GALLSTONES

General Information

DEFINITION--Stones in the gallbladder (the organ under the liver that stores bile). Most gallstones are composed primarily of cholesterol, others contain bile pigment or calcium. They are not cancerous.

BODY PARTS INVOLVED--Gallbladder; bile ducts.

SEX OR AGE MOST AFFECTED--Adolescents and adults of both sexes, but more common in women. 10% of the U.S. population--and 20% of those over 40--have gallstones.

SIGNS & SYMPTOMS

• Colicky (severe, spasmodic) pain in the upper right abdomen or between the shoulder blades.
• Nausea and vomiting.
• Bloating or belching.
• Intolerance for fatty foods (indigestion, bloating and belching).
• Jaundice.
• No symptoms in about 40% of cases.

CAUSES

• Failure of the gallbladder to empty competently.
• Alterations in bile mucus.
• Increased bilirubin concentration in bile. (Bilirubin is a yellowish, red-blood-cell waste product in bile that the blood carries to the liver. It contributes to urine's yellowish color and can cause jaundice if it builds up in the blood.)
• Infection in the tubes that carry bile out of the liver.

RISK INCREASES WITH

• Recent illness, such as coronary-artery disease, cirrhosis of the liver or disorder of the small intestine.
• Family history of gallstones.
• Genetic factors. Some ethnic groups are more susceptible.
• Obesity.
• Excess alcohol consumption.
• Oral contraceptives and estrogen replacement therapy.
• High fat, low fiber diet.
• Rapid weight loss.
• Women who have had many children.
• Smoking.

HOW TO PREVENT--Avoid risk factors where possible.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory studies, such as: blood count; blood chemistry; CT scan; cholecystography and ultrasound (See Glossary for all).

APPROPRIATE HEALTH CARE

• Self-care.
• Doctor's treatment.
• Surgery to remove the gallbladder and stones in the bile ducts may be needed for patients with severe symptoms. Laparoscopic cholecystectomy is usually the preferred procedure (see Gallbladder Removal in Surgery section).
• Shockwave (lithotripsy) treatment to break up (shatter) the stones may be recommended in some cases.

POSSIBLE COMPLICATIONS--Infection or rupture of the gallbladder.

PROBABLE OUTCOME--Many persons with gallstones have no symptoms. For those who do, the disorder is curable with surgery.

How To Treat

GENERAL MEASURES--

• If you know you have gallstones and experience pain in the upper right abdomen, apply heat to the area. If pain worsens or continues more than 3 hours, call your doctor.
• See Resources for Additional Information.

MEDICATION--

• For minor discomfort, you may use non-prescription drugs such as acetaminophen.
• Oral medication to try to dissolve stones. This treatment is used for certain types of stones and can take up to two years.

ACTIVITY--No restrictions, except to rest during attacks of gallbladder colic.

DIET--

• During an attack, sip water occasionally, but don't eat.
• Eat a low-fat diet (see Low-Fat Diet in Appendix). Fatty meals may bring on mild attacks.
• If you are overweight, begin a weight reduction program (see Weight-Loss Diet in Appendix).

Call Your Doctor If

• You have symptoms of gallstones.
• Fever rises to 101F (38.3C).
• Pain occurs that lasts for more than 3 hours.