Feb. 15, 2010 | Gallstones are small, pebble-like substances that develop in the gallbladder, a pear-shaped sac located below the liver in the right upper abdomen. Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. The liquid, called bile, helps the body digest fats. Bile is made in the liver, then stored in the gallbladder until the body needs it. The gallbladder contracts and pushes the bile into a tube, called the common bile duct, that carries it to the small intestine, where it helps with digestion. The two types of gallstones are cholesterol stones and pigment stones. Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Pigment stones are small, dark stones made of bilirubin. Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or a combination of the two.

Feb. 15, 2010 | Women are twice as likely as men to develop gallstones, solid clumps of cholesterol crystals and other substances that may be of variable size. Excess estrogen from pregnancy, hormone replacement therapy, and birth control pills appear to increase cholesterol levels in bile and decrease gallbladder movement, which can lead to gallstones. Obesity is another major risk factor for gallstones, especially in women. A large clinical study has shown that being even moderately overweight increases the risk for developing gallstones. The most likely reason is that the amount of bile salts in bile is reduced, resulting in more cholesterol. Increased cholesterol reduces emptying of the gallbladder. Rapid weight loss can also increase the chances of gallstones. As the body metabolizes fat during prolonged fasting and rapid weight loss, such as “crash diets,” the liver secretes extra cholesterol into bile, which can cause gallstones. In addition, the gallbladder does not empty properly.

Feb. 15, 2010 | As gallstones move into the bile ducts and create blockage, pressure increases in the gallbladder and one or more symptoms may occur. Signs of blocked bile ducts are often called a gallbladder “attack” because they occur suddenly. Gallbladder attacks often follow fatty meals, and they may occur during the night. A typical attack can cause steady pain in the right upper abdomen that increases rapidly and lasts from 30 minutes to several hours as well as pain in the back and under the right shoulder. If you experience pain for more than five hours, have nausea accompanied by vomiting and have a fever or chills, you should notify your doctor immediately. Although these attacks often pass as gallstones move, your gallbladder can become infected and rupture if a blockage remains. Many people with gallstones have no symptoms. These gallstones are called “silent stones.” They do not interfere with gallbladder, liver, or pancreas function and do not need treatment.

Feb. 15, 2010 | Gallstones are frequently discovered during tests for other health conditions. When gallstones are suspected to be the cause of symptoms, the doctor is likely to do an ultrasound exam, the most sensitive and specific test for gallstones. A handheld device, which a technician glides over the abdomen, sends sound waves toward the gallbladder. The sound waves bounce off the gallbladder, liver, and other organs, and their echoes make electrical impulses that create a picture of the gallbladder on a video monitor. If gallstones are present, the sound waves will bounce off them, too, showing their location. This test is not an X-ray and, unlike other tests, can be safely performed during pregnancy. Blood tests may be performed to look for signs of infection, obstruction, pancreatitis, or jaundice. Because gallstone symptoms may be similar to those of a heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis, an accurate diagnosis is important.

Feb. 15, 2010 | If you have gallstones without any apparent symptoms, treatment will not be necessary. If you are having frequent gallbladder attacks, your doctor will likely recommend you have your gallbladder removed, an operation called a cholecystectomy. Surgery to remove the gallbladder is one of the most common surgeries performed on adults in the United States. Nearly all cholecystectomies are performed with laparoscopy. After giving you medication to sedate you, the surgeon makes several tiny incisions in the abdomen and inserts a laparoscope and a miniature video camera. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, bile ducts, and other structures. Then the surgeon cuts the cystic duct and removes the gallbladder through one of the small incisions.