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Gallstone DiseaseWhat are Gallstones Just under your right rib cage (about 4 inches down from your right nipple towards your feet) sits a couple of organs called the liver and the gallbladder. Your gallbladder sits tucked away under your liver and is about the size of your two thumbs put together. It has the job of storing this stuff that the liver makes called bile. Bile is released from the gallbladder into your intestines (the place where food is broken down and absorbed) every time you eat a meal as it has the job of helping your body break up any fats that you eat so they are easier to digest. Bile itself is made up of a few ingredients; one of which is cholesterol. As the bile sits in the gallbladder this cholesterol can bind up and stick together forming micro crystals, or in other words small stones. As time goes on more and more cholesterol sticks together until you can have a pretty nice sized gallstone. Gallstones are actually very common. In fact, upwards of 20% of all people over the age of 65 years have gallstones. That means if you took any 5 people off the street over the age of 65 one of them would have gallstones. What causes Gallstone Disease Gallstones are most common in people who fit into one or more of the Four F’s: 1) Fat (being overweight increases your risk...skinny people can still get them). 2) Forty (advanced age increases your risk…young people can still get them). 3) Fertile (pregnancy increases your risk). 4) Female (women are more likely to form gallstones…men can still get them). What are some things people with Gallstones experience Most people with Gallstones are what doctors call asymptomatic. This means they don’t feel anything. In fact, only around one in ten people with gallstones actually have symptoms from them. For most people, the stones just sit in their gallbladder and do not cause any problems. When people do have symptoms from their gallstones it is usually the result of 1) the stone getting stuck in the cystic duct or common bile duct or 2) the gallbladder squeezing down on the stone as it tries to push out bile. The two “ducts” just mentioned are just the pipes that take bile from the gall bladder into the intestines. As the gallbladder flexes its muscles trying to squeeze out bile to help digest food, these stones can get pushed out with it. The problem with this is they can be bigger then the pipes carrying them and they can get stuck. As a result everything gets backed up behind them and can lead to problems. Similarly, big enough stones just sitting in the gallbladder can be painful. Imagine having a rock in your hand and having to squeeze it for hours each and every day. Eventually your hand would get pretty sore and irritated, just like a gallbladder. This pain experienced from bigger stones sitting in the gallbladder is called Biliary Colic. This is just a fancy term for pain you get in the top, right portion of your belly after eating meals due to the gallbladder squeezing onto stones. Gallstones can also cause a few other problems: 1) Acute Cholecystitis- This broken down is sudden inflammation of your gallbladder. Inflammation is when things get swollen, red, hot and painful. Acute cholecystitis happens when a gallstone blocks the ducts (pipes) for too long. People with this often have this right, upper belly pain along with fever, nausea (sick feeling) and vomiting (throwing up). 2) Pancreatitis- This is inflammation of your pancreas. Your pancreas is another organ in your belly that makes things called enzymes that help break down all the food you eat (along with the bile). The pancreas normally releases its enzymes into your intestines after you eat. The problem with gallstones, however, is that the pancreas uses some of the same pipes your gallbladder does to get to the intestines. As a result a gallstone can cause a back up of enzymes from the pancreas and lead to this very painful disease. When pancreatitis is caused by gallstones it is called, believe it or not, Gallstone Pancreatitis. 3) Cholangitis- This is a potentially deadly inflammation of all of the pipes connecting your liver, gallbladder and pancreas; called the biliary tree. This is caused by a gallstone getting stuck in the ducts as well. How is Gallstone Disease diagnosed Like almost everything in medicine, one of the easiest ways doctors diagnose Gallstone disease is by listening to the story you tell them. If you have pain in the right, upper part of your belly after eating fatty meals and also mention occasional nausea and back pain with it a big red flag yelling Gallstones should be going off in your doctor’s head. Along with your story, doctors have several tests they can run to help find gallstones. The first test usually performed is called an Ultrasound. Everyone is very familiar with ultrasounds as they are so common in pregnancy and are used to see the baby. Rather then looking at the baby’s head or feet, these ultrasounds can find stones in your gallbladder and even in those ducts (pipes) we talked about. Ultrasound is the best way to find and diagnose gallstones. Another test called a HIDA scan can also be used. In this test a dye is injected into your ducts and a picture is taken after. This dye lights up and can show doctors a map of all your ducts (pipes). Because almost everyone has the same set-up to these ducts, your doctor can see if one is blocked off by a stone as the dye does not get there and nothing lights up. Finally several blood tests can also be run, including alkaline phosphatase and Bilirubin. These are really not important for you to understand your disease. All you need to know is that if you have Gallstone Disease these blood tests will be higher then they should. How is Gallstone Disease treated If you are asymptomatic with your gallstones (do not notice anything) you don’t have to do anything to treat this. However, once you begin to have pain with eating meals or develop one of the other things we talked about (pancreatitis, cholecystitis, cholangitis) from your gallstones the best and really only treatment is to take out your gallbladder. This surgery is called Cholecystectomy…or in English, “removal of your gallbladder.” Recall your gallbladder only stores the bile and does not make it. So after having it taken out you will really don’t miss it. Your liver can still make bile to help break up and digest fats. | |
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