Cholelithiasis (gallbladder stone): see symptoms and how to treat

What is cholelithiasis (gallbladder stone)?

Cholelithiasis is best known as the gallstone  and occurs when stones (stones) form in this organ or bile ducts.

Gallbladder is a small sac-shaped organ that sits just below the liver. It stores bile , a liquid that is poured into the intestine to aid in the digestion of fats that enter the body through food.

Despite being called a gallbladder stone, cholelithiasis can form stones outside the organ, in the ducts that lead to bile from the liver, where it is produced, to the organ that stores it and to the intestine.

These represent only 10% of the cases, so the most common (90% of the time) is that the stones actually form inside the vesicle, hence the name.

Bile is formed by several substances such as water, calcium, cholesterol and pigments such as bilirubin, which gives a yellowish color. It is produced by the liver and taken to the gallbladder, where the organ leaves it concentrated, absorbing water.

The vesicle is capable of storing around 50 mL of bile, which digests fat and cancels acids from food in the duodenum, the initial portion of the small intestine.

Most of the salts used in bile are reused by the body.

On some occasions, these concentrated materials can solidify, forming small stones inside the vesicle or in the ducts that connect it with other organs.

Types

There are 3 types of gallstones. Are they:

Cholesterol cholelithiasis

The most common type of gallbladder stone is cholesterol. Composed mainly of crystallized cholesterol, these stones have a yellowish appearance and represent 80% of the cases of the disease, and are also known as yellow stones .

Brown pigments

Composed of bilirubin , a substance produced by the liver as a pigment, these stones, in most cases, are small and darkened, being called brown stones . They are more frequent in the bile ducts than inside the gallbladder itself, but they can appear in it.

Calcium bilirubinate

This type is the second most common and is formed by bilirubin, salts and calcium. These stones are black and usually form directly in the gallbladder. They are more common in patients with cirrhosis and infections in the biliary tract.

Size

The stones in the gallbladder can have different sizes and their type does not prevent them from being very large or small. They can vary from the size of a grain of sand to that of a golf ball, occupying a large space in the gallbladder.

Causes

The stones in the gallbladder are formed due to an imbalance in the concentration of bile materials in the organ. The vesicle absorbs water from the bile, making it well concentrated within the organ, allowing it to store more.

The problem is that if too much water is removed or the amount of salts, cholesterol, calcium, bilirubin or other material is too large, the bile solidifies due to lack of water. That is how stones are formed.

What causes this imbalance is not known. It is known that some situations can facilitate the formation of gallstones, such as diseases related to the destruction of red blood cells (whose material is used to produce excess bile), but the mechanisms by which the imbalance affects the organ have not yet been identified.

Old billiards

Bile mud gets its name from being in a state between liquid and solid. Normally bile is liquid, but when too much water is removed, it starts to solidify and looks more like mud. Bile mud is the stage before stones and is a major risk factor for cholelithiasis, especially cholesterol.

Groups and risk factors

Although we do not know what the exact causes of gallstones are, we do know some risk factors that cause them to form more easily, and they are many. Among them are:

Age

After the age of 40, the chances of developing gallstones increase. They are even bigger after 60.

Women

Women are up to 3 times more likely to develop bladder stones  than men. This is believed to be due to estrogen, a female hormone.

After menopause , the chances of cholelithiasis affecting women approach that of men, as hormone production decreases.

Old billiards

Bile mud is bile in a muddy state, between solid and liquid. It is usually liquid, but when its concentration is higher than it should be and water is lacking, it can get thick and muddy.

In this state, it is not long before bile begins to form stones and this increases the chances of the development of cholesterol stones.

Chronic haemolytic anemia

The anemia chronic hemolytic is a disease that causes the premature destruction of red blood cells, causing lack of substance in the blood. The remnants of red blood cells are often used to make bile by the liver.

When many are destroyed in a short time, the liver ends up having a lot of material and the production of bile does not cease. The result is that the body accumulates bile, which increases the chances of stone formation.

Duodenal ulcers

The gallbladder knows when to release the bile when the fat comes into contact with the duodenum (the first portion of the intestine). In case of ulcers in the duodenum, the signal that there is fat in it may not be sent to the gallbladder.

