Gallstones

General information

Gallstones form in the gallbladder, a pear-shaped organ that is eight to ten centimeters long and three centimeters wide. The gallbladder is located in the right upper abdomen, against the front side of the liver. The liver produces bile, or gall, which is transported via small channels through the liver to the biliary system outside of the liver. Transported through the bile duct, the bile reaches the gallbladder. The gallbladder can store 30 to 60 ml of bile.

Gallstones are accumulations of crystals in the gallbladder or biliary system. Most gallstones in the biliary system come from the gallbladder. They are formed because of abnormal biliary system stenosis or because the gallbladder has already been removed. Gallstones in the biliary system can lead to an inflammation of the biliary system (cholangitis), the pancreas (pancreatitis) or the liver.

Gallstone causes

There are two types of gallstones:

• Cholesterol gallstones: usually yellow-green; about 80 percent of gallstones ae cholesterol gallstones.
• Pigment gallstones: These are smaller and darker and consist of bilirubin.

The following factors contribute to the formation of gallstones:

• Genetic factors
• Age (elderly patients) and sex (women)
• Diabetes
• Reduced contractility of the gallbladder
• Factors leading to elevated cholesterol levels, like estrogen, obesity and drastic weight loss
• Cholesterol medication: certain cholesterol-lowering agents are known to elevate the level of cholesterol in the gallbladder, increasing the risk of cholesterol gallstones.

Pigment gallstones are more likely to occur in patients suffering from certain medical conditions such as cirrhosis or blood disorders such as sickle cell anemia.

Gallstone symptoms and complaints

Gallstones don’t always come with visible or tangible symptoms. When symptoms are present, however, they usually include:

• pain in the upper abdomen and upper back, sometimes for several hours,
• nausea,
• vomiting,
• and/or other gastro-intestinal problems such as a bloated feeling and indigestion

Gallstones diagnosis

The following tests and examinations may be required for a proper diagnosis:

• Blood test to check for signs of infection or gallbladder obstruction and to rule out other conditions
• Ultrasound
• CT scan
• Magnetic resonance cholangiopancreatography (MRCP)
• Cholescintigraphy: this test involves a radio-active fluid to determine if the gallbladder is functioning properly.
• Echo-endoscopy: a combination of an ultrasound and an endoscopy
• Endoscopic retrograde cholangiopancreatography (ERCP)

Gallstone treatment

Usually, gallstones are treated by removing the gallbladder. Surgeons traditionally opted for an open cholecystectomy. Nowadays however, the procedure is performed laparoscopically (a laparoscopic cholecystectomy is carried out), which is much less invasive.

Laparoscopic cholecystectomy

This procedure involves making small incisions into the abdomen allowing surgical instruments, a light and a camera to be inserted. Observing his movements via a monitor, the surgeon removes the gallbladder. After the procedure, the patient must stay hospitalized for one night for observation.

Open cholecystectomy

An open cholecystectomy is a more invasive procedure where the surgeon makes an incision into the abdomen. Patients must stay hospitalized for several days after surgery.