Gallstones: Test Your Medical IQ

Gallstones are small stones that form inside the gallbladder. Most of the time gallstones do not have any symptoms, but when symptoms do occur they may include:

• Abdominal pain, commonly on the right side just below the rib cage, or in the upper middle abdomen
• Nausea and vomiting
• Pain in the back or referred pain to the back of the right shoulder

Risk factors for developing gallstones include:

• Age over 40
• Family history
• Being female
• Pregnancy
• Taking estrogen
• Obesity
• High fat or high cholesterol diet
• Rapid weight loss (including patients who have had weight loss surgeries)
• Diabetes
• Fasting often
• Sedentary lifestyle
• Sickle cell disease
• Cirrhosis of the liver
• Certain medicines

A gallbladder attack refers to symptoms of gallstones and can often happen after eating a fatty meal. The most common sign of a gallbladder attack is pain in the upper right abdomen, just under the rib cage. Pain may also be felt in the upper center of the belly, or in the lower chest.

Other symptoms of a gallbladder attach include:

• Nausea and vomiting
• Pain in the right shoulder or back
• Fever or chills
• Yellowish skin or eyes (jaundice)
• Tea-colored urine and light-colored stools

Gallstones themselves are not usually serious. In most cases people have no symptoms. But in rare cases they can result in serious problems, such as:

• Gallbladder infection
• Inflammation of the pancreas
• Jaundice (yellowish skin and eyes)
• Blockage of the bile ducts and liver
• Tears in the gallbladder, which can be fatal

Gallstones are typically diagnosed by use of ultrasound imaging. This is a painless test that uses high-frequency sound waves to create an image of the gallbladder and to see if stones are present.

However, since gallstones often do not cause symptoms, it is possible symptoms may be a result of another condition and a doctor may order other tests to determine the cause of your symptoms.

If you have gallstones but no symptoms, you do not need treatment. When needed, choosing a treatment depends on how severe your symptoms are and how large the stones are.

Medications may help break up the gallstones while keeping the gallbladder. Medications are only effective on some types of gallstones, and they can take a long time to work. Shock wave therapy can also be used to help break up the stones while preserving the gallbladder. Stones often recur after using medications or shock wave therapy.

Surgery to remove the gallbladder (cholecystectomy) may be recommended. Gallstones do not come back if the gallbladder is removed. Some people may have more frequent bowel movements following gallbladder removal surgery.

Small gallstones can sometimes pass on their own. If stones are small enough, they may exit the gallbladder and pass through the bile ducts, into the intestine, where they are then excreted in your stool.

When gallstones become stuck in the gallbladder or bile ducts they can cause pain, obstructions, and infections.

If gallstones are not treated, they can get bigger and may lead to complications such as:

• Acute cholecystitis – when a stone blocks a bile duct, this can lead to a build-up of bile in the gallbladder, which can result in infection and inflammation
• Pancreatitis – A gallstone blocks the opening of the pancreas, causing inflammation
• Acute cholangitis – When bile ducts become blocked, they can become infected
• Jaundice (yellowing skin and eyes) – if a stone passes out of the gallbladder and into a bile duct, it can block the flow of bile

To help prevent gallstones, eat a high fiber diet including:

• Fruits and vegetables
• Beans
• Whole grains
• Healthy fats (such as fish oil and olive oil)

• Refined carbohydrates
• Sugary foods
• Fried foods

Gallstones may be prevented in some cases by:

• Eating high fiber diet, low in sugar and refined carbohydrates
• Maintaining a healthy weight. If you plan to lose weight do so slowly and safely (rapid weight loss can lead to gallstones).
• Exercise regularly
• Get adequate vitamin C