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What are gallstones? 

Gallstones are small pebble-like substances that develop in the gallbladder. The gall bladder is a small pear-shaped sack located just below the liver in the right upper portion of the abdomen. Gallstones happen when the liquid (bile) in the gallbladder hardens into pieces of stone-like material. Bile is important in that it helps the body digest fats. Bile is made in the liver and stored in the gallbladder until the body needs it. The gallbladder contracts and releases the bile in a tube-like structure called the common bile duct which carries the bile to the small intestines where it helps with the digestion of food. 

Bile contains:

• water
• cholesterol
• fats
• bile salts 
• proteins
• bilirubin (a waste product)

Bile salts break up fat, and bilirubin gives bile and stool a yellowish-brown color. If the liquid bile contains too much cholesterol, bile salts or bilirubin, it can harden into stones within the gallbladder (gallstones) and or common bile duct stones. 

There are two types of gallstones: Cholesterol and Pigment stones. Cholesterol stones are usually yellow -green and are made primarily of hardened cholesterol. They account for about 80% percent of gallstones. Pigment stones are small, dark stones made of bilirubin. 

Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop one large stone or hundreds of tiny stones or a combination of the two. Gallstones can block the normal flow of bile if they move from the gallbladder and lodge in any of the ducts that carry bile from the liver to the small intestines. 

The ducts include the: Hepatic duct (carry bile out of the liver) Cystic duct (takes bile to and from the gallbladder. Common bile duct (takes bile from the cystic and hepatic ducts to the small intestines. Bile trapped in these ducts can cause inflammation in the gall bladder, the ducts, or in rare cases, the liver. Other ducts open into the common bile duct including the pancreatic duct, which carries digestive enzymes out of the pancreas. Sometimes gallstones passing through the common bile duct provoke inflammation in the pancreas which is called gallstone pancreatitis a potentially dangerous and extremely painful condition. If any of the bile ducts remain blocked for a significant period, severe damage or infection can occur in the gallbladder, liver or pancreas. Left untreated, the condition can cause death. 

Warning signs that a serious condition exist include: 

• Fever
• Jaundice
• Persistent upper abdominal pain. 

What causes gallstones? 

Cholesterol stones form when bile contains too much cholesterol, too much bilirubin, not enough bile salts or when the gallbladder does not empty completely or often enough. Pigment stones are not fully understood however, these stones tend to develop in people who have liver cirrhosis, biliary tract infections, or hereditary blood disorders such as sickle cell anemia in which the liver makes too much bilirubin.

Who are at risk for gallstones? 

Women develop gallstones as result of excess estrogen from pregnancy, hormone replacement, and birth control pills. Gallstones often run in families indicating a possible genetic link. Being overweight increases the risk for developing gallstones. This is possibly due to the reduction of bile salts in the bile, resulting in more cholesterol production which reduces gallbladder emptying resulting in gallstones. High fat, cholesterol, and low fiber diets causes an increase of cholesterol in the bile which reduces gallbladder emptying and the risk of gallstones. Rapid weight loss can lead to gallstones. People age 60 and above are more likely to develop gall stones. American Indians, Pima Indians, and some Mexican Americans are more genetically predisposed to develop gallstones. Cholesterol lowering drugs increase bile secretion of cholesterol and risk of gallstones. Some people with diabetes have high fatty acids in the form of triglyceride which increase the risk of gallstones.

Symptoms associated with gallstones. 

• Pain- steady pain in the right upper abdomen that increases rapidly and last for 30 minutes to several hours
• Pain in the back between the shoulder blades. 
• Pain under the right shoulder

Notify your physician if you think that you have experienced a gallbladder attack. Even though these attacks often pass as the gallstones move, the gallbladder can become infected and rupture if a gallstone blockage occurs. 

Notify your physician if you experience: 

• Prolonged pain (more than 5 hours). 
• Nausea and vomiting. 
• Fever and or chills. 
• Yellow color to the skin or whites of the eyes. 
• Clay colored stools. 

Many people with gallstones have no symptoms; these stones are called silent stones. Silent stones do not interfere with gallbladder, liver, or pancreas function and often do not need treatment. How are gallstones diagnosed? Gallstones are frequently diagnosed while looking for other illness. When gallstones are suspected as the cause of symptoms, your physician will order an ultrasound exam (the most sensitive and specific test for gallstones). 

Other diagnostic tests include: 

• Blood tests. Blood tests are performed to look for signs of infection, obstruction, pancreatitis, or jaundice.
• Computerized tomography (CT) scan. The CT scan is a noninvasive x-ray that produces cross-section images of the body. The test may show gallstones or other complications such as infection, and or rupture of gallbladder or bile ducts. 
• Cholescintigraphy (HIDA scan). This test is performed by injecting a small amount of non-harmful radioactive material into the body which is absorbed by the gallbladder. The gallbladder is then stimulated to contract. The test is used to diagnose abnormal contraction of the gallbladder or obstruction of bile ducts. 
• Endoscopic retrograde cholangiopancreatography (ERCP). ERCP is used to locate and remove stones in the bile ducts. After light sedation, the physician inserts an endoscope (a flexible lighted tube with a camera attached). The tube is guided down the throat through the stomach and into the small intestines. A special dye is injected to visualize the stone better. The stone is captured in a tiny basket and removed with the endoscope. 

How should gallstones be treated? 

If you have gallstones without symptoms, you do not need treatment. If you are having frequent gallbladder attacks, you doctor will recommend that you have your gallbladder removed. This operation is called a cholecystectomy. Surgery to remove the gallbladder is one of the most common surgeries performed on adults in the United States. Many gallbladder surgeries are performed using a laparoscope and a very small video monitor that allows the physician to view the organs inside the body on a monitor outside the body. The surgeon dissects the gallbladder from the liver, bile ducts and other structures. The cystic duct is cut and the gallbladder is removed through one of the small incisions.