What you should know about gallstones

The gallbladder is a small, pear-shaped organ that is found just under the liver in the right upper belly. It is connected to the liver and the intestine through small tubes.The primary purpose of the gallbladder is to store and concentrate bile, a greenish-brown fluid that is produced by the liver. Bile is needed to digest and absorb fatty foods, and to absorb some important fat soluble vitamins.

Between meals, the gallbladder is relaxed and bile flows into the gallbladder, where it is stored and concentrated. With meals, fatty foods in the small intestine cause the gallbladder to contract (squeeze) and partially empty into the intestine. A few hours later, the gallbladder relaxes and begins to store bile again.

Gallstones are small stones (usually made out of mostly cholesterol, and others bilirubin- a product of red blood cell breakdown) that form inside the gallbladder. They can be tiny specks or get as big as up to 6 inches long. These gallstones can also pile in the tube that drains bile to the intestines causing blockage of bile flow

There is no one specific cause for these gallstones but a number of factors can increase ones risk of suffering from gallstones. These include; Female sex, as gallstones is more common in women than men. The risk of gallstones increases with age hence the condition is extremely rare in children and becomes progressively more frequent over time, especially after age 40 years. Gallstones are also more common in certain families; hence genetics has a role in gallstone development. Pregnancy, use of medicines that contain estrogen (such as birth control pills), obesity, frequent fasting, rapid weight loss (including patients who have surgical weight loss treatments), sedentary lifestyle, diabetes mellitus, sickle cell disease, use of certain medications, etc. are also known to increase ones risk of developing gallstone.

In most cases, initially the gallstones do not cause any symptoms. When they do cause symptoms, gallstones can cause; belly pain, which is often on the right side just under athe rib cage or less commonly in the middle top portion of the belly and some pain usually also felt at the right shoulder. Nausea and vomiting is a very common complaint in people with gallstone disease and this usually gets worse shortly after eating fatty meals. These symptoms can come and go, but they often get worse over time. The person might develop yellow colouration of the eyes, usually associated with generalized skin itching which can be uncomfortable for the person and at times interfering with ones sleep.

The diagnosis of gallstones is made by taking the patient’s detailed history of their illness, physical examination and investigations are done to confirm presence of gallstone and exclude other diseases with similar symptoms.

An ultrasound scan of the abdomen with focus to the gallbladder is often done and can help to visualize the gallbladder and any stones either inside the gallbladder or along the tube that drains bile from the gallbladder to the intestines. Blood samples are taken for laboratory tests to confirm if the gallstones are most likely causing bile flow obstruction.

Other investigations may be done to exclude other causes of bile flow obstruction such as cancer of the pancreas.

Treatment for gallstones depends on the severity of the condition. For someone with no symptoms to mild symptoms, the doctor might decide not to give any treatment and observe the patient for some time. The patient works upon the modifiable risk factors for progression of gallstones by; doing regular physical exercises, drinking plenty of water, low fat diet meal, avoiding prolonged fasting, and good control of sugar levels if diabetic.

There are medicines which can be given to dissolve these gallstones, although it may take a long time for these stones to completely dissolve, and the rate of recurrence in future is still high.

Surgery to remove the gallbladder and the gallstones can be performed. The gallbladder is an important organ, but you can live without it. Removing the gallbladder does not usually cause serious complications. Symptoms after gallbladder removal might include; loose stools, gas, and bloating and in most people these symptoms are only mild and do not require treatment, and improve with time.

Dr. Ian Shyaka is a
General Practitioner at Rwanda Military Hospital
iangashugi@gmail.com