Due to this lack of sensitivity in the duodenum (caused by the ulcer), bile can remain in the vesicle for a long time and stones can form.

Give us no duodenum

Like duodenal ulcers, any condition that affects the duodenum can have the same effect. This applies to cancers, surgeries that damage the nerves and any other type of damage to the organ.

Pregnant

During pregnancy the amount of estrogen in the female body is higher and therefore the chances of developing cholelithiasis increase. It is known that it is common to find bile mud in pregnant women.

Hormone replacement

Hormone replacement with estrogen also increases the chances of gallstones developing.

Diabetes

The diabetes increases the chances of developing stones in the gallbladder. This is because there is an increase in blood cholesterol with diabetes, and this excess substance can help form gallstones more easily.

Contraceptive use

Oral contraceptives use hormones to prevent pregnancy. Among these hormones estrogen is used, which increases the chances of gallstones arising.

Smoking

Tobacco smoke has the strongest effects on the airways and lungs, but it affects  the entire body , both because of the effects of its substances in the bloodstream and because of the smoke that also reaches the smoker’s stomach, albeit in a smaller amount. than in the lungs.

Smoking can increase the chances of several diseases and cholelithiasis is one of them. Gallbladder stones can arise in smokers.

High cholesterol

People with high amounts of cholesterol in the body may experience an overload of it in the gallbladder, which can unbalance the concentration of bile in the organ, thus increasing the chances of stones forming.

Rapid weight loss

Rapid weight loss can cause bile mud. The same applies to low-calorie diets used for long periods.

Obesity

The obesity is one of the main conditions linked to cholelithiasis in juventude.A amount of cholesterol and fats are directly related to the imbalance of bile concentration in the gallbladder.

Family history

Family history is a risk factor. If someone in your family has had gallstones, your chances of developing them also increase since genetics is a factor that can contribute to bile imbalance.

Five Fs

The five Fs are five of the main risk factors for cholelithiasis. They refer to the English words fertile, female, fat, forty and family . In Portuguese these words mean fertile, female, fat, 40 and family, referring to pregnancy, women, obesity, over 40 and family history, respectively.

Symptoms

Cholelithiasis often has no symptoms. This is because the stones may be too few and small for them to produce signs of their presence.

However, when there are large stones, many small stones, or when one of them enters the bile duct and blocks it, symptoms appear. They are as follows:

Biliary colic

Gallstones can cause severe pain when they block the pathway of the bile, causing an increase in the internal pressure of the gallbladder, which contracts by trying to push the bile out. Biliary colic is usually on the right side of the body.

This pain usually starts suddenly and intensely after eating fat and passes over the next hour, little by little.

Abdominal pain on the right side

Swelling of the organ can cause pain that spreads through the abdomen from the right side of the organ, where the gallbladder is. This symptom only appears in the most acute cases of the disease and can be accompanied by fever , chills and headaches.

Jaundice

Jaundice sets in when bilirubin accumulates in the tissues, leaving the person with a yellowish tinge. In the case of cholelithiasis, it appears when a gallstone blocks the choledochal duct , which takes bile into the gallbladder, causing the bilirubin to return to the liver and be absorbed into the blood.

Nausea and vomiting

Problems caused by stones can cause nausea and vomiting.

Abdominal swelling

Due to digestive problems caused by the lack of bile in the intestine, there may be swelling of the abdomen due to gas . In addition, the gallbladder may also become swollen.

Light stools and dark urine

Bilirubin is the substance responsible for stool staining. When something – like a stone – prevents it from reaching the intestine, the stool can become clear. Likewise, when it accumulates in the body because it cannot go to the intestine, it can be eliminated by urine, leaving it dark.

How is the diagnosis made?

Symptoms can raise the suspicion of the condition, but only the imaging exam is able to confirm the diagnosis. The doctor who makes this diagnosis is the gastroenterologist , responsible for the care of the digestive system.

Ultrasound

The ultrasound exam has a high efficiency, being able to identify 95% to 99% of cases of gallstones, even when they are small and have no symptoms. In addition, there is an advantage in this exam that it is neither expensive nor invasive. There is no need for contrast, anesthesia and there are no side effects.

Computed tomography

As effective as ultrasound, computed tomography can also find gallstones. This examination uses an X-ray to create an accurate image of the inside of the body.

