Understanding Gallstone Disease

Symptoms

Some signs and symptoms of gallstones are:

• The most common symptom is pain in upper right side of the abdomen or centre of your abdomen, just below your breastbone. The pain can be intermittent, frequent, or severe and occur at any time, lasting for a few minutes to a few hours.

• Nausea or vomiting

• Diarrhoea

• High fever or chills

• Jaundice or yellowing of the skin

• Loss of appetite

• Rapid heartbeat

• Pain in the back, right shoulder, or lower chest

• Digestive issues like indigestion, gas, or heartburn

Causes

Although the exact cause of gallstones is still not known, doctors believe it could be due to the following reasons —

• Excess cholesterol in your bile:

Your bile contains chemicals to dissolve the cholesterol produced by the liver. But when your liver makes excess cholesterol, and your bile cannot dissolve everything, the extra cholesterol will build up and form stones.

• Excess bilirubin in your bile:

Bilirubin is produced during the breakdown of red blood cells. However, in conditions like liver cirrhosis or other blood disorders, our liver produces too much bilirubin than required. This excess bilirubin leads to the formation of gallstones.

• Gallbladder doesn’t empty correctly:

For proper functioning of the gall bladder, it needs to completely empty its bile; otherwise, the bile will become concentrated, causing gallstones.

Risk Factors

The factors which increase the risk of getting gallstones include:

• Family history of gallstones

• Women above the age of 40

• Being overweight or obese

• Lack of exercise

• Diabetes, liver disease, or blood disorders like leukaemia or sickle cell anaemia

• A high-fat and high-cholesterol but low-fibre diet

• Rapid weight loss

• Medications that contain oestrogen, such as hormone therapy drugs or oral contraceptives

• Medications to reduce cholesterol

Diagnosis

1. Blood tests:

Blood tests will measure the amount of bilirubin and if your liver is functioning properly.

2. Physical examination:

The doctor will check if your skin and eyes have a yellowish tint, which can be a sign of jaundice due to excess bilirubin. The doctor will also examine your abdomen over the gallbladder area and ask you to breathe in during the examination. If there’s any pain, it’s a sign of gallstones.

3. Abdominal ultrasound:

This will show the inside of your abdomen and if there are any gallstones or gallbladder inflammation.

4. CT Scan:

This imaging test will help the doctor see the inside of your liver and gallbladder.

5. HIDA Scan:

In this test, the doctor will inject a harmless radioactive substance into your vein and watch its movement as it enters the gallbladder. The scan will confirm if the symptoms are due to gallstones or inflammation of the gallbladder.

6. Magnetic resonance cholangiopancreatography (MRCP):

A magnetic field and radio wave pulses are used to get images of the pancreatic and biliary system.

7. Endoscopic retrograde cholangiopancreatography (ERCP):

An endoscope or tube with a camera is inserted through your mouth into your small intestine. A dye is injected to see the bile ducts.

Treatment for Gallstone

1. Lifestyle modifications:

Certain lifestyle changes, such as physical activity, maintaining a healthy weight, keeping diabetes under control, limiting alcohol consumption, and quitting smoking, can help manage the symptoms of gallstones.

2. Medications:

Medicines are prescribed to dissolve small gallbladder stones, but they take longer to work. There are chances of gallstones coming back once you stop the treatment.

3. Surgery:

This is recommended if the pain is severe. There are 2 types of surgical procedures — Laparoscopic Cholecystectomy and Open Cholecystectomy which are done under general anaesthesia.

4. Non-surgical procedures:

If surgery can’t be done due to any medical conditions, you can opt for non-surgical procedures, such as Shock Wave Lithotripsy, Oral Dissolution Therapy, and Endoscopy.

Prevention Tips

While we can’t do anything about risk factors like age and sex, we can certainly make changes in our lifestyles that can help reduce the risk of gallstones.

• Eat more fibre-rich foods like fresh vegetables, fruits, and whole grains. High-fibre foods help in proper digestion.

• Avoid or limit processed foods, sugary beverages, caffeinated drinks, and fried and greasy foods.

• Avoid fasting or skipping meals. Try to maintain a mealtime.

• If you are overweight, don’t try to lose weight rapidly. Talk to your doctor about a personalised weight loss regime that will help you lose weight gradually in a healthy way. Rapid weight loss increases the risk of gallstones.

• Exercise for at least 30 minutes a day, 5 days a week.

• Try to have smaller meals for easy digestion.

• Make sure you drink at least 6-8 glasses of water every day.

• Maintain a healthy weight with proper diet and regular physical activity.