What Are Gallstones and How Are They Formed?
The gallbladder is an important organ that aids in the digestion of fatty foods.
Bile, a fluid produced by the liver, is stored in the gallbladder and is signaled by a hormone called cholecystokinin to contract and release the stored reservoir of bile into your small intestine.
The bile then breaks down fatty molecules and helps important fat-absorbable nutrients (such as vitamins A, D, E, and K) pass through the intestinal lining and enter the bloodstream to be used by your body.
The bile in your gallbladder is made up of mostly cholesterol and bile acids.
Normally, the concentration of bile acids is high enough to break down the cholesterol in the mixture and keep it in liquid form. However sometimes when the bile mixture balance is off, it begins to harden and turn into small pieces of solid material called gallstones.
Gallstones can be described as crystal-like deposits and can be as small as a grain of sand and as large as a golf ball. They can be smooth and round or rough and jagged.
You may have only one gallstone present in your gallbladder at a time, or you may have several that vary in size. The formation of gallstones is a slow one and you may be unaware they are even present for many years to come, if at all. The formation of gallstones in your gallbladder is called cholelithiasis.
The actual presence of gallstones within your gallbladder is called Choledocholithiasis.
Secondary Choledocholithiasis is when the gallstone originated in the gallbladder and has moved down into the common bile duct and become lodged. This happens in approximately 10% of people that experience gallstones. The result is jaundice and liver cell damage and it requires removal via your gallstone surgeon.
Even less often is the origination of gallstones within the bile duct itself. Although the majority of gallstones form in the gallbladder, when they form outside of the gallbladder and in the bile duct, it is called Primary Common Bile Duct Stones. These usually differ in color and are cause for more severe infections.
Symptoms of Gallstones
As mentioned above, the presence of gallstones may be asymptomatic for years.
In fact, it is thought that many people live their entire lives never knowing they have gallstones at all.
These “silent stones” do not require treatment as they never present any problems. When symptoms do occur however, it can become extremely painful and require treatment by your physician.
Symptoms usually appear because a gallstone in the gallbladder has moved and become lodged in the common bile duct that carries the bile to the small intestine during digestion.
The pain you will experience comes from the contraction of the gallbladder to release additional bile that is meeting resistance against the lodged gallstone.
These stones can also clog the hepatic ducts that carry the bile the liver has produced to the gallbladder for storage. These blocked ducts can become inflamed and infected creating many health issues.
Here are some common symptoms those suffering from gallstones may experience:
- Abdominal pain near the upper right section of your ribs, radiating to your shoulder blades and upper back.
- Nausea or vomiting
- Indigestion such as bloating and belching
Nearly 10% of men and 20% of women in the United States have gallstones or will develop them at some point in their lives. Yet, most will remain silent and never cause any harm.
It is important to note, though, that the longer a stone is present in your gallbladder, the more likely it is to cause you problems in the future.
Let’s take a look at some interesting statistics about gallstones:
- If you have gallstones, you have a 20% chance of having pain associated with them in your lifetime.
- Women are two times more likely to develop gallstones than men.
- Approximately one million new cases of gallstones are diagnosed each year in the United States.
- Native Americans have the highest rate of gallstone diagnosis.
- Gallstones are most common amongst those over the age of 60.
- Obesity or fast weight loss play a large role in gallstone formation.
- Diabetes increases your risk of gallstones.
- Women taking hormone replacement therapy, birth control pills, or are pregnant have a higher rate of gallstones.
- Family history can help determine whether you may develop gallstones in your lifetime.
There are two main types of gallstones that can form in your gallbladder: cholesterol stones and pigment stones.
Cholesterol gallstones form when the bile solution produced by the liver contains too much cholesterol and not enough bile acid salts to break the cholesterol down and keep the secretion liquid.
These make up about 80% of all gallstone cases.
Cholesterol gallstones are 80% cholesterol by weight, vary from light yellow to dark green or brown (and are sometimes chalk white), always have a dark central spot and on average are approximately 2-3 cm in length.
Here are some common reasons the concentration of cholesterol can increase and cause gallstones to form:
- Complete or infrequent gallbladder contractions creating an over-concentrated and stagnate bile solution.
- Proteins in the liver may become mixed in with the bile.
- Increased levels of estrogen (due to pregnancy, hormone therapy, or birth control pills) increase cholesterol levels and decrease gallbladder movement.
- High levels of bilirubin, formed by the breakdown of hemoglobin in red blood cells that is normally removed from the body via bile.
Pigment gallstones account for a much smaller number of gallstone diagnoses. Being only 20% cholesterol by weight, these gallstones are small and dark, and are comprised of bilirubin and calcium.
These gallstones can be broken into two categories based on their color.
Black Pigment Stones
Black pigment stones usually consist of bilirubin and calcium carbonate and rarely have any cholesterol present.
They are found originating in the gallbladder and develop as a result of liver damage, hemolytic anemia, and old age.
Brown Pigment Stones
Brown pigment stones are mostly made up of calcium bilirubinate, fatty acids, and small amounts of cholesterol. They are found in the bile duct and can be associated with bile infections and inflammation, and sometimes parasitic infestations of the liver.
Here are some additional reasons why black or brown pigment gallstones may form:
- The presence of the bacteria E. Coli (although usually associated with food poisoning) has been found in the bile concentrations of those with pigment gallstones in high concentrations.
- Sickle cell disease, which causes the deformation of many red blood cells that are easily broken down in the body, result in bilirubin collecting in the gallbladder and accumulating in excess, increasing the chance of pigment gallstone formation.
- Over 70% of all people with pigment gallstones have roundworm parts or eggs within their stones. As the roundworms amass in the gallbladder, a buildup of bile results. When these worms die and begin to breakdown, mixed with the excess bile, pigment gallstones develop.
Unfortunately there is no sure way to prevent gallstones. However, there are many lifestyle choices that can possibly lessen your chances of forming gallstones.
Let’s take a look at some of the most common things you can do to decrease your chances of experiencing gallstones:
- Maintain a healthy weight. If you do lose weight, do so in a slow manner. Yo-yo dieting can wreak havoc on your gallbladder and increase your risk for gallstones.
- Exercise your way to a healthy weight with low blood cholesterol.
- Follow a healthy diet to keep your gallbladder functioning properly. Eat on a regular basis as skipping meals can cause your gallbladder to store the same bile for too long increasing its chance of hardening. Check out these other healthy diet tips specifically for those affected by gallbladder disease.
- Discuss cholesterol lowering drugs with your physician as they sometimes increase gallstone formation.
- Check your hormone therapy medication and birth control pills with your physician to make sure they are not affecting your gallbladder.
- Gallstone dissolving medications may be given in pill form to dissolve cholesterol gallstones. However, this may take 2 years to work and the gallstones may return.
- Shock wave therapy of the gallbladder is an option for those who cannot have gallstone surgery. However, this treatment is not used very often as gallstones often come back.
- Consider Laparoscopic Cholecystectomy for extreme gallbladder issues. Your gallstone surgeon will be able to help you determine whether surgical removal of either the gallstones themselves or the entire gallbladder in necessary.
For most people gallstones will never become an issue. In fact, most people will never become aware of these “silent stones”. However, for those who experience severe gallstone pains, it is important to contact you gallstone surgeon for further treatment.
Dr. Fraiman is one of the most experienced gallstone surgeons on the East Coast. Named “America’s Top Surgeon” in 2014 by Guide to America’s Top Surgeons Magazine, you can rest assured that Dr. Fraiman’s 20 years of experience, highly trained medical staff, and patient-centered approach to gallstone treatment will provide you the best results possible.