Computed tomography is different from radiography (popular X-ray) in that it makes several images that are sent to a computer, which joins them together in order to show various details that could escape with the ordinary X-ray.

Is there a cure?

Yes , cholelithiasis can be cured. Or rather, it is possible to get rid of the condition. Since the mechanism that causes the stones is not usually identifiable, it is difficult to prevent them from reappearing.

In addition, there are serious complications that can be caused by the stones, so the removal of the gallbladder is the most common. This withdrawal does not affect the patient’s health, since the gallbladder, despite having a function, is not a vital organ.

What is the treatment?

Surgical removal of the gallbladder is the most common treatment. However, it is only applied when there are symptoms or several gallstones. In the case of just one or two small stones that do not cause symptoms, medical observation is recommended to monitor the development of the condition.

However, when there are risks that the stones will migrate through the ducts and get stuck in it, or when the stones are many, and even if there is a single large stone, surgery is done to avoid greater risks.

Laparoscopic cholecystectomy

Laparoscopic cholecystectomy is the name given to gallbladder removal surgery. It is not very invasive compared to an open cholecystectomy (which is the same surgery done with a wide cut) and the recovery is usually quick. The patient is usually discharged the next day.

To perform the surgery, 4 small incisions are made in the patient’s abdomen. A camera is inserted through one of them. For the other two, instruments for surgery. The instruments are used to remove the organ from its place, cut the connections, cauterize possible bleeding and finally to remove the gallbladder completely, with its stones still inside.

After this surgery, gallstones no longer appear.

Extracorporeal lithotripsy

This treatment is seldom used today due to the ease of cholecystectomy, however it is possible. A shock wave generating device is positioned next to the patient’s body, and these waves break the stones inside the vesicle, allowing pieces of them to escape through the ducts.

This treatment does not prevent other stones from appearing in the future and works only on small stones.

Dissolution by MTBE

This method is also seldom used as it causes some unpleasant side effects and still allows other calculations to appear. An organic solvent is injected into the vesicle that dissolves the stones. The problem is that this treatment can cause organ damage and cause a strong burning sensation, in addition to being effective only on small stones.

Medicines

There are medications that can be used to dissolve gallstones, however their effect is time-consuming, and it can take years before the stones are completely dissolved. In addition, there is no way to prevent new stones from appearing and that is why the surgery is usually performed.

The medications are as follows:

  • Bile acids

Attention!

NEVER  self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Living together

Living without getting rid of stones is defined in two extremes. Either there is a lot of pain and several risks of complications or you don’t even realize that the calculations are present. Therefore, if there are problems that require treatment, removal of the organ is the best option. Therefore, we will talk about how to live without the gallbladder. Do not worry, it is not difficult.

Non-vital organ

The body has several organs ranging from the skin to the heart and some of them are vital. This means that it is not possible to live without. This is the case of the heart, the kidneys (it is possible to live without a kidney, but not without both), the brain, the lungs (without one is also possible), among others.

However, there are organs that are not so necessary. They have functions and their removal can cause problems, but you can live without them. This is the case of the gallbladder.

The gallbladder has the purpose of storing bile and controlling its flow to the intestine, reacting when fats are detected by the body.

After its withdrawal, the bile goes straight from the liver to the intestine in a constant flow and will continue to digest fats. However, it is good that, after surgery, very fatty foods are avoided.

Post-surgery feeding

After the gallbladder is removed, bile will continue to flow from the liver and form part of the digestion and the foods that were consumed before surgery can be consumed by someone without a gallbladder.

However, in the first weeks after the surgery, it is recommended to avoid very fatty foods so that the region heals completely and so that the body gets used to the new flow, since there is now no accumulation of bile ready to be used.

During the first few weeks after surgery you should avoid certain types of foods that are very high in fiber, which cause gas and fatty foods. After some time, depending on the doctor’s recommendation, these foods can be slowly reintroduced into the diet. Foods that should be avoided are:

  • Fatty meats;
  • Fried food;
  • Pasta with cream;
  • Sausage;
  • Broccoli;
  • Cauliflower;
  • Cabbage;
  • Sweet potato;
  • Oilseeds (almonds, walnuts, Brazil nuts);
  • Alcoholic beverages;
  • Spicy foods.

