Gallstones

Gallstones, also known as cholelithiasis, are hard deposits that form inside the gallbladder.

The gallbladder is an organ of the digestive system located below the liver. The gallbladder serves to store bile, a digestive fluid produced by the liver, and release it into the small intestine to aid in the absorption and digestion of fats.

Although the gallbladder is not considered a vital organ, as it is possible to live without it, its removal, known as cholecystectomy, can result in slower and heavier digestion.

Gallstones, are formed through the combination of various substances, including cholesterol, bilirubin, protein, and mucin. Depending on the predominant substance, gallstones can be classified into several types:

• Cholesterol stones: These are the most common type of gallstones in developed countries, and they typically form when there is an imbalance in cholesterol metabolism, often due to inadequate nutrition.
• Bilirubin stones: These stones form when there is an excessive breakdown of red blood cells (hemolysis), leading to the release of bilirubin which accumulates in the bile ducts and can precipitate into bilirubin stones.
• Mixed stones: These stones are formed by a combination of various substances, such as calcium salts and other substances, and they do not have a single predominant component.

Several risk factors have been identified for the formation of gallstones, including:

• Family history: Having a family history of gallstones increases the risk of developing gallstones.
• Age and gender: Gallstones typically affect people over the age of 40, with a higher prevalence in women. In industrialized countries, gallstones are commonly associated with excess cholesterol, whereas in other regions, bacterial or helminthic infections (parasitic worms) may play a role.
• Obesity and metabolic syndrome: Obesity and metabolic syndrome, which is a cluster of metabolic risk factors, including abdominal obesity, high blood pressure, high blood sugar levels, and high triglycerides, are associated with an increased risk of gallstones.
• Diet: Diets high in saturated fat and carbohydrates, and rapid weight loss methods, such as crash diets or bariatric surgery, can increase the risk of gallstone formation.
• Medications: Certain medications, such as oral contraceptives (birth control pills), fibrates (used to lower cholesterol), thiazide diuretics (used to treat high blood pressure), and antibiotics, may promote the formation of gallstones.

Gallstones are often asymptomatic, with approximately 80% of people not experiencing any symptoms. However, a small percentage of individuals with gallstones may present with symptoms and associated complications, which can include:

• Moderate pain in the right hypochondrium: This is discomfort or pain in the upper right area of the abdomen, below the ribs, where the gallbladder and liver are located. The pain is typically triggered after the intake of fatty meals.
• Non-specific abdominal discomfort and gastric burning.
• Jaundice (yellowing of the skin and eyes, due to an excess of bilirubin in the blood).
• Nausea, vomiting, and sweating.
• Fever if complicated by cholecystitis (gallbladder infection).

Diagnosis of gallstones is primarily based on imaging tests, and laboratory tests are often used to complement the diagnosis and rule out other possible causes. Some commonly used diagnostic tests for gallstones include:

• Biochemical analysis, complete blood count, liver profile, and bilirubin.
• Ultrasound: the most used test to confirm the presence of gallstones.
• Endoscopic ultrasound (invasive procedure).
• Abdominal X-ray (less commonly used).
• Computed tomography (CT) and magnetic resonance imaging (MRI).

The treatment of gallstones typically involves managing the acute phase of biliary colic pain and subsequently receiving medical treatment to prevent future recurrences and complications.

Acute phase of biliary colic:

• Intravenous hydration.
• Analgesics or pain relief medications such as anti-inflammatories and opioids.
• Antiemetics (to relieve nausea and vomiting).

Medical treatment of gallstones:

• Laparoscopic cholecystectomy: This is the most common surgical technique used to remove the gallbladder.
• Open surgery: It is less commonly used nowadays.
• Ursodeoxycholic acid (UDCA), also known as ursodiol: It may be used as a medical treatment option in cases where surgery is not possible or ruled out. It is used to promote the dissolution of cholesterol stones in patients who meet certain criteria, such as having smaller stones (less than 1 cm), moderate symptoms, and good gallbladder function.
• Low-fat diet.

In general, gallstone disease (lithiasis) has a favorable prognosis. However, in a small percentage of patients, it can be complicated by acute cholecystitis, which is an infection of the gallbladder. This may require intravenous antibiotics and urgent surgical intervention to manage the infection effectively.

Another potential complication of gallstones is severe acute pancreatitis, which is inflammation of the pancreas. This condition may necessitate hospital admission for proper management and treatment.