MEDICAL MONDAYS NEWS NOTES
Mark Akins, MD, General Surgery
Jeff L. Ryan, MD, General Surgery
Middle Tennessee Medical Center
Is it my Gallbladder?
Monday, April 28, 2008
Gallstones - Topic Overview
The gallbladder is a small sac found just under the liver. It stores bile made by the liver. Bile helps you digest fats. Bile moves from the gallbladder to the small intestine through tubes called the cystic duct and common bile duct.
Most gallstones do not cause problems. But if they block a duct, they usually need treatment.
What causes gallstones?
Gallstones form when cholesterol and other things found in bile make stones. They can also form if the gallbladder does not empty as it should. People who are overweight or who are trying to lose weight quickly are more likely to get gallstones.
What are the symptoms?
Most people who have gallstones do not have symptoms.
If you have symptoms, you most likely will have mild pain in the pit of your stomach or in the upper right part of your belly. Pain may spread to your right upper back or shoulder blade area. Sometimes the pain is more severe. It may be steady, or it may come and go. Or it may get worse when you eat.
When gallstones keep blocking a bile duct, you may have pain with fever and chills, or your skin or the whites of your eyes may turn yellow. Call your doctor right away. Having stones in your bile duct increases your chance of having a swollen pancreas (pancreatitis). These symptoms may also be a sign of an infected gallbladder.
Call your doctor right away if you have sudden or bad pain in your belly or chest and you are not sure what is causing it. Symptoms of gallstones may feel like chest pain caused by a heart attack and other serious problems.
How are gallstones diagnosed?
You may go to the doctor because of pain in your belly. In this case, your doctor will ask you questions about when the pain started, where it is, and if it comes and goes or is always there. Your doctor may order imaging tests. These take pictures of the inside of your body. An ultrasound of the belly is the best test to find gallstones. This test does not hurt.
Your ultrasound may not show gallstones. But if your doctor still thinks you have a problem with your gallbladder, he or she may order a gallbladder scan. In this test, a doctor injects dye into a vein in your arm. Then a machine takes X-rays as the dye moves through your liver, bile duct, gallbladder, and intestine.
Most people have gallstones but do not know it because they do not have symptoms. Gallstones may be found by accident when you have tests for other health problems, or when a woman has an ultrasound during pregnancy.
How are they treated?
If you do not have symptoms, you probably do not need treatment.
If your first gallstone attack causes mild pain, your doctor may tell you to take pain medicine and wait to see if the pain goes away. You may never have another attack. Waiting to see what happens usually will not cause problems.
If you have a bad attack, or if you have a second attack, you may want to have your gallbladder removed. A second attack means you are more likely to have future attacks.
Many people have their gallbladders removed, and the surgery usually goes well. Doctors most often use laparoscopic surgery. For this, your surgeon will make small cuts in your belly and remove your gallbladder. You will probably be able to go back to work or your normal routine in a week or two, but it may take longer for some people. Sometimes the surgeon will have to make a larger cut to remove the gallbladder. It will take longer for you to recover from this type of surgery.
Do I need my gallbladder?
Your body will work fine without a gallbladder. Bile will flow straight from the liver to the intestine. There may be small changes in how you digest food, but you probably will not notice them.
Gallstones - What Increases Your Risk
How common are gallstones?
More women than men develop gallstones. People who are obese are more likely to develop gallstones than people who are not overweight.
Should I have surgery to treat gallstone attacks?
Surgery to remove the gallbladder usually prevents future gallstone attacks. The decision to have surgery depends largely on how often and how intense your gallstone attacks are and your ability to tolerate them. Consider the following when making your decision:
Two types of surgery may be done, one using a large incision (open cholecystectomy) and the other involving several small incisions (laparoscopic cholecystectomy). Laparoscopic surgery is generally preferred because it causes less pain after the operation and people can return to work and other activities more quickly than with open surgery.1, 2
In rare cases, doctors may try nonsurgical methods to remove gallstones. Bile acids are sometimes used to dissolve gallstones. They may be used alone or after lithotripsy, which breaks up small, noncalcified gallstones with shock waves that are focused by ultrasound.
For some people with stones in the common bile duct, a special type of endoscopic retrograde cholangiopancreatogram (ERCP) called endoscopic sphincterotomy may be used to remove gallstones that block the common bile duct. The doctor places an endoscope down the throat to the small intestine. The doctor then uses another procedure to widen the opening between the common bile duct and the small intestine and takes the stones out using a small basket. After ERCP, surgery to remove the gallbladder is often the next step.
However, endoscopic sphincterotomy may not prevent the need for gallbladder removal. One study found that symptoms returned within 2 years in 47% of people who had only sphincterotomy, compared with 2% who had immediate gallbladder removal. Of those people in the study who had recurrent symptoms, 81% eventually needed gallbladder removal (cholecystectomy).3
Overall, gallstones return within 5 years after nonsurgical treatment in 30% to 50% of people.1
What are the risks of not having the gallbladder removed?
There is little risk in not having surgery if you have only one bout of mild symptoms. However, if you have more than one episode of pain, you are likely to have more symptoms in the future.
The risks of not treating gallstones may include: