Gallstones (Cholelithiasis)

Gallstones are hardened deposits that form in the gallbladder, a small organ located beneath the liver that stores bile, a digestive fluid produced by the liver. These stones can vary in size from tiny grains to golf ball-sized masses and can be composed primarily of cholesterol, bilirubin, or a mixture of substances. When gallstones block the bile ducts, they can cause severe pain, inflammation, and potentially serious complications. At Blume Health, our gastroenterology and surgical teams provide comprehensive care for gallstone disease, from diagnosis to treatment.

Causes

  • Excess cholesterol in bile that crystallizes to form stones
  • Excess bilirubin in bile (often due to liver conditions or blood disorders)
  • Insufficient bile salts to dissolve cholesterol in bile
  • Concentration of bile due to inadequate gallbladder emptying
  • Genetic predisposition to gallstone formation
  • Female gender (women are twice as likely to develop gallstones)
  • Age over 40
  • Obesity or rapid weight loss
  • High-fat, high-cholesterol, low-fiber diet
  • Diabetes and metabolic syndrome
  • Certain medications (including hormone therapy and cholesterol-lowering drugs)
  • Pregnancy and elevated estrogen levels

Signs and Symptoms

  • Sudden, intensifying pain in the upper right abdomen (biliary colic)
  • Pain that may radiate to the right shoulder or back
  • Pain after meals, particularly fatty foods
  • Nausea and vomiting
  • Fever and chills (if infection is present)
  • Jaundice (yellowing of the skin and eyes) if bile ducts are blocked
  • Clay-colored stools
  • Indigestion, bloating, and gas
  • Many people with gallstones remain asymptomatic until complications occur
  • Episodes of pain typically last 1-4 hours
  • Complications may include cholecystitis (gallbladder inflammation), cholangitis (bile duct infection), or pancreatitis

Diagnosis

Abdominal Ultrasound

The primary diagnostic tool for gallstones, using sound waves to create images of the gallbladder. It can identify stones as small as 2mm with high accuracy and is non-invasive and painless.

HIDA Scan (Hepatobiliary Iminodiacetic Acid Scan)

A nuclear medicine test that evaluates gallbladder function and detects bile duct obstructions. A radioactive tracer is injected and its movement through the liver, gallbladder, and intestines is monitored.

Endoscopic Ultrasound (EUS)

An endoscope with an ultrasound probe is passed through the mouth to obtain detailed images of the gallbladder, bile ducts, and pancreas. This can detect smaller stones and complications that might be missed by other imaging methods.

MRCP (Magnetic Resonance Cholangiopancreatography)

A specialized MRI technique that provides detailed images of the liver, gallbladder, bile ducts, and pancreatic duct without invasive procedures or contrast agents.

ERCP (Endoscopic Retrograde Cholangiopancreatography)

Both a diagnostic and therapeutic procedure where an endoscope is used to inject contrast into the bile ducts, followed by X-rays. It can both identify stones in the bile ducts and remove them during the same procedure.

Treatment Options

Watchful Waiting

For asymptomatic gallstones (those not causing symptoms), often no treatment is needed. Regular monitoring ensures that if symptoms develop, prompt intervention can be provided. About 80% of people with silent gallstones never develop symptoms requiring treatment.

Medications

In select cases, medications like ursodeoxycholic acid (ursodiol) may be prescribed to dissolve cholesterol gallstones. However, this approach is effective only for small stones, takes months to years to work, and stones often recur when medication is stopped. Pain medications and antibiotics may be needed for acute symptoms or infections.

ERCP for Bile Duct Stones

For stones in the common bile duct, Endoscopic Retrograde Cholangiopancreatography (ERCP) can be performed to remove the stones without surgery. A specialized endoscope is used to access the bile ducts, and various techniques including balloon extraction or lithotripsy may be employed to clear the stones.

Home Remedies

Dietary Modifications

Adopting a low-fat diet can help manage symptoms by reducing gallbladder contraction and inflammation. Gradually increase fiber intake, include healthy fats like olive oil, and avoid trigger foods that worsen your symptoms.

Maintain a Healthy Weight

Achieve and maintain a healthy weight through balanced diet and regular exercise. However, avoid rapid weight loss, as it can increase the risk of gallstone formation by altering bile composition.

Stay Hydrated

Drink plenty of water throughout the day to support overall digestive health and help prevent bile from becoming overly concentrated, which can contribute to stone formation.

Apply Heat

During a gallbladder attack, applying a heating pad to the painful area may help relax the muscles and provide temporary pain relief while waiting for medical attention.

Turmeric and Anti-inflammatory Foods

Some people find that incorporating anti-inflammatory foods like turmeric, which contains curcumin, may help manage inflammation. However, consult with your healthcare provider before using any supplements, especially if you take medications.

Preventive Care

  • Maintain a healthy weight through balanced diet and regular exercise
  • Avoid crash diets and rapid weight loss (lose weight gradually if needed)
  • Eat regular meals and avoid skipping meals
  • Follow a diet low in saturated and trans fats
  • Increase fiber intake through fruits, vegetables, and whole grains
  • Stay well-hydrated throughout the day
  • Exercise regularly to help maintain a healthy weight and promote gallbladder health
  • If you have risk factors for gallstones, discuss preventive strategies with your doctor
  • Women considering hormone replacement therapy should discuss gallstone risk with their doctor
  • Consider getting cholesterol levels checked regularly, as high cholesterol is a risk factor

Surgical Options

Laparoscopic Cholecystectomy

The gold standard treatment for symptomatic gallstones, involving removal of the gallbladder through several small incisions in the abdomen. This minimally invasive approach results in less pain, shorter hospital stays, faster recovery, and minimal scarring compared to open surgery. Most patients return home the same day or after overnight observation.

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Open Cholecystectomy

Traditional surgery performed through a larger incision when laparoscopic approach is not possible due to severe inflammation, scarring from previous surgeries, obesity, pregnancy, or bleeding disorders. While less common today, it remains an important option in complex cases.

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ERCP with Stone Extraction

For stones in the common bile duct, an endoscopic procedure (ERCP) can be performed to remove stones without removing the gallbladder. This is often done before or after cholecystectomy when stones have migrated from the gallbladder into the bile ducts.

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Schedule a Consultation

If you're experiencing symptoms of gallstones (cholelithiasis), our expert team is here to help you find the right treatment approach for your specific needs.

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