Gallstones (Cholelithiasis): Symptoms, Causes, Diagnosis & Treatment

Gallstones (Cholelithiasis): Symptoms, Causes, Diagnosis & Treatment

Gallstones are also known as cholelithiasis. Gallstones are hardened deposits of a digestive fluid called bile, that form in the gallbladder. The gallbladder is a small, pear-shaped organ on the right side of the abdomen, just beneath the liver, and it holds bile juice which is further released into the small intestine.

The size of Cholelithiasis range from as small as a grain of sand to as large as a golf ball. While some people can develop just one gallstone, others can develop multiple gallstones at the same time. Increased cholesterol and/or bilirubin, decreased bile salts, and gallbladder stasis, cause stones. There are 2 types of stones-

  • Cholesterol stones are radiolucent with 10–20% opaque due to calcifications, and comprise 80% of the stones. These are associated with obesity, Crohn disease, advanced age, estrogen therapy, multiparity, and rapid weight loss.
  • Pigment stones A are associated with Crohn disease, chronic hemolysis, alcoholic cirrhosis, advanced age, biliary infections, and total parenteral nutrition (TPN).

People experiencing symptoms due to gallstones usually require gallbladder removal surgery. But if there are no signs and symptoms, treatment is not necessary. If the gallstone is visible by X-ray, medical therapy with bile acids is unlikely to work.

Symptoms of Cholelithiasis are often misunderstood as kidney stones or pancreatitis. One cannot be sure of it until tests are performed. Usually, people experience intense pain in the upper right corner of the abdomen. In adults, approximately 60% of intrahepatic gallbladders are associated with gallstones. Mostly females are affected by these stones.

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How Do Gallstones Affect Your Body?

When gallstones block bile ducts, bile builds up in the gallbladder causing a gallbladder attack. Gallbladder attacks usually cause pain in the upper right abdomen and gallstones may form if bile contains too much cholesterol, bilirubin, or not enough bile salts.

What Are The Causes of Gallstones?

The causes for the formation of gallstones are as follows:

  • Bile contains enough chemicals to dissolve the cholesterol excreted by the liver. But if the liver excretes more cholesterol than the bile can dissolve, the excess cholesterol may form into crystals and eventually lead to the formation of stones.
  • Bilirubin is a chemical that is produced when the body breaks down red blood cells. Certain conditions can lead to overproduction of bilirubin which contributes to gallstone formation.
  • If the gallbladder doesn’t empty completely or often enough, bile may become very concentrated, contributing to the formation of Cholelithiasis.
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What Are The Risk Factors of Gallstones?

The risk factors are popularly recognized as 4’Fs:

  • Female
  • Fat
  • Fertile (multiparity)
  • Forty
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What Are The Symptoms of Gallstones?

If a gallstone lodges in a duct and causes a blockage, the following symptoms may be observed:

  • Sudden and rapidly intensifying pain in the upper right portion of the abdomen
  • Sudden and rapidly intensifying pain in the center of the abdomen, just below the breastbone
  • Back pain between shoulder blades
  • Pain in right shoulder
  • Nausea or vomiting

Cholelithiasis pain usually lasts several minutes to a few hours, making it difficult to stand or sit due to a continuous hike in the intensity.

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How are Gallstones Diagnosed?

  • Ultrasound exam – Ultrasound uses a device that bounces safe sound waves off organs to create an image of their structure. A trained technician performs the procedure and a radiologist interprets the images. Ultrasound is the most accurate method to diagnose gallstones.
  • Computerized Tomography (CT) scan – A CT scan is an x-ray that produces pictures of the body and shows gallstones or complications, such as infection and blockage of the gallbladder or bile ducts.
  • Magnetic Resonance Imaging (MRI) – It uses radio waves and magnets to produce detailed pictures of the internal organs and soft tissues without using X-rays. An MRI can show gallstones in the ducts of the biliary system.
  • Cholescintigraphy – Cholescintigraphy uses a safe radioactive material to produce pictures of the biliary system and is used to diagnose abnormal contractions of the gallbladder or obstruction of the bile ducts.
  • Endoscopic Retrograde Cholangiopancreatography (ERCP) – This technique uses an X-ray to look into the bile and pancreatic ducts. It helps in locating the affected bile ducts and the Cholelithiasis. The stone is captured in a tiny basket attached to the endoscope and is removed.
  • Blood tests – It is done to look for signs of infection or inflammation of the bile ducts, gallbladder, pancreas, or the liver.

