fever, fast heart rate, swelling in the abdomen, yellow tinge to the skin and eyes, dark-coloured urine and light-coloured stools.
Typical gallstone pain is sudden and severe and may make you sick to your stomach. This is called a gallstone attack. One might feel it most severely after eating, when the gallbladder contracts, creating more pressure in one’s biliary system. It might wake you up from sleep.Gallstone pain that builds to a peak and then slowly fades is called biliary colic. It comes in episodes that may last minutes to hours. The episode ends when and if the stone moves or the pressure eases. People describe the pain as intense, sharp, stabbing, cramping or squeezing. One might be unable to sit still.
The biliary system is located in the upper right quadrant of the abdomen, which is under one’s right ribcage. Most people feel gallstone pain in this region. But sometimes, it can radiate to other areas. Some people feel it in their right arm or shoulder or in their back between their shoulder blades.Others may feel gallstone pain in the middle of their abdomen or chest. This can be confusing because the feeling might resemble other conditions. Some people mistake gallstone pain for heartburn or indigestion and even like a heart attack.
Gallstone pain means that a gallstone has gotten stuck in one’s biliary tract and caused a blockage. If it’s a major blockage, one might feel it right away. If it’s only a partial blockage, one might not notice it until the gallbladder contracts, creating more pressure in the system. Eating triggers this contraction.A rich, heavy or fatty meal will trigger a bigger gallbladder contraction. That’s because one’s small intestine detects the fat content in the meal and indicates to the gall bladder how much bile it will need to help break it down. The gallbladder responds by squeezing the needed bile out into the bile ducts.
Biliary colic is the only warning sign of gallstones that one gets. It happens when a gallstone causes a temporary blockage, then manages to move out of the way and let bile flow through again. Even though the pain eventually goes away, it’s important to recognize these episodes as a warning. Once a gallstone has caused a blockage in the biliary tract, it’s likely to keep happening. The same one may be hanging around the same tight spot and continuing to grow. Or one may have more gallstones waiting in the wings. One day, a gallstone might get stuck and stay stuck. This would lead to an emergency.
Gallstones can lead to complications, which include Cholecystitis, Pancreatitis, Cholangitis, Hepatitis, and Jaundice. If a gallstone blocks the flow of bile through the biliary system, it can affect any or all of the organs in that system. Bile that can’t flow backs up into the bile ducts and organs, causing acute inflammation and encouraging bacterial infections. If severe, these conditions can become life-threatening.
Gallstones can be detected by a simple abdominal ultrasound though in case it is stuck somewhere else in the biliary tract, it may need another kind of test like HIDA scan, Endoscopy, ERCP or MRCP tests, to locate it.
If your gallstones never cause problems, you won’t need treatment for them. But if gallstones cause a blockage in your biliary tract, your healthcare provider will want to remove them — not just the blockage, but all of them. Once gallstones have caused a blockage, they’re highly likely to do so again.Most people who need treatment for gallstones will have surgery to remove them. Surgery is the only way to ensure gallstones won’t cause issues for you again. Removal of gall bladder through laparoscopic intervention is also desirable inasmuch as one can live well without a gallbladder.
There’s no sure way to prevent gallstones from forming, but one can take certain steps to reduce the overall risk. For example, one can reduce the risk of cholesterol stones, which are by far the most common type, by reducing cholesterol in one’s diet. However, this won’t prevent pigment stones. Losing weight by obese people also serves them well.
If you are overweight or obese, losing some weight can reduce your risk of cholesterol stones. But losing weight fast can raise your risk. If you’re expecting rapid weight loss from a procedure or other treatment, your healthcare provider might recommend taking gallstone medications preventatively.
Gallstones won’t go away without treatment. Gallstones can sometimes come out in through urine and stools, but it won’t be all of them. Even if some are removed from the bile duct, there will be others left behind, and one can get new ones. Only removal of the Gallbladder is the sure way to make them stop for good.
Bhushan Lal Razdan, formerly of the Indian Revenue Service, Post-retirement, he is actively associated with medical, educational, cultural and heritage.
He is also the Chairman of Vitasta Health Care Trust