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Gallstones (cholelithiasis) Causes, Symptoms and Treatment

Called gallstones or cholelithiasis , stone formation in the gall bladder , the organ that stores bile secreted by the liver. Calculations, sometimes called “stones”, do look like small pebbles. In the majority of cases, they are composed of crystallized cholesterol . Calculations of bile pigments can also occur, especially in cases of severe liver disease or sickle cell anemia, but this is not the case here.

The form, size and number of calculations (there may be several hundred) differ from one individual to another. They can be as small as a grain of sand or as big as a golf ball.

Most of the time, the calculations do not cause any symptoms. However, they can obstruct the ducts that carry the bile to the liver and intestines. This is called biliary colic if the crisis is temporary. No longer able to empty, the gallbladder starts to swell, which can cause violent pain . When calculi do not cause colic, they are sometimes discovered by random ultrasound or CT scan of the abdomen.

Note that the intensity of the symptoms does not depend on the size of the calculations. Indeed, small stones can result in intense pain, while large calculations will go unnoticed. They are sometimes too big to get out of the bladder and block the channels.

What is the gallbladder?

The gallbladder is a small pear-shaped bag measuring 7 to 12 cm long. It stores bile, a greenish-yellow liquid produced by the liver, which serves to facilitate the digestion of food. During meals, the vesicle contracts and releases the bile, which then circulates in the common bile duct to the intestine, where it contributes to digestion, includes fat. The gallbladder relaxes and refills with bile.

Causes of Gallstones (cholelithiasis)

The bile is composed mainly of water, bile salts (which by emulsifying fats, play an important role in digestion in the intestine), cholesterol, phospholipids, pigments and electrolytes.

The gallstones of cholesterol form when:

  • bile contains too much cholesterol;
  • bile does not contain enough bile salts;
  • the gallbladder does not contract regularly (the bladder is then called “lazy”).

It is unclear exactly what triggers the formation of stones, but various risk factors have been identified. Obesity is one of them. It should be noted that there is no link between hypercholesterolemia and the concentration of cholesterol in bile.

Calculations can appear in various hollow organs (kidneys, bladder) or in glands (gallbladder, salivary glands), then circulate or get stuck in the excretory lanes of these. Depending on where they are located, these calculations will be composed of various substances: calcium, phosphate, cholesterol, digestive juices or others.

Gallstones are usually formed in the gallbladder and not in the liver because the bile is more concentrated.

Who is affected?

The cholelithiasis , or calculation of the gallbladder is quite widespread and affects 2 to 3 times more women than men. From age 70, 10% to 15% of men are affected, as well as 25% to 30% of women. The risk of having gallstones increases with age , reaching nearly 60% after age 80, probably because of the decreased effectiveness of gallbladder contractions. The stones cause complications only for 20% of them and they may be hepatic colic, cholecystitis, cholangitis, or acute biliary pancreatitis.

Biliary colic

seizure of hepatic colic or biliary colic, is due to a calculation of the gallbladder that passes into the bile ducts and blocks transiently, temporarily preventing the bile from flowing. It lasts an average of 30 minutes to 4 hours. Duration of more than 6 hours should cause a fear of complication. The pain fades when the calculus dislodges spontaneously, allowing the bile to flow again normally. A person who has suffered from a biliary colic attack risks, in 70% of the cases, to undergo others. If the first attacks are bearable, they tend to get worse when the calculations are not processed.

Most seizures occur outside of meals. They can be declared at any time of day, and most often there is no triggering event. The seizure occurs after the gallbladder has contracted and ejected a calculus that can block a bile duct. The ingestion of a meal naturally causes the contraction of the vesicle, stimulated by the presence of food in the digestive tract. The gallbladder also contracts randomly and spontaneously at any time of day and night.

Possible complications

In the majority of cases, gallstones do not cause complications. However, untreated persistent pain may one day or another intensify to the point of leading to life-threatening situations: acute cholecystitis ( inflammation of the gallbladder), acute cholangitis (inflammation of the bile ducts) or acute pancreatitis (inflammation of the pancreas).

In the presence of the symptoms below, consult a doctor urgently  :

  • fever;
  • abnormally yellow color of the skin;
  • very severe and sudden pain on the right side of the abdomen and persists beyond 6 hours;
  • persistent vomiting.

