Oh! The pain of gallstones

Column by Tim Moser

By Dr. Tim Moser, Denver House Calls in Denver
Posted

Paige had been experiencing severe pain in her upper abdomen area after meals for the past several weeks. About an hour after eating the pain began - slowly at first, but gaining in intensity until she was completely immobilized for about 45 minutes. When most severe, the pain would often radiate to the tip of her right shoulder from her right upper abdomen. Taking a deep breath and bending over only made the pain worse.

Paige knew her body well, and was aware something serious might be wrong. After doing some research on the internet, she decided gallstones might be the problem. Since her mom and sister also had gallstones, she decided to make an appointment with her doctor to check things out. An ultrasound of her abdomen confirmed the diagnosis, and surgery was scheduled to remove Paige's gallbladder.

Gallstones are a very common condition, that can sometimes cause significant pain, especially after meals. The gallbladder, which is a small organ near the liver, acts to store the bile produced in the liver. Bile is released into the first part of the small intestine after a meal. Since bile helps to digest fats, the gallbladder squeezes out the stored bile in response to meals, especially when fatty foods are consumed.

Gonna roll the stones...

Gallstones form in the gallbladders of many individuals. They range in size from grains of sand, to the size of a golf ball. Gallstones cause problems if they obstruct the outflow of bile from the gallbladder to the small intestine. Because stones may plug up the plumbing, pain is a common symptom. Infection of the gallbladder can also occur when the flow of bile is impeded by gallstones.

Symptoms are more common after meals, since the gallbladder is called to action after eating. Pain is primarily in the right upper portion of the abdomen, but sometimes in the upper central abdomen. The severe symptoms may last up to an hour, but then typically decrease slowly.

Pressing on the liver will often make the pain worse. Taking a deep breath or leaning forwards can place pressure on the liver, also causing an increase in symptoms.

How to build a gallstone

Gallstones are usually composed of cholesterol crystals, sometimes mixed with fats and bilirubin. If a gallstone is cut in half, it becomes obvious the stone started small, and grew in layers, much like a dirty snowball rolled downhill. As the gallstones form next to each other, the sides of the stones may become flat, so more stones can fit neatly in the confines of the gallbladder. Gallstones range in color from yellow to green, to dark brown. Women are at a greater risk of developing gallstones, especially after the age of forty. There has been some association made between having more than one child and developing gallstones. As with all things in life, family history also plays a role.

Finding the elusive stones

Since gallstones are usually composed of cholesterol, they often are not detected by a regular X-ray. Patients having a CAT scan of their abdomen may be told gallstones are present. The most common test used to diagnose gallstones is an abdominal ultrasound. This test has the advantage of lower cost, and no exposure to radiation for the patient. The stones cast striking shadows during the scan, and are easily seen. The wall of the gallbladder can also be assessed on ultrasound, so if something more serious is going on (such as an infected gallbladder), this may also be detected.

If gallstones are seen, but no symptoms are present, then treatment is usually not indicated. Many people have gallstones for life that never cause problems.

Treatment

The standard of treatment for gallstones that are causing symptoms is to remove the gallbladder. The most common method of doing this is a Iaprascopic cholecystectomy. In plain English, this means four small incisions are made in the abdominal wall. A small camera and surgical instruments are inserted into the abdominal cavity, and the gallbladder is identified and removed. Recovery time is usually several days.

Less invasive treatments may include using sound waves to break up the gallstones and allowing them to pass into the intestine, where they will do no harm. This is a rare treatment, since it has not been shown to be very effective.

Taking medications by mouth can be used to dissolve the gallstones. This treatment may take years to be effective, and is seldom used nowadays.

After the gallbladder is removed, patients may experience diarrhea after eating fatty foods, since the body may have more difficulty digesting fats. Over time, the body often compensates, and the loose stools improve after eating a fatty meal.

Need more information concerning gallstones?

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001318/

http://www.mayoclinic.com/health/gallstones/DS00165