Gallstones - Symptoms, Causes, Treatment, Types & More

The gallbladder, a pear-shaped organ beneath the liver, stores bile (digestive fluid) and releases it into the small intestine during digestion. The stones are solidified accumulations of digestive fluid that may develop within the gallbladder. 

It may vary in size, from tiny particles resembling grains of sand to large spheres comparable to golf balls. While a gallstones diagnosis may sometimes show a single gallstone for some individuals, others may form multiple stones simultaneously.

There exist two primary categories of stones in the gallbladder. They are cholesterol stones and bilirubin stones. Let us understand them below:

1. Cholesterol Stones: These are the most prevalent type. They do not appear on CT scans but can be detected via abdominal sonograms (ultrasounds).

2. Bilirubin Stones: Also known as pigment stones, these form when excessive bilirubin is present in bile due to the breakdown of RBC (red blood cells).

Gallbladder Stones Grade

The PGS grades cholecystitis (gallbladder inflammation) and helps in predicting the complexity of gallbladder stone surgery by the surgeon. The above table categorises gallbladder conditions from Grade 1 (no adhesions) to Grade 5 (gallbladder perforation or tissue death).

Some individuals with silent stones in the gallbladder may not exhibit any symptoms. These stones do not impede the function of the gallbladder, liver, or pancreas and don't require gallstone treatment. However, sometimes gallstone pain can be excruciating when they obstruct the biliary tract:

• Persistent, intense pain in the upper abdomen that escalated quickly. It can endure for periods ranging from 30 minutes to several hours.

• Pain in the right shoulder and back

• Nausea and vomiting

• Fever and chills

• Jaundice, characterised by yellowing of the skin or eyes

• Gastric symptoms like abdominal bloating, indigestion, belching or excess gas

• Inability to tolerate fatty foods

Gallbladder stones are mainly caused due to changes in the bile. However, researchers cannot precisely predict the reasons behind these modifications. Here are some specific gallstones causes of this condition:

1. Excess Cholesterol: When the bile contains more cholesterol than can be dissolved, it can form cholesterol stones.

2. Bilirubin: High bilirubin levels in bile can contribute to the formation of pigment stones.

3. Incomplete Emptying of the Gallbladder: If this organ fails to empty due to a lack of fibre or water intake, it can contribute to the formation of stones in the gallbladder.

Risk Factor of Gallbladder Stones

Gallbladder stones pose different risks, some of which are not easily visible. Some such risk factors associated with gallbladder stones include:

Modifiable Risks

1. Obesity: A significant risk factor for stones in the gallbladder, especially notable in women.

2. Cholesterol-lowering Drugs: Medications to reduce blood cholesterol can boost bile cholesterol secretion. This can increase gallstone risk.

3. Diabetes: Diabetics often have elevated triglyceride levels, elevating gallstone risk.

4. Rapid Weight Loss: During rapid weight loss, the liver releases excess cholesterol into bile, promoting gallstone formation.

5. Fasting: It slows gallbladder movement, leading to cholesterol over-concentration in bile.

6. Oestrogen: Excess oestrogen, whether from pregnancy, hormone therapy, or birth control, raises bile cholesterol levels. This, in turn, reduces gallbladder activity, increasing gallstone risk.

Non Modifiable Risks

• Gender: Women are twice as prone to gallbladder stones as men.

• Age: Individuals over 60 years of age face higher gallstone risks compared to younger age groups.

Prevention of Gallbladder Stones

One can take a few measures to lessen the occurrence of stones in the gallbladder. Follow these guidelines to avoid developing stones in the gallbladder:

1. Maintain regular meal times and don't skip meals. Irregular eating patterns or fasting can heighten the risk of gallbladder stones.

2. If individuals need to shed pounds, they must do so gradually. Sudden weight loss can elevate the chances of stones in gallbladder. Aim for a loss of 1 or 2 pounds (0.5 to 1 kilogram) per week.

3. Increase the intake of high-fibre foods like fruits, vegetables, and whole grains.

4. Keep a healthy weight because being overweight or obese is associated with a higher risk of gallbladder stones. It can be achieved by reducing calorie intake and increasing physical activity. Once the target weight is reached, maintain it by sustaining a balanced diet and staying active.

The healthcare provider may examine if a person feels persistent or recurring pain in the abdomen or neck. Below is the gallbladder diagnosis:

1. Ultrasound: This method utilises high-frequency sound waves to produce images of internal organs.

2. Cholecystography: An X-ray procedure that reveals the movement of contrast fluid from the intestines into the gallbladder.