On the other hand, people with gallstones have a slightly higher risk of developing gallbladder cancer in the long term , which is, however, very rare.

Symptoms of Gallstones (cholelithiasis)

In the vast majority of cases, cholelithiasis does not cause symptoms. The calculations are thus discovered during a vesicle examination, most often an ultrasound.

When gallstones cause symptoms, these are seizures, hepatic colic also known as biliary colic. They last from 30 minutes to 4 hours. Here are the main symptoms.

  • A brutal, intense and permanent pain, type of grinding or torsion, felt in the middle or in the upper right part of the abdomen. The pain sometimes radiates to the right shoulder and shoulder blade. The sufferer tends to limit his breathing amplitude.
  • Nausea and vomiting.
  • There is no fever or jaundice. And if there are, it is not a matter of hepatic colic, but a complication.

People at risk for Gallstones (cholelithiasis)

  • The women.  They are 2 to 3 times more prone to cholelithiasis than men. This is believed to be attributable to  estrogens  that would cause an increase in the amount of cholesterol in the bile.
  • Women who gave birth to more than one child.  Since the estrogen level is higher during pregnancy, the risk of cholelithiasis would be higher as well. The more pregnancies there are, the more the risk increases.
  • Women  indigenous  or original  Hispanic . It seems that this would be partly related to genetic factors, but also to dietary habits.
  • People with  gastrointestinal disease , such as Crohn’s disease and ulcerative colitis.
  • People who have undergone  bariatric surgery . About a third of people who have undergone this surgery will suffer from gallstones in the months following the operation.
  • The risk of gallstones also increases with age .

Risk factors

  • Obesity.  This is one of the main risk factors. Men and older women who show overweight have twice the risk of suffering from gallstones than those who have a healthy weight . In their case, the liver would produce too much cholesterol in the bile. Physical inactivity and a diet that is too high in calories have also been associated with an increased risk of gallstones. Obesity is defined by body mass index (BMI). To calculate yours, do our  Body Mass Index (BMI) and waist measurement .
  • Physical inactivity  An epidemiological study has proved that this is a serious risk factor. According to the Health Professionals Follow-up Study, men 65 years and older who watch TV more than 40 hours a week are 3 times more likely to have gallstones than viewers who watch less than 6 hours per week.
  • Diabetes . The hypertriglyceridemia often associated with diabetes would facilitate the formation of stones, in addition to obesity and physical inactivity, which are other risk factors for gallstones and diabetes.
  • Fast weight loss.  Studies have shown that people who lose more than 3 pounds a week on dieting have a higher risk of gallstones than those who lose weight more slowly. According to these same studies, following a very low calorie diet (about 800 calories a day) leads to the formation of stones in 10% to 25% of individuals (one-third of these stones were symptomatic, that is, say they caused a biliary colic attack). It is believed that cholesterol levels in the bile will increase as the liver metabolizes more fat (including cholesterol) during weight loss.
  • Gain and weight loss cycles.  Especially if they exceed ten pounds.
  • Young.  When the gallbladder is little or no solicited for a long time, it does not drain regularly and the stagnation of the bile can create stones.
  • Estrogen.  Hormone therapy at menopause and oral contraceptive use increase cholesterol levels in the bile and reduce gallbladder movement. Regarding hormone therapy during menopause, it seems that the risk increases with duration: hormone therapy for less than three years leads to two and a half times more risk, while hormone therapy over five years produces four times more .
  • Some drugs used to lower cholesterol levels in the blood.  Some of them increase the amount of cholesterol in the bile.
  • A genetic predisposition could be involved.
  • The young protracted,
  • Pregnancy probably because it causes stasis.
  • A diet low in fiber .

