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OVERVIEW

What are gallstones?

Gallstones are hard deposits that can form inside the gallbladder.  The gallbladder is a small, pear-shaped organ just under your liver. It stores bile, the digestive fluids that are made by the liver. Sometimes the bile becomes solid and forms stones. Some are as small as a grain of sand. Others can be the size of a golf ball.

SYMPTOMS

What problems can gallstones cause?

Most people who have gallstones never experience any symptoms.  These are called silent gallstones. Sometimes, a gallstone can leave your gallbladder and go into bile duct. If a gallstone gets stuck in that passageway and blocks it completely, you may experience:

• severe pain in the right upper part of your belly.
• pain in your upper back.

The pain usually starts suddenly and lasts for several hours. This is known as a gallbladder attack. Complete or partial blockage can also cause your gallbladder to get irritated and inflamed. If this happens, you may:

• have pain that lasts several hours.
• develop a fever.
• vomit or feel nauseous.

Your skin may turn a yellowish color, known as jaundice.

Gallbladder attacks tend to happen after heavy meals. They’re more likely to happen in the evening or during the night. They stop when the gallstones move and are no longer lodged in the duct. If the duct remains blocked for more than a few hours, complications can occur.

CAUSES & RISK FACTORS

 What causes gallstones?

Gallstones are causes by imbalances in the substances that make up bile.

Most gallstones (80%) are made of cholesterol. Normally, acids in the bile break down cholesterol. But a high-fat diet can lead the liver to produce extra cholesterol that the acids can’t break down. This leads the excess cholesterol to solidify. Other gallstones are made of bilirubin. Bilirubin is a yellowish pigment in bile that is produced when red blood cells break down. These stones are formed when there is too much bilirubin in the bile.

Gallstones may also form if the gallbladder doesn’t empty itself completely.

You’re more likely to get gallstones if:

• You are a woman
• Gallstones occur in up to 20 percent of Canadian women and 10 percent of men by age 60. Prevalence increases with age.
• You are of First Nations descent
• You have diabetes
• You have a family history of gallstones
• You are pregnant
• You are taking birth control pills
• You eat a diet high in cholesterol
• You are overweight or obese
• You are on a low-calorie diet and have recently lost weight very quickly

DIAGNOSIS

How are gallstones diagnosed?

Gallstones can be hard to diagnose because they share symptoms with other conditions. Your healthcare provider may do a physical exam to look for signs of gallstones. This will include looking for yellowing of the skin and tenderness in the abdomen. They may order blood tests. They may also order imaging tests. These could include an ultrasound or CT scan, which will make pictures of your gallbladder and bile ducts. If your healthcare provider thinks you have a gallstone stuck in a bile duct, they could try to remove the stone.

PREVENTION

Can gallstones be prevented or avoided?

In most cases, gallstones can’t be prevented or avoided. Eating a healthy diet, maintaining a healthy weight, and avoiding rapid weight loss could reduce your risk.

TREATMENT

Your treatment depends on the severity of your symptoms and what the doctor finds from the tests.

• No treatment. If the gallstones are floating free and you have no pain, you won’t need treatment.
• Wait and see. If you have one gallbladder attack, your healthcare provider may want to take a wait-and-see approach. The problem may solve itself. Then if you have more attacks, your healthcare provider may recommend surgery.
• Once you have one gallbladder attack, the chance of having another one is high (about 70%). Many healthcare providers will suggest surgery to remove your gallbladder to prevent a future attack. If your gallbladder is irritated or inflamed, most healthcare providers will want to take it out right away. The surgery is most often done with laparoscopic surgery. This means that small tools are inserted into small incisions in your abdomen to remove your gallbladder. The surgery is safe and effective. Without surgery, the gallbladder can get infected. It might even burst open, causing further problems.

Are there other treatments?

Other treatments are available for people who would have a high risk in surgery.  This could be because they are elderly or have heart problems or lung disease. However, gallstones usually return when they are not treated with surgery.  Other options include:

• Sound wave therapy. This can break up the stones so they can move into the intestine without problem. However, not everyone can receive this treatment. If you have more than 1 gallstone, if your gallstone is large or if you have other medical conditions, you may not be able to receive sound wave therapy.
• You might be able to take a pill to dissolve the stones. This pill does not work for all people and can be very expensive.

Surgery is still the best way to cure gallstones. Talk with your healthcare provider about what is right for you.

Living with gallstones

If your gallstones aren’t causing symptoms, you may live the rest of your life without any problems. If you do experience symptoms, your healthcare provider may want to remove your gallbladder. You don’t need your gallbladder to live. So, when it’s removed, you won’t notice much difference. Some people may find they need to eat a lower-fat diet.

FOR MORE INFORMATION

Canadian Liver Foundation

https://www.liver.ca/patients-caregivers/liver-diseases/gallstones/