GALLSTONES
WHAT IS IT?
Gallstones are hard lumps that form in the gallbladder, a small, pear-shaped organ under your liver that stores a digestive juice called bile. Gallstones can be as small as a grain of sand or as large as a golf ball.
About 80 percent of gallstones are made mostly of cholesterol, a fatty substance found throughout the body. The other 20 percent-called pigment stones-are made of calcium salts and bilirubin-a reddish-yellow pigment found in bile and blood.About one in ten Americans has gallstones. They are more common in women and in people over 60. Most gallstones are “silent stones” that show no symptoms and cause no harm. But others cause pain and sometimes require surgery to remove the gallbladder. Today this operation involves much less pain and quicker recovery than in times past. Once the gallbladder is removed, stones can no longer form.
WHAT IS HAPPENING?
The gallbladder is part of the digestive system. It lies between the liver and the small intestine. Many ducts, or small tubes, connect these three parts of the body. The liver produces a fluid called bile, which flows through the ducts into the gallbladder for storage. After you eat, the gallbladder sends bile, which helps the body digest fats, into the small intestine.
Sometimes, substances in the bile-most often cholesterol or calcium-form crystals that can build up in the gallbladder and turn into gallstones. Small gallstones often pass out of the gallbladder and move harmlessly through the ducts into the intestines, and then from the body. But larger stones may get stuck in one of the ducts and block the flow of bile. This triggers a gallbladder attack. You may feel intense pain in your abdomen until the stone shifts out of the way. In some cases, a blocked bile duct becomes infected. Then you may vomit and feel feverish and chilled. If bile pigment builds up in your blood, it can cause jaundice, marked by yellow skin and whites of the eyes. Blocked ducts that aren’t treated promptly can lead to liver, gallbladder, or pancreas damage. In some cases, the problem can be fatal.
WHAT CAUSES IT?
Some researchers believe that gallstones result from upsets in the bile’s balance of substances. For instance, cholesterol stones may form when bile contains too much cholesterol and not enough bile salts. No one knows for sure, though, why one person has such imbalances and another doesn’t. The experts do know that certain risk factors play a role in causing gallstones. Some-such as age and family history-are beyond your control. But you can do plenty about other factors, such as your weight and diet.
THINGS YOU CAN’T CHANGE
Age
Gallstones are more common in people over age 60 than in younger people.
Sex
Before menopause, women are more likely than men to get gallstones. In fact, women between 20 and 60 years of age are twice as likely to develop gallstones as men.
Genes
If a close relative, such as your mother or father, had gallstones, your risk is higher than normal.
Ethnic group
Native Americans have the highest risk of gallstones in the United States. More than half of Native American men have gallstones by the time they’re 60. Mexican Americans also have a higher risk.
Pregnancy
Women who are pregnant, or have been pregnant, are more likely than other women to get gallstones.
THINGS YOU CAN CHANGE
Obesity
Gallstones are more common among heavy men and women.
Quick weight loss
People who go on crash diets and lose a lot of weight quickly may raise their risk of developing gallstones.
Diet
Researchers have not proven a clear link between diet and gallstones. But some studies suggest that a diet low in fiber or high in fat, cholesterol, starchy foods, or total calories may raise your risk.
Estrogen
Increased estrogen levels from birth control pills or estrogen replacement therapy after menopause can raise a woman’s risk.
WHAT YOU CAN DO FOR YOURSELF
Get medical help
Call your doctor right away if you’ve never had a gallstone attack before but you think you are now, or if you have a fever with the pain. Don’t eat or drink anything.
If you know you have gallstones, call your doctor if you have severe pain in your abdomen that lasts more than two hours, or if you notice that your skin or the whites of your eyes look yellow. An attack may stop on its own, but if it doesn’t, you may need treatment.
Ask about your options
Even if your gallstones cause symptoms, you may not need surgery or drugs. Instead, your doctor may suggest a low-fat diet to help you avoid future attacks. (Write down what you eat and when the pain occurs, so that you and your doctor can determine whether certain foods trigger your attacks.)
Many people find that fatty or fried foods, such as french fries or fried chicken, can lead to problems. While fatty foods don’t actually cause gallstones, they can trigger an attack in a person who already has them.
To help prevent gallstones:
Watch your weight
If you’re overweight, do what you can to lose the extra pounds. Staying at or achieving your ideal weight will lower your risk of gallstones. Don’t go on a crash diet. Most crash dieters gain back any weight they’ve lost, and if you have gallstones, rapid weight loss can bring on an attack. The best approach? Combine smart eating with exercise to lose weight slowly-no more than about 1 percent of your body weight each week.
Ask about estrogen
If you take birth control pills or estrogen replacement therapy, ask your doctor about your risk.
WHAT YOUR DOCTOR CAN DO FOR YOU
If you’re having a painful attack, your doctor may give you a painkiller to help you get through it. Surgery is the most common treatment for gallstones that cause symptoms. Afterward, you’ll be able to live and eat normally because your liver will send bile directly to the small intestine.
Laparoscopic cholecystectomy is the standard surgery for removing the gallbladder. In this operation, the surgeon makes tiny cuts in the abdomen, then places very small tools, including a miniature video camera, into these openings. The camera sends an image from inside the body to a video monitor. On the monitor, the surgeon can get a close-up view of the organs and tissues while operating.
There is less pain, quicker healing, and less chance of infection following laparoscopic surgery than after major gallbladder surgery. In most cases, the patient needs only one night in the hospital and a few days at home to recover.
Sometimes the surgeon will have to do an open cholecystectomy. This is major surgery because the surgeon has to make a large cut in the abdomen to remove the gallbladder. You may stay in the hospital for two to seven days after, and then recover at home for several weeks. Open surgery is required in about 5 percent of gallbladder operations.
If surgery isn’t an option, and your gallstones are cholesterol stones, your doctor may try oral dissolution therapy. This medication, which comes in pill form, contains the acid naturally found in bile. However, it may take months or even years to dissolve small stones, and since the gallbladder is left intact, stones can form again after treatment.