Eating these foods without a gallbladder right after surgery can cause problems with the digestion of fats, which can lead to diarrhea .

Prognosis

The prognosis of cholelithiasis is usually positive and complete recovery is likely. Complications can arise if there is no treatment of stones of relevant size or quantity, but this treatment is not usually a problem or has serious consequences.

Healing is guaranteed in most cases when the condition is diagnosed, which is usually easy thanks to imaging tests and clear symptoms of the condition.

Complications

If left untreated, cholelithiasis can develop in serious situations. The possible complications when this happens are as follows:

Cancer in the gallbladder

Although it is not possible to say that gallstones directly cause gallbladder cancer , this type of tumor is more common in those who have had stones than in those who have not.

Biliary colic

Biliary colic is one of the symptoms of cholelithiasis, but if the condition is not treated, the pain only tends to increase.

Cholecystitis

The cholecystitis occurs when the tissue becomes inflamed gallbladder. This can happen when the organ makes the contraction, repeatedly, to push the bile out of itself, but a block prevents it from happening. Organ damage can lead to inflammation.

Cholangitis

Cholangitis is the infection of the bile ducts. It happens when there is an accumulation of bile in the ducts because of calculations that block them. Bile provides its own environment for the proliferation of bacteria.

Gallstone pancreatitis

Stones can appear or be carried into the pancreatic ducts, causing the same problem of inflammation and pain in cholecystitis in the pancreas.

Necrosis

Cholecystitis can still progress to gallbladder necrosis. The same applies to pancreatitis , which can lead to necrosis of the pancreas. Necrosis happens when an organ does not receive oxygen properly and dies.

BECAUSE

The sepsis is called generalized infection . It happens when an infection spreads to other places on the body besides where it started. It is extremely dangerous and without treatment it kills very fast.

How to prevent cholelithiasis (gallbladder stone)?

Since the development of gallstones is not directly linked to food, there is not much to do to prevent the condition. Its causes are mainly genetic, so avoiding them is difficult. However, it is possible to leave some of the risk groups.

Slow down slowly

Weight loss too fast increases the chances of gall stones developing. Therefore, losing weight gradually can reduce the chance of them appearing.

Lose weight

Obesity is one of the factors that increases the chances of stones appearing in the gallbladder as it increases cholesterol in the blood. Eat properly and maintain weight control and fewer stones can develop.

Medical follow-up

Especially in situations where the amount of estrogen is high (such as during pregnancy or when taking birth control pills) medical monitoring can be important to discover possible cholelithiasis and prevent its development to something more serious.

Common questions

Do you have to remove the gallbladder too?

Not exactly, but it is the most recommended. The gallbladder is not an essential organ and it is quite easy to live without it. Also, if you have gall bladder stones, it is very likely that they will form again. Therefore, removal of the entire organ is usually the indicated and safest.

Can I have gallstones after removing the gallbladder?

Interestingly, yes, it is possible. Gallstones usually form inside the organ as this is where there is accumulation of standing bile, which allows it to solidify more easily, but it is possible for a stone to form in the bile ducts, which lead bile from the liver to the gallbladder. or from the gallbladder to the intestine.

After the gallbladder is removed, the bile goes directly from the liver to the intestine, but it can still solidify on the way if there is a propensity for it in the patient. If the stone blocks the duct, it causes symptoms such as gallbladder cholelithiasis.

When this happens, the treatment is usually to remove the stones surgically, but it is possible that the stone will go out alone to the intestine, where it is eliminated with the feces.

Why do I have to remove the stones even if they are asymptomatic?

Although asymptomatic stones do not cause any harm, it is dangerous to set them aside. If you have gallstones, it is a matter of time before more are formed, filling the organ, so removal is important.

Eventually they will block some duct, causing severe pain, as well as inflammation and infection. These can spread to other organs and lead to death.

What are the risks of surgery to remove the gallbladder?

The gallbladder removal surgery is perfectly safe. However, like any surgical procedure, it has risks of bleeding and infections, in addition to bleeding from organs neighboring the gallbladder.

Talk to your doctor before the surgery, as he will be able to explain in detail what the risks are.


You have learned that cholelithiasis is not a serious problem if it is treated. However, it can develop in dangerous situations when ignored. Remember to share this text with your friends so they can find out about the disease!

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