3. Blood Tests: These examinations evaluate for signs of infection, obstruction, jaundice, and/or pancreatitis.

4. Computed Tomography Scan (CT or CAT scan): A diagnostic imaging technique that merges X-rays with computer technology. CT scans excel at detecting gallstones that contain calcium. These stones appear bright white on the scan and are easily distinguishable from surrounding tissues.

5. Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure involves inserting an endoscope (a viewing tube) through the stomach into the small intestine. Then, a special dye is administered to see the ducts within the biliary system.

6. Sphincterotomy: It widens the sphincter muscle, a ring-like muscle surrounding a natural opening acting as a valve. This eases the passage of stones into the intestine.

How do you prepare for a doctor consultation?

Certain aspects must be considered when preparing for a gastroenterologist doctor consultation for gallbladder stones. This ensures that the patient gets the most out of their visit. Here's how one can prepare:

• Collect all the medical records and any relevant test results.

• Request a family member to accompany you.

• Prepare a list of all current medications or supplements.

• Note down the symptoms, pain areas and the severity of pain. 

• Write down any questions for the doctor.

Questions to ask the doctor

When consulting a doctor about gallbladder stone surgery, having a well-prepared list of questions is essential. This will allow people to understand their condition and the available treatment options. 

1. What is the severity or grade of the gallbladder stones? 

2. What are the available treatment options?

3. What is the recommended course of action? 

4. What are the potential side effects of these treatments? 

5. How will this affect my daily life?

If gallbladder stones are symptomatic, it's essential to contact a doctor. Even if these symptoms subside, they may reoccur, necessitating treatment. The typical approach for managing gallstones involves the following: 

Nonsurgical Treatments

Nonsurgical options are reserved for specific situations, such as when surgery is contraindicated due to severe medical conditions. However, gallstone pain may still recur even with treatment, requiring ongoing or lifelong management. These may include:

1. Endoscopic Retrograde Cholangiopancreatography (ERCP): Used to remove stones in the gallbladder stuck in the common bile duct.
2. Oral Dissolution Therapy: Medications containing bile acids, such as Ursodiol and Chenodiol, can help dissolve small cholesterol stones over months or years.
3. Shock Wave Lithotripsy: Occasionally used to break the stones in the gallbladder into smaller fragments, sometimes in combination with oral dissolution therapy.

Ayurvedic Treatment for Gallbladder Stones

Certain ayurvedic therapies detoxify the liver and gallbladder, boost bile flow, dissolve stones, and aid digestion. These therapies include:

1. Panchakarma: Includes vamana, virechana, basti, nasya, and raktamokshana to eliminate toxins and restore organ health.

2. Liver Flush: This procedure involves olive oil, lemon juice, and spices to stimulate gallbladder contraction and cleanse the liver.

3. Hot Pack: Apply heat or a castor oil compress to the gallbladder area to reduce inflammation, pain, and spasms and enhance blood circulation and bile flow.

Ayurvedic medicines can also help detoxify and improve the liver and gallbladder health. These medicines include:

1. Shankavati: Contains shankha bhasma, trikatu, triphala, and other herbs to reduce acidity, inflammation, pain, dissolve stones, and prevent infections.

2. Sootasekar Ras: This supplement includes purified metals and herbs that enhance liver and gallbladder function, aid digestion, and dissolve stones.

3. Pravaalpanchaamrit: Balances Pitta, reduces inflammation and gallbladder pain, and prevents stone recurrence.

4. Hingwaashtak Choorna: A powder blend of hing, shunthi, maricha, pippali, ajmoda, saunf, jeera, and saindhav lavan to enhance digestive fire, reduce gas, stimulate gallbladder and liver, improve bile flow, and dissolve stones.

5. Avipattikar Choorna: Powder with trikatu, triphala, vidanga, musta, ela, lavang, patra, trivrit, and sharkara. It reduces acidity, inflammation, gallbladder pain, cleanses liver and gallbladder, improves digestion, and dissolves stones.

Homoeopathic Treatment for Gallbladder Stones

Several medicines in homoeopathic Materia Medica are effective for gallstone disease. Some notable ones include:

• Berberis vulgaris

• Calcarea carbonica

• Carduus marianus

• China

• Chamomilla

• Chionanthus

• Lycopodium

• Veratrum album

Gallbladder Surgery Options

Cholecystectomy, the surgical gallbladder removal, is a standard gallstone procedure. Since it is not an essential organ, its removal doesn't significantly impact normal bodily functions.

