The gallbladder is an organ that works silently and is part of our gastrointestinal tract, known to be the cause of the formation of stones or calculi inside the gallbladder.
What is the gallbladder?
Located in the upper right quadrant of our abdomen and attached to the liver, the gallbladder contains the largest volume of bile in the body (40-60 ml).
It is a pear-shaped organ which receives bile directly from the common hepatic duct for storage.
Bile is a liquid composed of water, bile salts, proteins, lipids, bilirubin and electrolytes, useful for the correct absorption of fats and digestion of food.
The gallbladder itself is capable of extracting up to 90% of the water contained in bile, increasing the concentration of the other substances.
The contents of the bile after passing through the gallbladder are released into the small intestine to mix with the residues coming from the stomach.
What are gallbladder stones?
Gallstones is a pathology in which stones or “stones” appear either in the gallbladder or obstructing the bile ducts.
When we talk about cholelithiasis, we are talking specifically about stones inside the gallbladder, being the most recurrent disease related to bile.
On the other hand, there is also choledocholithiasis, where stones obstruct the proper flow of bile throughout the common bile duct.
What causes gallstones?
Gallstones or stones in the gallbladder are made up of compounds that are transported by the bile itself directly from the liver.
And from these two types of stones can originate, those containing cholesterol or pigment stones.
Types of gallstones
Cholesterol gallstones
They are the most common in adult life, and in addition to cholesterol, they contain bile salts, proteins and certain metals in smaller quantities.
Large and unique, they develop when cholesterol levels are higher than normal. They are also caused by a lower content of bile acids in the bile.
The presence of calcium and bilirubin is added to mixed cholesterol stones, which leads to a greater number of stones, smaller and yellowish.
Pigment stones
They occur more frequently in infants and are composed of unconjugated bilirubin and cholesterol at different percentages.
If these stones do not have enough cholesterol, they have a firm and dark consistency, whereas if cholesterol is elevated they are soft and brown.
They usually appear in cases of bacterial infections or biliary stasis.
What are the risk factors?
Among the most prominent are female gender and advanced age, mainly affecting women over 60 years of age. Other factors include the use of contraceptives, pregnancy, parity and estrogen replacement.
There are other controllable factors in addition to the two previous ones, such as sedentary life, dyslipidemia or insulin resistance.
Diseases such as type 2 diabetes mellitus and obesity are conducive to the development of gallstones and many other complications.
To mention some pathologies, biliary stenosis, sclerosing cholangitis, diverticula, cirrhosis and chronic pancreatitis can cause lithiasis.
However, the incidence of controllable factors is higher in males.
How certain drugs increase the risk of stones continues to be studied. Fibrates capable of lowering cholesterol and triglycerides are great exponents.
What are the symptoms after having gallstones?
Unlike many other pathologies where the digestive system is involved, cholelithiasis does not usually present with symptoms.
In fact, even biliary lithiasis does not cause early signs to establish a diagnosis, so it is considered asymptomatic.
In cases where signs and symptoms are present, they are:
- Nausea and vomiting.
- Abdominal discomfort and distension.
- Fever.
- Biliary colic (the most important).
- Biliary colic is the starting point to diagnose a possible case of biliary lithiasis.
This sign expresses intense, prolonged pain that does not change in intensity until the gallbladder and stones are removed.
It is reflected in the right upper quadrant of the abdomen and may also radiate to the right shoulder.
When it occurs, a differential diagnosis between cholecystitis, choledocholithiasis, cholangitis and acute pancreatitis is necessary.
Complications of gallstones
In cases of cholelithiasis or gallbladder stones, there are almost always no major complications other than intense pain or migration of the stone.
Unlike choledocholithiasis, where the obstruction of the biliary flow, besides causing intense pain, generates acute cholecystitis, jaundice and even acute pancreatitis.
In addition to this, there is the risk of generating biliary ileus, contracting a porcelain gallbladder (calcified gallbladder) or enterobiliary fistula.
Likewise, hydrocholecystitis and Mirizzi’s syndrome (compression of the common hepatic duct due to a gallstone) must be taken into account.
The striking diagnostic method for finding gallstones
Ultrasound is the gold standard for finding gallstones in the gallbladder, other tests such as plain radiography are less commonly used.
As the presence of biliary symptoms in the patient is rare, the discovery usually occurs in routine studies, such as pregnancies or when attending the doctor due to another pathology.
When the patient presents with digestive discomfort, ultrasound or endoscopic retrograde cholangiopancreatography (ERCP) is used directly.
Abdominal Ultrasound Findings
Totally safe and non-invasive technique for the study of gallstones. They are visible by the hyperechoic image (white silhouette) and acoustic shadow presented by the stones.
It is more relevant in cases of cholelithiasis due to the accumulation of stones in the organ, which facilitates diagnosis and treatment.
Use of ERCP in cases of biliary lithiasis
It consists of invading the biliary tract by means of an endoscope capable of confirming the diagnosis, decompressing the affected ducts and even removing the stones.
The use of ERCP needs to be careful, otherwise the patient could develop acute pancreatitis due to ERCP.
Surgical-medical treatment
Depending on the type of patient and whether he/she manifests symptoms, the choice of treatment is modified to have the greatest benefit.
Variants such as age, comorbidities, size, shape and type of stones are as important as the manifestation of signs and symptoms.
Medical therapy
In asymptomatic cases, no treatment is indicated because of the low possibility of developing symptoms.
The use of ursodeoxycholic acid contributes to the dissolution of the stones in the vesicles as long as they are tiny.
Surgical intervention
In the presence of biliary colic, the therapeutic method of choice is the resection of the gallbladder by cholecystectomy.
The great advantage of cholecystectomy is that it is a totally safe procedure performed laparoscopically, reducing organ invasion and patient morbidity.
As mentioned above, ERCP is also useful to remove gallstones that obstruct bile flow in the common bile duct.
Lastly, we have lithotripsy, used in the highest risk cases in surgeries and when medical treatment has failed.
It works by means of shock waves that disintegrate the composition of the stones to facilitate extractions.
Daily life after gallbladder removal
Gallstone sufferers are able to live fully without a gallbladder for a long period of time.
As long as the flow of bile is optimal, it can reach the small intestine to continue its normal function.
In spite of this, there are some symptoms to consider after gallbladder removal, such as increased recurrence of flatulence and abdominal discomfort.
In addition, it is vital to maintain a stricter diet because intolerance to fatty and acidic foods will be higher.
Prevention of gallstones in the gallbladder
In the risk factors, mention was made of some controllable factors and others that are not entirely controllable.
Basically, controlling our weight and what we consume reduces or increases our risk of gallstones.
While it is up to each woman to decide about pregnancy, being in the stages of gestation increases the possibility of developing gallstones.
Being part of an estrogen-based therapy is equally problematic in this pathology due to the recurrence of stones after undergoing treatment.
In case of any symptom or discomfort, we invite you to consult our medical specialists who confirm the area of Gastroenterology.