Prevention of gallstones

Can we prevent gallstones?
  • People who have never had gallstones can reduce the risk of being affected by healthy lifestyle habits, especially if they help prevent obesity.
  • Once a calculus has formed in the bladder, it cannot be regressed only by healthy habits. It is therefore necessary to treat them, but only if they pose a problem. A calculation with no annoying signs must not be made. Nevertheless, eating well and preventing obesity offers many health benefits, and may reduce the risk of new stones.
Measures to be taken to prevent cholelithiasis
  • Strive to maintain a normal weight. People who want to lose weight should do it gradually. Experts recommend losing only half a pound to two pounds a week, at most. It is better to aim for a lower weight loss that can be better maintained.
  • Regularly indulge in physical exercises . Practicing 30 minutes of endurance exercise a day, 5 times a week, reduces the risk of symptomatic cholelithiasis, in addition to preventing excess weight. This preventive effect is observed as much in men as in women.
  • Consume good fats . According to the results of the Health Professional Study – a large epidemiological study conducted for 14 years at Harvard Medical School – people who consume mostly polyunsaturated and monounsaturated fat are at lower risk of cholelithiasis. The main sources of these fats are vegetable oils , nuts and seeds . Subsequent analysis of the same cohort of individuals showed a high intake of trans fats, hydrogenated vegetable oils derived (margarine and shortening), increases the risk of gallstones.
  • Eat dietary fiber. Dietary fiber, because of the satiety effect it provides, helps maintain normal calorie intake and prevent obesity.
  • Limit intake of sugars (carbohydrates), especially those with a high glycemic index, as they increase the risk of calculus.

Note. It seems that vegetarianism would have a preventive effect on gallstones. The vegetarian diet is low in saturated fat, cholesterol and animal protein, and provides a good intake of complex fiber and sugars.

Medical treatment of gallstones

Important. People who believe they have biliary colic should always talk to their doctor. Even if the crisis stops spontaneously, it is necessary to practice an ultrasound and perhaps to carry out an intervention, in order to avoid sometimes serious complications.
And if a crisis does not stop after a few hours, or in case of alarm symptoms occurring quickly (fever, jaundice, vomiting), you should consult as soon as possible.

The ultrasound of the abdomen makes it possible to establish the diagnosis, detecting 90% of the computations. It is associated with biological examinations (blood test) to estimate the seriousness of the situation. Treatment is indicated when gallstones result in painful seizures or complications. When gallstones are accidentally discovered during a medical examination and do not cause discomfort, it is not recommended to treat them.

Diet

It is prescribed for a period of at least 48 hours.

pharmaceuticals

In the event of a seizure, the gallstone can obstruct a canal through which the bile passes. This causes difficulty in the flow of bile and inflammation reactions, and vesicle wall pain (ischemia or lack of oxygen, necrosis or destruction of the cells of the wall) and sometimes a bacterial infection. where essential medical treatments.

Antibiotics
They are prescribed according to criteria allowing estimating if the presence of bacteria is probable in the bile liquid. These criteria include the severity of symptoms, age, chills, diabetes, poor immunity, temperature above 38 ° C, and laboratory tests.

The painkillers
The crisis of hepatic colic sometimes being very painful, analgesics is essential. The doctor prescribes non-opioid analgesic medicines such as Visceralgine.

Antispasmodics
Associated with analgesics, such as Spasfon.

Antiemetic
drugs These are drugs against nausea and vomiting, for example, Primperan.

Surgery

In case of hepatic colic or biliary colic, the pain treatment allows passing the painful crisis. An abdominal ultrasound is however always performed and in case of calculation, a vesicle removal operation is scheduled in the following month, so as to avoid recurrence or complications.

In the case of gallstones causing acute cholecystitis of low or moderate severity, the surgeon performs ablation of the gallbladder (cholecystectomy). This is the only sure way to avoid the recurrence of gallstones, which is common.
The procedure is most often performed by laparoscopy, that is to say by making small incisions by which the surgeon passes optical fibers to see and the instruments necessary for the intervention. This avoids wide opening of the abdominal wall and allows a faster recovery. In some cases, however, the surgeon chooses to perform a laparotomy, that is to say, an opening of the belly.

Recovery takes only a few days. This intervention is very frequent and the consequences in general very positive. When the cholecystitis is severe, the operation is to perform a drainage of the vesicle in the skin.

During such interventions, the surgical team performs an intraoperative cholangiography, examination to detect a calculation in the other intra- or extrahepatic bile ducts, and the main bile ducts. If they exist they could trigger complications later and so they must be treated ..

Removal of the gallbladder usually has few long-term consequences. After the operation , the liver continues to produce bile, which passes into the common bile duct to be directly discharged into the small intestine. The person can therefore eat normally. The bile is then secreted more frequently, which can cause more liquid stools. If the problem exists and is very troublesome, some changes in the diet can help, such as avoiding fatty and spicy foods and consuming more fiber.
In addition, cholestyramine (for example, Questran), a drug that absorbs bile in the gut, helps to control this situation.

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