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Gallstones - Symptoms - Treatments - Prevention
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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.

Screening and diagnosis

Many gallstones, especially those that don't cause signs or symptoms, are discovered while you're being tested for other problems. If you have signs or symptoms of gallstones, your doctor is likely to suspect them based on your medical history and a physical exam. During the exam he or she will check for jaundice of your skin or the whites of your eyes and will feel (palpate) your abdomen to see if it's tender. If your doctor suspects gallstones, you may have a blood test to check for signs of infection (shown by an elevated white blood cell count), abnormal levels of liver or pancreatic enzymes, or excess bilirubin.

You may also undergo these diagnostic tests:

  • Ultrasonography. An ultrasound test uses sound waves rather than X-rays to display an image of the organs in your abdomen, including your gallbladder. It's usually the best way to detect gallstones in your gallbladder and sometimes in the common bile duct.

  • Computerized tomography (CT) scan. A CT scan is a diagnostic imaging procedure that uses a series of computer-generated X-rays to provide a comprehensive view of your internal organs.

  • Radionuclide scan. In this test, you'll receive a small amount of a radioactive tracer material through your veins (intravenously), followed by a scan of the gallbladder to see if the tracer material gains access to the gallbladder. If it doesn't, a stone is likely blocking the opening of the gallbladder or cystic duct.

  • Endoscopic retrograde cholangiopancreatography (ERCP). Your doctor may perform this procedure to help diagnose an obstruction of the common bile duct. During ERCP, a flexible, lighted viewing instrument (endoscope) is gently passed down your throat, through your stomach and into the upper part of your small intestine (duodenum). Air is used to inflate your intestinal tract so your doctor can more easily see the openings of the bile and pancreatic ducts. Then, a dye is injected into these ducts through a tiny hollow tube (cannula) that's passed through the endoscope. Finally, X-rays are taken of the ducts. If a stone is blocking one of the ducts, a specialized kind of cutting instrument may be inserted through the endoscope to try to remove the stone. A less invasive alternative, called magnetic resonance cholangiopancreatography, is used in some medical centers. However, this technique doesn't allow for the removal of the stone.

  • Endoscopic ultrasound (EUS). In some cases, your doctor may use this relatively new technique to help diagnose stones in the common bile duct. In this procedure, an ultrasound transducer is placed on the tip of an endoscope, which is then gently passed down your throat and through your stomach. Because the ultrasound instrument is closer to the bile ducts, it provides clearer and more accurate images than does traditional ultrasound. EUS is a less invasive and complex procedure than is ERCP, but if any stones need to be removed, your doctor will still need to perform an ERCP.

Complications

In some cases, gallstones can block the ducts that lead from your gallbladder, liver or pancreas to your small intestine. The symptoms of common bile duct obstruction include yellowing of the whites of the eyes and skin (jaundice), dark urine, and pain in the upper abdomen. If you also have fever and chills, you may have an underlying complication such as an inflamed gallbladder (cholecystitis) or an infection in your bile duct (cholangitis).

An obstruction in the common bile duct near the junction with the pancreatic duct can also cause a blockage in the pancreatic duct or inflammation of the pancreas (acute pancreatitis). In many people the common duct and the pancreatic duct empty into the duodenum at a common opening.

Pancreatitis is likely to cause an intense, constant pain in your upper abdomen that may radiate to your back or chest. The pain is usually worse when you lie flat and better when you sit up or bend forward. You may not be able to pass gas, and your abdomen may be tender and distended. Sometimes, you may also have nausea, vomiting and fever. In mild cases, symptoms usually subside within a few days to a week, but severe acute pancreatitis can be life-threatening.

People with gallstones are also more likely to develop gallbladder cancer. In fact, between 75 percent and 90 percent of people with diagnosed gallbladder cancer also have gallstones. Researchers speculate that gallstones may cause your gallbladder to release bile more slowly, which increases the amount of time cells are exposed to toxins. Even so, the vast majority of people with gallstones never develop gallbladder cancer.

Gallstones > 1 > 2 > 3 > 4

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