How To Prevent And Control Gallstones?

  • Don’t skip meals and try to stick to the usual mealtimes every day.
  • Do not try to lose weight suddenly over a short period of time. Such rapid weight loss may increase the risk of gallstones.
  • Obesity and being overweight can increase the risk of gallstones. Exercising regularly and following a healthy diet can prevent gallstones.

Treatment of Gallstones – Allopathic Treatment

  • The most common therapy for Cholelithiasis is cholecystectomy (surgery). It is of two types – Laparoscopic Cholecystectomy and Open Cholecystectomy.
  • Bile acids may be used as medical therapy for cholesterol gallstones. Bile acids are ineffective in calcified or pigmented gallstones.
  • Chenodeoxycholic Acid – Chenodeoxycholic acid is an older therapy for gallstones. Bile acids reduce cholesterol absorption and prevent the formation of stones. The most common adverse effects include increased liver enzymes and diarrhea.
  • Ursodeoxycholic Acid – Ursodeoxycholic acid or ursodiol, is the most common medical therapy for cholesterol gallstones. The most frequent adverse effects include diarrhea and constipation.
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Treatment of Gallstones – Homeopathic Treatment

  • Calcarea carbonica – This medicine is given when the patient has a family history of kidney and gallstones, is anxious, slow, overweight, and has high deposits of triglycerides and cholesterol.
  • Chelidonium – This medicine is prescribed when there is pain under the right shoulder blade and pain in the upper right abdomen, which spreads to the back.
  • Lycopodium – This medicine is usually recommended in case of a family history of stones in the kidney or the gallbladder, along with other complications like chronic digestive disorders, high cholesterol, gastric problems, constipation, peptic ulcers, gas, and bloating. The patient may usually experience biliary colic pains late in the afternoon.
  • Natrum sulphuricum – This medicine is given when the patient may have problems like chronic diarrhea, gallstone pain, asthma, chronic obstructive pulmonary disease, depression, obesity and a problem in joints. This medicine is also prescribed when the patient is too sensitive to changes in humidity and weather.
  • Nux vomica – This is given when a patient suffers from nausea, colic pains, spasmodic pains, heartburn, acidity, gas, bloating, and consumes rich and oily food in excess.

Gallstones – Lifestyle Tips

  • Maintain a healthy weight
  • Avoid rapid weight loss
  • Eat an anti-inflammatory diet
  • Get regular exercise

What Are The Recommended Exercises For a Person With Gallstones?

The following exercises are recommended for a person with gallstones:

  • Walking
  • Running
  • Yoga

Gallstones & Pregnancy – Things to Know

  • During pregnancy, the odds of gallstones are even higher because the estrogen produced during pregnancy can lead to higher cholesterol levels in the bile juice.
  • It is the second most common cause of surgery during pregnancy that isn’t pregnancy related, and about 1 in 1,600 women have their gallbladder removed due to gallstones during pregnancy.
  • Surgery is not performed during the first or the third trimester, mostly because of the risk of miscarriage as this poses a harm to the development of the baby.

Common Complications Related to Gallstones

  • The most common complication related to gallstones is cholecystitis.
  • It can also cause acute pancreatitis or ascending cholangitis.
  • People with a history of gallstones have an increased risk of gallbladder cancer. However, this is a rare occurence.

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