Gallstones: Causes, Diagnosis and Treatment Options

Gallstone is a solid crystal deposit that is formed by cholesterol, calcium ions and bile pigments in the gallbladder or bile duct.

Gallstones can be found in both the Gallbladder and Bile duct

1. Cholelithiasis is the presence of gallstones in the gallbladder.
2. Choledocholithiasis is the presence of gallstones in the bile ducts.

Gallstones are always present inside the gallbladder; that's why they are known as Gallstones.

Stone in CBD is known as Choledocholithiasis.

1. If it is formed inside the CBD, it is known as a Primary CBD stone and
2. It is known as Secondary CBD stone if it has travelled from the gallbladder to the bile duct.

Your body forms gallstones when there is an imbalance in the composition of bile juice. Also, the gallbladder function is compromised, and traces of bile remain inside the gallbladder. As a result, the bile contents get precipitated, forming gallstones.

Gallstones can contain:

1. Too much cholesterol: Most gallstones are made from cholesterol. If you eat a high-fat diet regularly, your liver will break down those fats and produce extra cholesterol. The bile juice won’t be able to digest this excess cholesterol further, which causes the cholesterol to solidify in the gallbladder, causing gallstones.
2. Too much bilirubin: Another reason your body can form gallstones is when the bile juice has excess bilirubin. Bilirubin is a yellowish-coloured material produced by the breakdown of red blood cells in your body

The symptoms and signs are as follows:

1. Pain in the Abdomen after a fatty meal or at night. This pain is called biliary colic. 
2. You may also have other symptoms like: 
3. Excessive sweating 
4. Vomiting.
5. Nausea
6. Feeling of fullness
7. Flatulence or gas.
8. Severe symptoms: 
9. Due to the blocked bile duct or if your gallstone moves to other organs, such as the pancreas, you may develop more symptoms such as:

1. Fever
2. Shivering or chills
3. Jaundice, which causes yellowing of skin and white part of the eyes
4. A reduced desire to eat
5. Fast heartbeat 
6. Itchy skin
7. Confusion.
8. You should contact your gastroenterologist if you experience any of these symptoms.

The gastroenterologist can do several tests to diagnose gallstones:

1. Indirect Evidence: These tests will give your doctor a hint if you have gallstones.
2. Blood Test: It detects any infection, jaundice, or inflammation in the pancreas. The healthcare staff will collect your blood sample and send it to the laboratory for analysis.
3. Direct evidence: Your gastroenterologist can make an accurate diagnosis by the following tests:
4. Ultrasound This is a primary method to diagnose gallstones accurately. It is a painless procedure that creates images of the internal organs. However, sometimes, gallstones might be present in the bile duct, which may not be detected on ultrasonography. In such cases, your gastroenterologist will use other tools to identify gallstones.
5. Endoscopic retrograde cholangiopancreatography (ERCP): In this method, a camera is inserted in your mouth and taken to the bile duct. An advantage of the ERCP method is that if gallstones are detected in your bile duct, the gastroenterologist can remove them simultaneously.
6. Magnetic resonance cholangiopancreatography (MRCP): In this method, gallstones are detected via magnetic resonance imaging, generating computerised images of the gallstones. In MRCP, your gastroenterologist can look for gallstones that have moved from the gallbladder to the common bile duct. However, this method cannot remove the gallstones. It is safer as compared to ERCP.
7.  Endoscopic ultrasound: This method is a combination of ERCP and ultrasonography. Initially, your gastroenterologist will insert a tube via the mouth into the bile duct and identify gallstones. Then, the gastroenterologist will use ERCP to remove the gallstones.

Home Remedies

There are no home remedies available to treat gallstones.

Medications

1. Treatment of gallstones depends on your age, the severity of the symptoms, medical history, health, tolerance to different therapies, and preference.
2. Medications that might help dissolve the stones are available; however, the problem is mainly with the gallbladder, which medicines cannot completely cure.

Surgery

Surgery is the most common treatment option for gallstones if you experience frequent and severe pain. Your gastroenterologist may either go for laparoscopy or open surgery.

1. Laparoscopic Cholecystectomy: The surgeon will insert a long and thin tube by making several minor cuts in the stomach. The camera attached to the tube helps get a magnified image from within your body, allowing the surgeon to separate the gallbladder from the neighbouring organs carefully. This surgery is done under general anaesthesia and will take up to 90 minutes.
2. Single-Incision Keyhole Surgery: This is an advanced form of laparoscopic cholecystectomy in which only one small cut is made in the stomach.
3. Open Cholecystectomy: Your gastroenterologist will recommend it if your gallbladder is severely inflamed or infected. In this surgery, the surgeon will make a four- to six-inch-long cut in your stomach, underneath your ribs and remove the gallbladder.

Treatment for Gallbladder helps in:

1. Relief from sudden pain in the abdomen 
2. The risk of perforated gallbladder decreases
3. The risk of gallstone ileus decreases, wherein the gallstone travels to the intestine and blocks it. This could be fatal. 
4. The risk of gallbladder abscess also decreases, wherein pus forms in the gallbladder.

What Happens if Gallstones Are Left Untreated?

Delaying the treatment for gallstones can cause the following complications:

1. Stone slipped into CBD: Gallstones can travel from the gallbladder and get trapped in the bile duct (the tube that conveys bile juice from the gallbladder to the small intestine), causing sharp pain in the middle to the upper right part of your belly that may spread to the upper back. This pain can last for anywhere between 30 minutes to several hours. 
2. Blockage and Acute Inflammation (Swelling): If the gallstones are blocked in the gallbladder duct (a small duct that joins the gallbladder to the bile duct) for a long time, your gallbladder can get inflamed (a condition known as cholecystitis). This can cause fever, gallbladder infection, and pain.
3. Death of Gallbladder Tissue and Infection: When cholecystitis occurs due to blockage of the gallbladder duct due to gallstones, it can further lead to the death of the gallbladder tissue if not treated appropriately. Gallbladder tissue death may also lead to Empyema, Gangrene, Perforation, Sepsis
4. Obstruction of Gallstones in the Bile Duct: The gallstones can pass from the gallbladder into the common bile duct and block it. This condition is called choledocholithiasis.
5. Severe Jaundice: When the gallstone leaves the gallbladder and enters the bile duct, it blocks the bile flow. This blockage of bile can cause jaundice with symptoms such as yellowing of the skin and the white portion of the eyes, dark brown urine, and pale stools.
6. Pancreatitis: Gallstones may move out of the gallbladder and block the duct of the pancreas, leading to swelling in the pancreas. You may experience severe pain in the centre of your upper belly, worsening until it becomes a constant ache.