Second opinion on gallstone disease

The gallbladder is a pear-shaped organ located in the right side of the abdominal cavity. It stores bile produced by the liver. When we eat fatty foods, the organ contracts and bile flows through the bile duct into the small intestine. There it dissolves food fats into tiny droplets, so that they can be digested and absorbed through the intestinal wall into the bloodstream. The most common gallbladder disease is gallstones.

What are crystalline formations in the gallbladder?

Gallstones are made up of insoluble substances such as cholesterol. Once formed in the gallbladder, they usually remain there, but sometimes they can migrate into the bile duct or form directly in it. The medical term for this abnormal condition is gallstone disease, or gallstones. An even more professional name is cholelithiasis, made up of two Greek words meaning "bile" and "stone".

Why do gallstones form?

Bile consists mainly of water. It also contains other components: bile salts, cholesterol, fats and pigments. The most important pigment in bile is bilirubin, which is formed when red blood cells break down in the liver. The problem is that some of these substances are not soluble in water. If their content balance is disturbed, they can clump together to form crystals. In most cases, those consist of cholesterol. Less common are so-called pigment stones made of calcium and bilirubin.

Risk factors

It is not known for sure why some people develop gallstones, while others never get affected. However, there are some risk factors, in particular:

• age (gallstones are more likely to form after the age of 40);
• genetic predisposition;
• gender (women are more prone to gallstones, presumably due to the influence of female sex hormones);
• pregnancy;
• estrogen intake (e.g., birth control pills or hormone replacement therapy during menopause);
• certain medical conditions (gallbladder dysfunction, cirrhosis of the liver, diabetes);
• severe obesity;
• significant weight loss in a short period of time;
• intake of very high-calorie foods.

Symptoms of gallstone disease

Most people do not even notice that there are gallstones in their body, as they rarely manifest themselves in any way. However, with certain location and size, they can cause symptoms and complications. This happens in about 2-4% of cases.

If stones are present in the duct, jaundice (icterus) may also develop. The skin and eyes turn yellow because the bile cannot drain properly and more bilirubin enters the bloodstream. As a frequent result, urine becomes darker.

Possible gallstone disease complications

In about 0.2% of patients, the disease leads to complications. Their risk increases once the stones begin to cause symptoms and discomfort. The following conditions are possible:

• inflammation of the gallbladder or bile duct;
• inflammation of the pancreas;
• (very rarely) intestinal obstruction.

Diagnosis

The basis of diagnosis is information about pain. Important issues are whether and where the pain is felt, where it spreads and when it occurs (in relation to the time of the day and food intake). It is also important how the patient feels after eating fatty foods. The presence of gallbladder diseases among close relatives is also important.

All this information is obtained by the doctor in the process of talking to the patient (collecting anamnesis).

Next, during the physical examination, the doctor checks if there is typical abdominal pain on pressure ("Murphy's sign"). It is done by pressing on the right upper abdomen during inhalation. If the gallbladder is irritated, this usually causes pain.

If all signs suggest the possibility of disease, further diagnostic workup is then initiated.

Mandatory examinations:

• abdomen ultrasound (sonography);
• laboratory blood tests (C-reactive protein, ESR, bilirubin, GGT, alkaline phosphatase, AST, ALT, amylase and lipase).

In addition to the basic tests, additional studies may be performed depending on the situation, such as:

• a CT scan of the upper abdominal cavity;
• MRCP (magnetic resonance cholangiopancreatography, a non-invasive method of visualizing the biliary and pancreatic systems);
• endosonography (endoscopic ultrasound examination of the upper abdomen).

If bile duct stones are suspected, endoscopic retrograde cholangiopancreatography (ERCP) may be performed. It combines both diagnosis and treatment. During this procedure, a thin tube with a camera (endoscope) is inserted through the esophagus into the duodenum under sedation, as in gastroscopy. Using a contrast agent, bile duct stones are made visible on X-ray and are removed under X-ray control using thin instruments delivered through the endoscope.

Gallstone disease treatment options

However, if symptoms and complaints are present, doctors may prescribe medication. This can be analgesic and antispasmodic drugs that help to cope with painful colic. Special medications for nausea or a feeling of overfilling the stomach are also prescribed.

There are drugs that can dissolve a certain type of stones, but such treatment is ineffective and is used very rarely.

The only reliable way to solve the problems caused by gallstones is to remove the organ itself (cholecystectomy). This allows you to avoid colics and possible complications. As a rule, the operation is performed in a minimally invasive way and is seen as quite a routine and safe procedure by modern medicine.

Crystalls located in the bile ducts are removed with the help of an endoscopic procedure (ERCP).

Which doctor should I see for symptomatic gallstones?

At the very first stage, complaints can be presented to your primary care provider. But most likely this doctor would recommend an immediate appointment with a gastroenterologist. It is this medical specialty that is mainly responsible for making a diagnosis of gallstones, identifying possible complications, and working out treatment strategy. Endoscopic procedures (endosonography, ERCP) are also performed by gastroenterologists with appropriatetraining. If it comes to surgical intervention, it is necessary to consult a visceral surgeon.