Once the gallbladder has been removed, the bile will flow directly from the liver, hepatic duct and common bile duct into the duodenum, bypassing the gallbladder. Cholecystectomy is commonly of two types:

1. Laparoscopic Cholecystectomy: This minimally invasive procedure is preferred by most surgeons and is often performed on an outpatient basis. This allows patients to return home the same day. Recovery time is typically about a week.
2. Open Cholecystectomy: This procedure is performed when the gallbladder is severely inflamed, infected, or scarred from previous surgeries. Hospitalisation may take up to a week, with full recovery taking about a month.

Note: The gallbladder stones treatment approach may be selected based on a patient's condition, symptoms and doctor's opinion.

The minimum cost of laparoscopic cholecystectomy in India is ₹40,000, with costs varying among hospitals and centres due to several factors. On average, this procedure costs around ₹65,000, but prices can range up to ₹80,000.

Delaying treatment for gallbladder stones can lead to recurrent pain. However, there are some more complications associated with the delay. These are:

1. Stone Slipped Into CBD: Stones may move from the gallbladder and block a bile duct. This may result in intense abdominal pain radiating to the upper back, lasting from minutes to hours.

2. Biliary Tract Blockage and Inflammation: Prolonged blockage in the gallbladder duct can cause inflammation (cholecystitis). This may manifest as fever, infection, and pain.

3. Gallbladder Tissue Necrosis and Infection: Untreated cholecystitis can progress to gallbladder tissue death, potentially leading to serious conditions. These may include empyema (a pus-filled cavity in an organ), gangrene (death of body tissue due to a lack of blood supply), perforation, and sepsis (organ dysfunction).

4. Common Bile Duct Obstruction: Gallbladder stones passing into the common bile duct can obstruct it, resulting in choledocholithiasis.

5. Jaundice: Stones in the gallbladder can block bile flow, causing jaundice. This is characterised by yellowing of the eyes and skin, dark urine, and pale stools.

6. Pancreatitis: Gallbladder stones may obstruct the pancreatic duct, causing severe pancreatitis and worsening abdominal pain.

When to consult a doctor?

Schedule a consultation with the doctor when experiencing any concerning gallstone symptoms or signs. Here are situations that call for medical attention:

• If the temperature exceeds 101 F

• Urinary discharge with a thick, yellow, or green hue

• If surgical wounds exhibit bleeding, redness, warmth

• When pain persists despite medication

• Difficulty in breathing or a persistent cough

• Yellowing of the skin or eyes

• Grey or pale stools

"I frequently see gallstones, especially in patients with diets high in refined carbohydrates and saturated fats. Obesity, rapid weight loss, and genetic factors also contribute significantly. To reduce the risk of gallstone formation, I encourage my patients to eat a balanced fibre-rich diet, maintain a healthy weight, and engage in regular physical activity."

- Dr Vasudevan KR
Liver transplant, Gastro Surgeon

To reduce the chances of developing stones in the gallbladder, adopt a diet rich in nutrients and indulge in more physical activities. It is essential to achieve and sustain a healthy weight. Health experts advise the following strategies for gallstone prevention:

1. Fibre-rich Diet: Increase consumption of fibre-rich foods such as fruits, legumes, vegetables and whole grains like brown rice, oats, and whole wheat bread. This reduces the chance of cholesterol in bile crystallising and forming gallstones.

2. Decrease Sugar Intake: Refined carbohydrates and sugar can cause rapid swings in blood sugar levels. This might trigger the liver to produce more cholesterol, which can contribute to gallstone formation.

3. Healthy Fats: Incorporate fish oil and olive oil into a regular diet to promote regular contraction and emptying of the gallbladder.

4. Avoid Unhealthy Fats: These are commonly found in desserts and fried foods. Unhealthy fats can increase cholesterol levels in bile, promoting gallstone formation.

Before making any alterations to dietary habits, consult with a healthcare provider. Rapid weight loss can pose health risks, so it's essential to approach weight management cautiously. 

Gallbladder stones are small, pebble-like objects that can cause significant harm if they enter narrow passages in the biliary system. Experiencing a gallstone attack can be distressing. Nonetheless, gallbladder removal is a routine procedure with an excellent prognosis. 

For those experiencing Gallbladder stone symptoms, surgery is an effective procedure that helps resolve this condition. At HexaHealth, we specialise in assisting patients experiencing gallstone symptoms by connecting them with expert doctors for optimal care. We help facilitate timely diagnosis, treatment and also offer comprehensive support throughout their treatment.  

Read Also

• How to Remove Gallstones Naturally
• Difference Between Kidney Stone and Gallstone
• Side Effects of Gallbladder Removal