Overview
Gallstones are hardened deposits formed in the gallbladder when substances like cholesterol or bilirubin crystallize. In our country, 15% of women and 5% of men have gallstones.
Stones can be as small as a grain of sand or as large as a golf ball. Most people have no symptoms (silent stones); however, they cause serious problems when they block the bile ducts.
Types of Stones
- Cholesterol stones (80%) — yellow-green
- Pigment stones (20%) — contain bilirubin, dark color
Symptoms
Usually asymptomatic. When a stone moves and blocks the bile ducts:
- Biliary colic: Severe pain in the upper right abdomen
- Pain usually lasts 30 minutes to a few hours
- Pain radiating to the right side of the back, right shoulder
- Pain after fatty meals
- Nausea, vomiting
- Bloating, gas
- Indigestion
- Belching
- Loss of appetite
Complication symptoms:
- High fever, chills (cholecystitis, cholangitis)
- Jaundice (yellowing of eyes, skin)
- Dark urine
- Pale, clay-like stools
- Severe abdominal pain
- Change in consciousness
Causes
Excess accumulation of cholesterol or bilirubin in bile, inability of the gallbladder to empty adequately.
Risk Factors
4F rule:
- Female
- Fat (obesity)
- Forty (over 40)
- Fertile (reproductive age)
Other factors:
- Family history
- Pregnancy
- Birth control pills
- Hormone replacement therapy
- Rapid weight loss or weight cycling
- High-fat, low-fiber diet
- Diabetes
- High cholesterol
- Crohn's disease
- Liver cirrhosis
- Some blood diseases (sickle cell anemia)
- Some medications (estrogen, fibrates, octreotide)
- After bariatric surgery
Complications
- Cholecystitis: Gallbladder inflammation
- Cholangitis: Bile duct inflammation (life-threatening)
- Pancreatitis: Pancreas inflammation
- Obstructive jaundice
- Gallbladder perforation
- Gallbladder cancer (long-term risk)
- Ileus (intestinal obstruction)
- Mirizzi syndrome
When to See a Doctor
Scheduled:
- Recurring right upper abdominal pain
- Complaints after fatty meals
- Persistent indigestion, nausea
Emergency:
- Severe, persistent abdominal pain
- Fever + abdominal pain
- Jaundice
- Severe nausea, vomiting
- Bloody vomiting
- Change in consciousness
- Signs of shock
Diagnosis and Treatment
Diagnosis:
- Abdominal ultrasound (gold standard, 95% sensitive)
- Blood tests: Liver enzymes, bilirubin, white blood cells, amylase, lipase
- MRCP (magnetic resonance cholangiopancreatography)
- ERCP (both diagnostic and therapeutic - if bile duct stones)
- HIDA scintigraphy (gallbladder function)
- CT (if complications)
Treatment:
1. Asymptomatic stones:
- Usually follow-up
- Surgery not required (except in special cases)
2. Symptomatic stones:
- Cholecystectomy (gallbladder removal) — mainstay treatment
- Laparoscopic: Standard, small incisions, rapid recovery
- Open surgery: In complicated cases
- ERCP: For stones in the bile duct (endoscopic)
- Stenting for blocked bile ducts
3. For those who cannot undergo surgery:
- Ursodeoxycholic acid (can dissolve stones, limited effect)
- Shock wave lithotripsy
4. Complication treatment:
- Antibiotics (cholecystitis, cholangitis)
- IV fluids
- Emergency intervention with ERCP
- Surgery
Prevention
Nutrition:
- Healthy, balanced diet
- High fiber (vegetables, fruits, whole grains)
- Healthy fats (olive oil, fish, nuts)
- Low saturated fat
- Less sugar, less processed food
- Less red meat
- Coffee consumption (moderate, protective)
Weight management:
- Maintain a healthy weight
- Do not lose weight rapidly (0.5-1 kg per week)
- Avoid extreme diets and fasting
- Regular meal habits
Lifestyle:
- Regular exercise (150 min per week)
- Active life
Medical:
- Manage diabetes
- Treat high cholesterol
- Follow-up after bariatric surgery
- Regular check-up if family history exists
- Discuss with your doctor if you use hormone therapy