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Gallstones - Symptoms - Treatments - Prevention
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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.


Because about 80 percent of gallstones produce no symptoms, they require no treatment. Doctors often discover these "silent stones" during routine medical checkups or exams for other illnesses and usually recommend taking a wait-and-see approach to treatment. If your gallstones cause symptoms, however, several possible treatments are available.

Removing the gallbladder is the preferred treatment for the majority of people who have gallstones that cause symptoms. In fact, gallbladder surgery (cholecystectomy) is one of the most common surgeries.

Most often gallbladder surgery is performed using a laparoscope, a pencil-thin tube with its own lighting system and miniature video camera. A surgeon inserts the laparoscope into your abdomen through a hollow instrument (cannula). Only small incisions are required. The video camera then produces a magnified view on a television monitor of the inside of your abdomen. This allows the surgeon to see the surgery in detail. To remove your gallbladder, he or she uses tiny instruments inserted through several other small abdominal incisions.

Because laparoscopic cholecystectomy uses smaller incisions, you'll likely have less postoperative pain, less scarring and an earlier return to your normal activity — usually within just a few days.

Laparoscopic removal of the gallbladder is effective in the majority of cases. But occasionally an option is open surgery, in which the gallbladder is removed through a large abdominal incision. Your doctor may regard this surgery as the best option in severe cases. It may also be used when the gallbladder walls are thick and hard, the gallbladder is obviously infected, or there is scar tissue from earlier abdominal operations. Recovery from open surgery typically entails up to a week's stay in the hospital, followed by several weeks at home.

After surgery your liver continues to produce enough bile to digest a normal diet. But you may notice you're having more bowel movements than usual and that their consistency is less solid. For some people these changes can be major. In most cases the symptoms usually lessen over time. When diarrhea remains a problem, general self-care measures — such as avoiding dairy products, fats and spicy foods as well as adding more fiber to your diet — may help. If diarrhea persists, see your doctor, as medications can sometimes help.

If you have stones in the bile duct as well as your gallbladder, your doctor may recommend surgical removal of both the duct stones and your gallbladder. But in some cases, your doctor may suggest removing the stones in the bile duct using an endoscope. Your gallbladder also may be removed at a later date. Often, a cutting instrument is inserted through the endoscope, and the entrance of the bile duct is enlarged so the stone can pass through it. The same procedure may be used to remove a stone from a blocked pancreatic duct.

Nonsurgical options
Stones usually recur when nonsurgical treatments are used. However, when surgery isn't the best option, your doctor may recommend one of the following options:

  • Bile salt tablets. These tablets dissolve cholesterol stones over a period of time. The treatment works best on small cholesterol stones. Many doctors prefer the medication ursodiol (Actigall) because it's one of the safest and seems to have the fewest side effects. Unfortunately, ursodiol is expensive, and its effects aren't permanent. To prevent a recurrence, most people need to take ursodiol indefinitely.

  • Sound wave therapy (extracorporeal shock wave lithotripsy). This treatment uses high-frequency sound waves to break up gallstones. You then take ursodiol tablets to dissolve the fragments. Sound wave therapy is appropriate for only a small percentage of people with gallstones. If you have more than one stone, your stone is large, or you have acute cholecystitis or cholangitis, you're probably not a good candidate for this treatment. And, as with other nonsurgical therapies, your gallstones are likely to return unless you take ursodiol indefinitely.


Although you can't entirely prevent gallstones from forming, you may be able to lower your risk by following these suggestions:

  • Maintain a healthy body weight.

  • Avoid crash diets or a very low intake of calories — less than 800 calories a day.

  • Exercise regularly — at least 30 minutes on most days.

  • Choose a low-fat, high-fiber diet that emphasizes fresh fruits, vegetables and whole grains. Reduce the amount of animal fat, butter, margarine, mayonnaise and fried foods you eat.

Gallstones > 1 > 2 > 3 > 4

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