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Gallstones

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DIGESTIVE SYSTEM
Diseases & Conditions  

Like many people, you may have gallstones and not know it. In fact, gallstones — solid deposits of cholesterol or calcium salts that form in your gallbladder or nearby bile ducts — often cause no symptoms and require no treatment. But up to about one-fifth of people with gallstones will have a gallbladder attack that can cause symptoms such as nausea and an intense, steady ache in their upper-middle or upper-right abdomen. In some cases the pain can be severe.

You're at greater risk of developing gallstones if you're older, female or overweight. A diet high in fat and sugar along with a sedentary lifestyle also increases your risk. So does rapid weight loss or eating a very low-calorie diet.

Complications from gallstones can be serious, and even fatal, if left untreated. Fortunately, treatment is usually straightforward, and newer techniques often allow faster recovery time.

Signs and symptoms

You may not know you have gallstones until they're discovered during tests — including ultrasounds or computerized tomography (CT) scans — done for other reasons. But sometimes they may cause certain signs and symptoms. These include:

  • Chronic indigestion. Symptoms of indigestion may include nausea, gas, bloating and sometimes abdominal pain. These symptoms may occur or be made worse after you eat high-fat foods. But even if you have gallstones, they often aren't the cause of your digestive problems. A number of other conditions — including gastroesophageal reflux disease (GERD) and peptic ulcers of the stomach or duodenum — also can cause chronic indigestion. For that reason, it's important to discuss your symptoms carefully with your doctor.

  • Sudden, steady and moderate to intense pain in your upper-middle or upper-right abdomen. This may signal a gallbladder attack. The pain may begin after you eat, but may also occur at other times — even at night. It can last from 15 to 30 minutes to several hours. Gallbladder pain starts in your upper-middle or upper-right abdomen and, on occasion, may shift to your back or right shoulder blade. After the pain subsides, you might have a mild aching or soreness in your upper abdomen that can last for up to a day or so. Gallbladder attacks tend to occur infrequently — weeks, months or even years apart. Daily abdominal pain is usually not a symptom of gallbladder disease.

  • Nausea and vomiting. These symptoms may accompany a gallbladder attack.

Sometimes small gallstones escape the gallbladder and enter the duct leading from your liver and gallbladder to your small intestine (common bile duct). They may also occasionally enter the duct leading to your pancreas. In some cases, a stone may block one of these ducts — a condition that can be fatal if you don't receive treatment. You'll likely have pain and sometimes fever due to inflammation at or near the site of the blockage. Other signs and symptoms of bile duct obstruction include:

  • Yellowing of your skin and the whites of your eyes (jaundice)

  • Clay-colored stools

  • Tea- or coffee-colored urine

  • A high fever with shaking chills if an infection in the biliary system (cholangitis) develops as a result of the obstruction

If you experience any of these symptoms, seek medical treatment right away. Keep in mind that sometimes you may have jaundice and changes in the color of your urine or stools without also having much pain or indigestion. It may take a few days before you notice the discoloration.

Causes

Your liver produces bile — a greenish-brown fluid made of bile salts, fatty compounds, cholesterol and other chemicals. This fluid is concentrated and stored in your gallbladder until it's needed to help digest fats in your small intestine.

When you eat, your gallbladder contracts and releases bile into the common bile duct — a continuation of the hepatic and cystic ducts. The common bile duct then carries bile to the upper part of your small intestine (duodenum), where it begins to help break down the fat in your food. But if bile within your gallbladder becomes chemically unbalanced, it can form into hardened particles that eventually grow into stones. This may take several years.

Gallstones can be as small as a grain of sand or as large as a golf ball and may be smooth and round or irregular with a number of edges. You can have just one stone or hundreds of them.

No matter what their size, shape or number, gallstones fall into one of three categories:

  • Cholesterol gallstones. These gallstones are composed mainly of undissolved cholesterol, although most also have other components, such as calcium and bilirubin, the residue from the breakdown of red blood cells. About 80 percent of gallstones are cholesterol stones.

  • Pigment gallstones. These small, dark brown or black stones form when your bile contains too much bilirubin. It's not always clear what causes them. The destruction of red blood cells in some types of anemia also may create excess bilirubin.

  • Primary bile duct stones. Unlike stones that form in your gallbladder but escape into your bile ducts, these stones form in the ducts themselves. They're usually soft and brown and made of decomposed bile.

Many factors, some of which aren't well-understood, contribute to the formation of gallstones. They include:

  • Too much cholesterol. Normally, your bile contains enough bile salts and lecithin — a fatty compound — to dissolve the cholesterol excreted by your liver. But if your bile contains more cholesterol than can be dissolved, the cholesterol may form into crystals and eventually into stones. It's important to know that cholesterol in your bile has no relation to the levels of cholesterol in your blood, and cholesterol-lowering drugs don't help prevent gallstones.

  • Incomplete or infrequent gallbladder emptying. If your gallbladder doesn't empty completely or often enough, bile may become too concentrated and contribute to the formation of gallstones. This may occur during pregnancy. Eating too little fat or going long periods without eating, such as skipping breakfast, also can decrease gallbladder contractions. Fewer contractions can keep the gallbladder from emptying completely or frequently.

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