Gallstones

Most cases of gallstones are unknown to the patient until discovered by a doctor. Gallstones are small, pebble-like stone particles of cholesterol or calcium salts that form from bile in the gallbladder. The gallbladder is located just below the liver in the upper-right abdomen and looks like a pear-shaped sac. Bile is a liquid, water-like substance made up of cells from the liver and is used for digesting food.

Gallstones can develop within the gallbladder or in the nearby bile ducts in a variety of sizes that vary from that of a grain of sand to a golf ball. Although gallstones found in the gallbladder may not cause immediate problems, they may produce discomfort when certain foods are ingested. More serious cases of gallstones can lead to inflammation and severe abdominal pain; they can become life-threatening if the pancreas becomes inflamed.

Symptoms of Gallstones
The condition shows almost no signs or symptoms, but as the gallstones move into the bile ducts, they can create blockage and increased pressure inside the gallbladder, causing problems that usually lead to the first signs and symptoms including:

• Chronic indigestion
• Upper abdominal pain
• Nausea and vomiting
• Fever/chills
• Intolerance of fatty, greasy foods
• Jaundice (in severe cases)
• Clay-colored stools

Gallstone Diagnosis
Our highly skilled Houston Methodist gastroenterologists use the latest state-of-the-art technology to diagnose gallstones in order to begin treatment as early as possible. Common tests may include:

• Computed tomography (CT)
• Cholescintigraphy (HIDA scan)
• Endoscopic retrograde cholangio-pancreatography (ERCP)
• Blood test (to look for infection)
• Ultrasonography

Gallstone Treatments and Procedures
Although there is no way to prevent gallstones from forming, several treatment options are available that include both surgical and nonsurgical options.

A cholecystectomy is surgery to remove the gallbladder completely and is recommended especially for patients with severe or chronic gallstone complications. This is performed by laparoscopic surgery, which uses a laparoscope (a tiny video camera with a special surgical tool) to remove the gallbladder through a small incision. Another option is open surgery, which will remove the gallbladder through a larger abdominal incision. In extreme cases, when the gallbladder needs to be removed immediately, your surgeon may only have the latter option.
 
Nonsurgical treatments offer additional options:

• Oral dissolution therapy or bile salt tablets can dissolve small cholesterol stones.
• Sound-wave therapy uses high-frequency sound waves to destroy gallstones and is followed by ursodiol (bile) tablets to dissolve remaining fragments.
• Percutaneous electrohydraulic lithotripsy uses a catheter containing a small probe to send bursts of energy to destroy gallstones.
• Topical gallstone dissolution uses a catheter to inject a solution that will dissolve the cholesterol gallstones in the gallbladder.

Some risk factors can lead to gallstones, including:

• Females are at a higher risk for developing gallstones
• Obesity or overweight
• Rapid weight loss
• Age
• Increased levels of cholesterol in the blood
• Diets high in fat content in combination with high cholesterol
• Family history
• Patients with diabetes