Gallstones - What They Are and How They Can Be Prevented
by Beth G. Hodges, MD

Gallstones are hardened, rocklike structures that can form abnormally in the gall bladder. The gall bladder is a saclike organ that sits just below the liver in the abdominal cavity. It contains bile salts, necessary to digest fats that are consumed by the body.

When a person eats fat, the gall bladder contracts, releasing bile acids through the common bile duct and into the small intestines to digest it.

Gallstones are comprised of cholesterol. Many more people have them than ever have symptoms from them. The most common reason for gallstones to cause pain is if one passes from the gall bladder through the common bile duct. This causes pressure as the gall bladder tries to function, contracting after an intake of fat. The affected person can experience pain in the right upper quadrant of the abdomen. Sometimes the pain radiates through to the right shoulder blade or up into the chest. The pain is worse after eating for the reason mentioned above. The pain is sometimes accompanied by nausea and/or vomiting. Sometimes, the passage of a gallstone irritates the pancreas and causes pancreatitis, which also is expressed as abdominal pain, nausea, and vomiting.

Diagnosis of gallstones is made by visualizing them, best done by ultrasound of the abdomen, but sometimes also by CT. Blood tests can show elevations of liver enzymes and sometimes pancreatic markers, but these are not specific to gallstones and may have other causes.

Gallstones can occur in anyone, but are most common in fair-skinned females in their forties. Certain medications, including birth control pills, can make gallstones more prevalent.

If gallstones are found incidentally, meaning they are found in an asymptomatic person who has an ultrasound or CT of the abdomen for other reasons, they do not have to be treated. They can become symptomatic, however, at any time.

There are no medications that can be used to treat gallstones. The only possible treatment is removal of the gallbladder itself. Gall bladder removal, or cholecystectomy, is a fairly simple and routine surgical procedure, though any surgical procedure carries with it some risk. The most common complication of cholecystectomy is diarrhea after eating high fat meals, since the gallbladder was responsible for storing bile acids, and since it is no longer there, the ability of the digestive system to handle high fat meals is compromised.

Published - January, 2010