Gallbladder (Gallstones) stones

What are gallbladder stones ?

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

What are the types of gallbladder stones ?

Types of gallstones that can form in the gallbladder include:

  1. 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.
  2. Pigment gallstones These dark brown or black stones form when your bile contains too much bilirubin.

What are the causes of gallbladder stones ?

It's not clear what causes gallstones to form.

  1. Your bile contains too much cholesterol. Normally, your bile contains enough chemicals to dissolve the cholesterol excreted by your liver. But if your liver excretes more cholesterol than your bile can dissolve, the excess cholesterol may form into crystals and eventually into stones.
  2. Your bile contains too much bilirubin. Bilirubin is a chemical that's produced when your body breaks down red blood cells. Certain conditions cause your liver to make too much bilirubin, including liver cirrhosis, biliary tract infections and certain blood disorders. The excess bilirubin contributes to gallstone formation.
  3. Your gallbladder doesn't empty correctly. If your gallbladder doesn't empty completely or often enough, bile may become very concentrated, contributing to the formation of gallstones.

What are the risk factors for gallbladder stones ?

Factors that may increase your risk of gallstones include:

  1. Being female
  2. Being age 40 or older
  3. Being overweight or obese
  4. Being sedentary
  5. Being pregnant
  6. Eating a high-fat diet
  7. Eating a high-cholesterol diet
  8. Eating a low-fiber diet
  9. Having a family history of gallstones
  10. Having diabetes
  11. Having certain blood disorders, such as sickle cell anemia or leukemia
  12. Losing weight very quickly
  13. Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugs
  14. Having liver disease

What are the symptoms of gallbladder stones ?

The symptoms of gallstones can vary based on the size of the gallstone. When the gallstones cause symptoms, they may include:

  1. Pain in the upper mid abdomen or upper right abdomen.
  2. Associated pain in the right shoulder.
  3. Chest pain.
  4. Nausea and vomiting.
  5. Repeated similar episodes.
  6. Jaundice (a yellow tint to the skin and eyes).

Stones that pass out of the gallbladder and into the common bile duct can cause a complete blockage of the duct with jaundice, infection and pancreatitis.You may feel pain in several places, including:

  1. Upper part of the abdomen, on the right side.
  2. Between the shoulder blades.
  3. Under the right shoulder.

How are gallbladder stones treated?

The most common treatment for gallstones is to remove the gallbladder surgically. Removal of the gallbladder is called a cholecystectomy. In the majority of cases (90%), this surgery can be performed laparoscopically, a minimally invasive technique that results in less post-operative pain and a faster recovery than conventional cholecystectomy.

What is a laparoscopic cholecystectomy?

Laparoscopic cholecystectomy is known as a minimally invasive procedure because it uses several small incisions instead of one large one. A laparoscope is a narrow tube with a camera. This surgical tool is inserted through one incision. The camera allows your doctor to see your gallbladder on a TV screen. Your gallbladder is then removed through another small incision

What happens if surgery is not done for gallbladder stones that are symptomatic?

If symptomatic gallstones are not treated by timely surgery, complications may develop. They include :

  1. 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.
  2. 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. Severe pain, jaundice and bile duct infection can result.
  3. Blockage of the pancreatic duct. The pancreatic duct is a tube that runs from the pancreas and connects to the common bile duct just before entering the duodenum. Pancreatic juices, which aid in digestion, flow through the pancreatic duct.
  4. 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.

  5. Gallbladder cancer. People with a history of gallstones have an increased risk of gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of cancer is elevated, the likelihood of gallbladder cancer is still very small.

Bile duct Stones (Choledocholithiasis)

What are bile duct stones?

Bile duct stones are gallstones in the bile duct. They can start in the gallbladder and migrate into the bile duct or they can form in the bile duct itself. The stones can become lodged in the bile duct, causing a blockage.

How are they formed?

In most cases, bile duct stones drop down from gallbladder into the bile duct. Rarely they are formed with in the bile duct itself.

What are the symptoms of bile duct stones?

Gallstones in the bile duct may not cause symptoms for months or even years. But if a stone becomes lodged in the duct and obstructs it, you may experience the following:

  1. abdominal pain in the right upper or middle upper abdomen
  2. fever
  3. jaundice (yellowing of the skin and eyes)
  4. loss of appetite
  5. nausea and vomiting
  6. clay-colored stools

How are bile duct stones diagnosed?

the following imaging tests:

  1. Ultrasound: an imaging procedure that uses high-frequency sound waves to examine the liver, gallbladder, spleen, kidneys, and pancreas
  2. CT scan: cross-sectional X-rays of the abdomen
  3. Endoscopic ultrasound (EUS): an ultrasound probe is inserted on a flexible endoscopic tube and inserted through the mouth to examine the digestive tract
  4. Magnetic resonance cholangiopancreatography (MRCP): an MRI of the gallbladder, bile ducts, and pancreatic duct

What is the treatment for bile duct stones?

Bile duct stones are typically removed using endoscopic retrograde cholangiopancreatography (ERCP), a minimally invasive procedure that combines x-ray and endoscopy. The doctor passesthe endoscope through the mouth and into the duodenum, then injects a contrast dye into the bile ducts, which can then be seen on x-ray. Special tools can be guided through the endoscope to remove the stones. After removing the bile duct stones, a small tube (stent)is placed in the bile duct which is removed after few weeks.

Does bile duct stones require gallbladder removal surgery?

In most cases bile duct stones are originally formed in the gallbladder and migrate to the bile duct to cause symptoms. It is always required to perform gallbladder removal surgery after ERCP. If gallbladder is not removed there is chance of recurrent bile duct stones which leads to repeated hospital admissions.