Gallstones is a common disease of the gallbladder as well as the bile ducts. In this case, gallstones are mainly caused by solidified remnants of protein and cholesterol in the gallbladder, which can then clump together in the bile duct.
What are gallstones?
Schematic diagram showing the anatomy and structure of the gallbladder with gallstones. Click to enlarge. Gallstones, are a product of bile and about one-fifth of adult residents in industrialized states are its carriers. They are an end product of crystalline fluids which have thickened. The crystalline fluids are produced in the liver and then enter the gallbladder. Many gallstones are not dangerous and do not cause pain. There is a problem only when the bile meets a narrowing on its way from the liver to the gallbladder. This is where gallstones can form, some are so small that they can be excreted through the bladder, other stones are so large that they must be surgically removed.
Causes
Causes that lead to the formation of gallstones is not yet fully understood. Some scientists suspect the formation of gallstones to a defect of a certain gene, a faulty mutation, which is responsible for the formation of gallstones. Other researchers suspect that the formation of gallstones is promoted by an increased cholesterol level in connection with the decreased formation of bile. In addition to these factors, there are several other medical reasons, such as pregnancy. High fat diet or even a radical diet with a complete deprivation of fats. Likewise, the causes of gallstones can also be triggered by other diseases such as diabetes mellitus, obesity, thyroid problems or even family pressure. Furthermore, gallstones can also be triggered after major surgery, but also inflammation of the liver, in the direct vicinity or directly in the gallbladder can lead to the formation. Therefore, anyone suffering from the aforementioned reasons should have a precautionary medical examination performed with regard to gallstones.
Symptoms, complaints and signs
An endoscope is used to remove gallstones. Click to enlarge. Whether patients with gallstones have symptoms, and if so, what they are, depends in part on the size of the stones, the number of them, and their location in the gallbladder or bile duct. A large proportion of people with stones in the gallbladder have no symptoms at all or only rarely. The remaining patients experience the typical symptoms of gallstone disease. These include a feeling of fullness, nausea and pain in the right upper abdomen. These complaints occur in particular after high-fat meals. It becomes particularly unpleasant when so-called biliary colic occurs. Colic is the rhythmic contraction of the gallbladder muscles. Often there is a stone in the bile duct. The body tries to transport the stone in this way in order to remove it from the duct. The pain that results is classically wavelike, meaning that it waxes and wanes as it progresses. In addition, it may radiate to the back or right shoulder. Another symptom of a stone in the bile duct is jaundice. Since the bile can no longer drain from the gallbladder due to the stone, it backs up and the typical yellowing of the eyes and skin develops. In the course of time, this backlog can also lead to an inflammation of the gallbladder. In this case, fever, chills and severe pain in the right upper abdomen occur.
Course
The course in the disease gallstones is different from patient to patient. Many do not notice at all that they suffer from this disease, while others can not walk or lie down because of pain. After one or more gallstones have formed, flatulence, bloating, vomiting and sweating may occur. At the same time, very severe pain in the upper abdomen, pressure pain. Furthermore, the liver values are very strongly increased and a discoloration of the urine and the stool can be observed. Many complaints then occur mainly in the evening and also at night, especially after abundant consumption of fatty dishes. Should this happen, everyone should get checked for gallstones as soon as possible.
Complications
Complications from gallstones are particularly imminent when the bile duct becomes blocked by a stone. As a result, bile is no longer able to flow freely into the intestine, which in turn causes a backflow toward the gallbladder and liver. In some cases, the pancreas is also involved. The accumulated secretion can sometimes cause painful inflammation. Typical symptoms of cholecystitis are weakness, fatigue and fever. In extreme cases, the inflammation of the gallbladder leads to brittleness of the organ, which eventually ruptures. If the bile therefore enters the abdominal cavity, there is a risk of life-threatening peritonitis. There is also a risk of inflammation of the liver and pancreas. Before the bile duct enters the intestine, there is an inflow from the pancreas. If the stone is located at this inflow near the exit of the intestine, there is a buildup of bile secretion in the liver and gallbladder as well as in the pancreas. Another complication of gallstones is jaundice. This yellowish discoloration of the skin occurs when the impaired outflow of bile continues for a long period of time. The whites of the eyes also turn yellow. The urine shows a dark discoloration, while the stool becomes lighter. In rare cases, the gallbladder wall may be perforated by the gallstones.
When should you see a doctor?
