Gallstone

Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder holds a digestive fluid called bile that’s released into your small intestine.

Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.

Gallstones are common in India. People who experience symptoms from their gallstones usually require gallbladder removal surgery. Gallstones that don’t cause any signs and symptoms (asymptomatic gallstones)typically don’t need treatment in the West. But the optimum treatment for such stones in India is still controversial. As gallbladder cancer is associated with gallstones in most of the cases and in India , particularly in North and East India the incidence of gallbladder cancer is high so surgically removing gallbladder may be advised especially in young patients. This needs to be done after proper counselling explaining the indication of the procedure.

Gallstones may cause no signs or symptoms. If a gallstone lodges in a duct and causes a blockage, signs and symptoms may result, such as:

• Sudden and rapidly intensifying pain in the upper right portion of your abdomen
• Sudden and rapidly intensifying pain in the center of your abdomen, just below your breastbone
• Back pain between your shoulder blades
• Pain in your right shoulder

Gallstone pain may last several minutes to a few hours.

Types of gallstones that can form in the gallbladder include:

• Cholesterol gallstones. The most common type of gallstone, called a cholesterol gallstone, often appears yellow in color. These gallstones are composed mainly of undissolved cholesterol, but may contain other components.
• Pigment gallstones. These dark brown or black stones form when your bile contains too much bilirubin.

Factors that may increase your risk of gallstones include:

• Being female
• Being age 60 or older
• Being overweight or obese
• Being pregnant
• Eating a high-fat diet
• Eating a high-cholesterol diet
• Eating a low-fiber diet
• Having a family history of gallstones
• Having diabetes
• Losing weight very quickly
• Taking some cholesterol-lowering medications
• Taking medications that contain estrogen, such as hormone therapy drugs

Complications of gallstones may include:

• Inflammation of the gallbladder. A gallstone that becomes lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain and fever.
• Blockage of the common bile duct. Gallstones can block the tubes (ducts) through which bile flows from your gallbladder or liver to your small intestine. Jaundice and bile duct infection can result.
• Blockage of the pancreatic duct. The pancreatic duct is a tube that runs from the pancreas to the common bile duct. Pancreatic juices, which aid in digestion, flow through the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.
• Gallbladder cancer. People with a history of gallstones have an increased risk of gallbladder cancer.

Tests and procedures used to diagnose gallstones include:

• Tests to create pictures of your gallbladder. Your doctor may recommend an abdominal ultrasound (USG) to create pictures of your gallbladder. These images can be analyzed to look for signs of gallstones.
• Tests to check your bile ducts for gallstones. A test that  highlight your bile ducts on images may help your doctor determine whether a gallstone is causing a blockage in the bile duct, magnetic resonance imaging (MRI/ MRCP).
• Blood tests to look for complications. Blood tests may reveal an infection, jaundice, pancreatitis or other complications caused by gallstones.
• If there is any suspicion of cancer, usually a Triphasic CECT is ordered to look for its resectability.

• Surgery to remove the gallbladder (cholecystectomy). Your doctor will recommend surgery to remove your gallbladder. Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder. You don’t need your gallbladder to live, and gallbladder removal doesn’t affect your ability to digest food, but it can cause diarrhea, which is usually temporary. Read more about the surgery .

You can reduce your risk of gallstones if you:

• Don’t skip meals. Try to stick to your usual mealtimes each day. Skipping meals or fasting can increase the risk of gallstones.
• Lose weight slowly. If you need to lose weight, go slow. Rapid weight loss can increase the risk of gallstones.
• Maintain a healthy weight. Obesity and being overweight increase the risk of gallstones. Work to achieve a healthy weight by reducing the number of calories you eat and increasing the amount of physical activity you get. Once you achieve a healthy weight, work to maintain that weight by continuing your healthy diet and continuing to exercise.