Gallstones: Causes & risk factors

Gallstones: Causes & risk factors

A gallstone is a stone formed within the gall bladder.

Majority with gallstones (about 80%) never have symptoms. Gallstones may be asymptomatic for years. These gallstones are called “silent stones” and do not require treatment.Occasional nausea and vomiting may occur in milder cases. More extreme cases are characterized by intractable vomiting, dehydration, severe right upper quadrant or epigastric pain, and pain that radiates to the back.When a gallstone blocks the bileduct, a crampy pain in the right upper part of the abdomen, known as biliary colic (lasting from 30 minutes to several hours) can result. A person may also experience referred painbetween the shoulder blades or below the right shoulder. Often, attacks occur after a particularly fatty meal and almost always happen at night. Complications of gallstones may include inflammation of the gallbladder (Cholecystitis), inflammation pancreas (pancreatitis), jaundice, and infection of bile duct (cholangitis). Symptoms of these complications may include pain lasting from few minutes to hours, fever, yellowish skin, vomiting, dark urine, and pale stools.

Risk factors for gallstones include birth control pills, pregnancy, a family history of gallstones, high intake of carbohydrate, obesity, rapid weight loss (people taking orlistat), diabetes, liver disease, haemolytic anemias (sickle cell disease or hereditary spherocytosis) or cirrhosis of liver. Gallstone risk increases for females (especially before menopause) and for people near or above 40 years. Gallstones may be suspected based on symptoms as well. The risk of gallstones may be decreased by maintaining a healthy weight through sufficient exercise and eating a healthy diet rich in fibres.

Diagnosis is then typically confirmed by ultrasound. Complications may be detected on blood tests.

If there are no symptoms, treatment is usually not needed.In those who are having acute gallbladder attacks,cases may be treated conservatively with intravenous antibiotics, keeping nil by mouth and giving good hydration through intravenous fluids, or if severe or recurrent, may require invasive treatment to relieve the obstruction. Surgery to remove the gallbladder is typically recommended in symptomatic cases and in those who are diabetic. This can be either done laparoscopically or through a single larger incision. Surgery is typically done under general anesthesia. For patients who decline surgery or who are at high surgical risk (because of concomitant medical disorders or advanced age), some gallbladder stones can sometimes be dissolved by ingesting bile acids(ursodeoxycholic acid) orally for many months. The best candidates for this treatment are those with small, radiolucent stones in a functioning non-obstructed gallbladder.

Ursodeoxycholic acid dissolves 80% of tiny stones < 5mm in diameter within 6 months. For larger stones (the majority), the success rate is very low, even with higher doses of ursodeoxycholic acid. Further, after successful dissolution, stones recur in 50% within 5 yr. Most patients are thus not suitable candidates for medical management and prefers laparoscopic cholecystectomy. However, ursodeoxycholic acid 300 mg twice daily can help prevent stone formation in morbidly obese patients who are losing weight rapidly after bariatric surgery or while on a very low calorie diet. This treatment, however, should not be taken without medical prescription.

Frequently asked question:

What food to eat and avoid: certain foods can protect as well as promote a healthy gallbladder while others can increase the likelihood of problems for the gallbladder stone. Foods which help to keep a healthy gallbladder are: green leafy vegetables, low fat diary items, citrus fruits, fish, beans and nuts. Foods to be avoided are: any oily and spicy foods, processed foods, high fat containing food and refined white foods (pastas, breads). Tobacco and alcohol should be avoided to maintain a healthy gallbladder.

Any immediate home remedy to relieve the pain in sudden attacks:

  1. Applying hot fomentation (towel wet with warm water/ hot water bottle) to the affected area for 10-15minutes relieves the spasm.
  2. Turmeric drinks can relieve pain as well. It contains curcumin which is anti inflammatory reducing inflammation and gallbladder pain.
  3. Apple cider vinegar contains anti inflammatory properties and can relieve gallbladder pain but care has to be taken consuming it as it aggravates gastritis and damages teeth.
    These home remedies provide temporary relieve and should be immediately followed up with treatment from doctor for better management.

Dr Bogisg Saluni
MS (General Surgery), Consultant
Department of Surgery, Christian Institute
of Health Sciences & Research(CIHSR)