The following applies: if painful symptoms or discoloration of the skin, chills and fever occur, a doctor or hospital should be consulted immediately. Since these symptoms recur, clarification of the cause is essential. Pain caused by gallstones is only temporarily numbed by painkillers and only provides relief from symptoms – this does not replace seeing a doctor. Biliary colic occurs suddenly and also poses a danger to others by reflexively wincing and doubled over, for example when driving machinery or motor vehicles. The clarification of other non-specific complaints (constant feeling of fullness, etc.), does not require an immediate diagnosis. If the complaints recur, a doctor should nevertheless be consulted. If gallstones have already been diagnosed, but do not cause any symptoms, attention must be paid to the occurrence of symptoms and the whereabouts of the stones (do the gallstones migrate? Is the bile duct partially blocked? ) must be checked at regular intervals. In this way, gentle treatment can be started at an early stage if necessary. If the gallstones remain symptom-free, no treatment is necessary.
Treatment and therapy
Treatment and therapy are different for each patient with gallstones. It depends on the severity of the disease. Gallstones that do not cause pain do not require treatment. All other patients should be treated upfront with pain medication, antibiotics and a special diet. Only when the persistent pain has disappeared, it is possible to think about removing the gallstones. There are several options here. One is the destruction of the stones by means of medication. However, it must be remembered that the medication must be taken for up to two years. Another alternative is to break up the stones with shock waves. Here, there is a risk that new stones may form as a result of the destroyed gallstones. The last variant is a radical therapy. Here the gallstones are removed together with the gallbladder. This therapy is one of the safest methods to remove the pain and prevent new formation.
Outlook and prognosis
In most cases, gallstones do not cause any problems for those affected. However, if symptoms do occur, surgical removal is usually without complications. If the gallbladder is removed in the process, the bile duct takes over its role as a storage site for bile. Patients usually experience discomfort from the operation for only a few days. Afterwards, they are usually completely free of symptoms. The dissolution of gallstones with medication also usually has no complications. However, the rate of recurrence is relatively high with all treatment options. Even after removal of the gallbladder, new gallstones form again within five years in 30 to 50 % of cases.With drug treatment, the risk is even greater. Gallstones often even go unnoticed because they do not cause any symptoms. However, if they become symptomatic, they should be removed. This is because they increase the risk of developing rare cancers such as gallbladder or bile duct cancer. In a few cases, they can assume a position that causes them to obstruct the common bile duct. As a result, bile cannot drain, causing a life-threatening back-up to form. In addition, gallstones can, in rare cases, bore through the gallbladder wall. Bile could thus migrate into the abdominal cavity and cause peritonitis. Treatment is strongly advised to avoid such complications.
Follow-up
If the gallstones have dissolved with medication or even on their own, no further follow-up is necessary. If this is not the case, possible causes must be diagnosed and treated. The patient must primarily take it easy and otherwise follow the doctor’s instructions regarding diet and physical exercise. After gallstone surgery, pain and fatigue may initially persist. As part of follow-up care, the physician will check the surgical wound and, if necessary, also check the bile duct and gallbladder artery. In the first hours after surgery, the patient will receive pain medication, initially by drip and later as tablets. If no complications are found, the patient may leave the hospital after a few days. At home, painkillers must continue to be taken, which should be gradually reduced according to the doctor’s instructions. Magnesium supplements prescribed for flatulence may need to be taken for a few days longer. The follow-up examination is carried out by the family doctor. Here, the physician will ask about the findings and then perform a physical examination and a brief patient interview. Any remaining stitches may need to be removed. Depending on how fit the patient is, he or she may also need a sick note. In case of a positive course, a short check-up is sufficient. Further progress checks are not necessary after successful gallstone surgery.
What you can do yourself
Gallstones become conspicuous in only about a quarter of all cases. The rest of the stones remain asymptomatic. They are therefore usually discovered only by an incidental finding. This also means that there is no need to adjust behavior in everyday life, and self-help consists mainly of preventive measures, especially if there are known cases of gallstones in the family, because genetic factors certainly play a role in the formation of gallstones in the gallbladder or bile ducts. The most important preventive measure is a healthy diet, which should also include natural food components such as vegetables and fruits with a balanced amount of indigestible fiber. Extreme obesity, as well as rapid weight loss and metabolic diseases such as diabetes, are risk factors for the development of gallstones, which then predominantly belong to the category of cholesterol stones. As soon as gallstones show symptoms, which are often non-specific at first, biliary colic is feared above all. It is caused by spasmodic contraction of the muscles in the walls of the gallbladder in order to move the gallstone further into the bile duct and into the small intestine. If biliary colic or other painful symptoms occur, a decision should be made about dissolving the stones with medication or mechanically removing them through surgery or catheters. Other self-help measures are not necessary because, for example, biliary colic occurs intermittently and without prior notice.
