Understanding Cholelithiasis: Causes, Symptoms, Diagnosis, and Treatment
Cholelithiasis, also known as gallstones, are small, solid particles that form in the gallbladder. They are surprisingly common, affecting millions of people worldwide. Gallstones can go unnoticed, as they often do not cause any symptoms in many individuals. These silent gallstones are typically discovered incidentally during medical imaging procedures performed for unrelated issues. Gallstones can become life-threatening when they block a bile duct, leading to painful symptoms requiring immediate doctor’s care. In this comprehensive guide, we will delve into the various aspects of cholelithiasis treatment, providing you with the information you need to navigate this health challenge.
Causes
There are two types of stones: cholesterol stones (made up of undissolved cholesterol) and pigment stones (made up of bilirubin). Various factors can contribute to the formation of gallstones, and they are often a result of a combination of these factors. The main causes of gallstones include:
- Excess Cholesterol
Excess cholesterol contributes to gallstone formation by disrupting the delicate balance of bile composition.
Normally, bile, a digestive fluid produced by the liver, contains cholesterol along with bile salts and bilirubin. When the liver produces an excess of cholesterol or if the gallbladder fails to efficiently release bile, the surplus cholesterol can solidify into crystals, forming gallstones.
- Excess Bilirubin
Excess bilirubin can contribute to the formation of gallstones when there is an imbalance in the levels of this pigment in the bile.
Bilirubin is a breakdown product of haemoglobin. When the liver processes an excess amount of bilirubin due to certain conditions, it may become concentrated in the bile. If their concentration surpasses the bile’s capacity to keep it in a dissolved state, bilirubin can form solid particles, contributing to the formation of gallstones.
- Gallbladder Stasis
Gallbladder stasis, or impaired gallbladder emptying, is one of the significant risk factors for gallstones. The gallbladder is responsible for storing and releasing bile. When the gallbladder doesn’t effectively contract and empty its contents, bile becomes stagnant and concentrated. This stagnant bile creates an environment conducive to the formation of gallstones.
Symptoms
Gallstones often don’t cause any symptoms, but when they start to block a bile duct, they can cause noticeable and uncomfortable symptoms that can be fatal. Here are some of the main gallstone symptoms to watch out for:
- Upper abdominal pain
- Back pain or pain between shoulder blades
- Nausea and vomiting
- Indigestion and bloating
- Changes in bowel movements (light-coloured stools, dark urine)
- Jaundice
- Fever and chills
Diagnosis
For effective cholelithiasis treatment, an accurate diagnosis is critical. A gallstone diagnosis involves a combination of medical history assessment, physical examination, and various imaging tests. Let’s have a look at the popular diagnostic tools used for gallstone.
- Blood Tests
Blood tests play a crucial role in diagnosing gallstones by providing information about the overall health of the liver and detecting specific markers associated with gallbladder issues.
Elevated liver enzymes like ALT and AST indicate potential liver involvement due to gallstone complications, while measurement of bilirubin levels helps identify obstructions in the bile ducts, causing jaundice.
Though blood tests alone may not directly diagnose gallstones, they serve as vital indicators, guiding healthcare professionals to further diagnostic measures like imaging studies.
- Abdominal Ultrasound
Abdominal ultrasound is a pivotal diagnostic tool for identifying gallstones and assessing the condition of the gallbladder and surrounding structures. This non-invasive procedure employs high-frequency sound waves to create real-time images of the abdomen.
Gallstones manifest as bright echoes or shadows on the ultrasound, allowing for precise determination of their size, number, and location within the gallbladder.
- Endoscopic Ultrasound
Endoscopic ultrasound (EUS) is a highly effective diagnostic tool for detecting gallstones and assessing the gallbladder and surrounding structures. This minimally invasive procedure combines endoscopy and ultrasound imaging, allowing for detailed visualisation of the gastrointestinal tract and adjacent organs.
During an endoscopic ultrasound, a thin, flexible tube (endoscope) equipped with an ultrasound probe is passed through the mouth or nose, reaching the duodenum (first part of small intestine) and allowing the ultrasound device to be close to the gallbladder and surrounding structures.
- Abdominal CT scan
An abdominal CT (computed tomography) scan is a valuable diagnostic tool in the identification and assessment of gallstones.
This imaging technique utilises X-rays and computer technology to create detailed cross-sectional images of the abdominal organs, including the gallbladder and surrounding structures.
Gallstones appear as dense structures within the gallbladder or bile ducts, and the CT images can reveal their size, number, and location.
- Magnetic Resonance Cholangiopancreatography
Magnetic Resonance Cholangiopancreatography, commonly known as MRCP, is a specialised imaging technique that uses magnetic resonance imaging (MRI) to visualise the bile ducts, pancreatic duct, and gallbladder.
During MRCP, powerful magnets and radio waves are used to create detailed, high-resolution images of the biliary and pancreatic systems.
- Endoscopic Retrograde Cholangiopancreatography
During an Endoscopic Retrograde Cholangiopancreatography, commonly referred to as ERCP, a flexible, lighted endoscope is inserted through the mouth into the stomach and duodenum. Then a small catheter is advanced through the ampulla of Vater, the opening that drains both the bile ducts and the pancreatic duct into the duodenum. Using contrast dye and X-ray imaging, doctors then capture detailed images of the bile and pancreatic ducts.
Treatment
The cholelithiasis treatment approach depends on various factors, including the presence of symptoms, the size and number of stones, and the overall health of the patient.
Surgery
Gall bladder stone surgery typically involves the removal of gallbladder itself through a procedure known as cholecystectomy. This is a particularly effective cholelithiasis treatment for patients with painful symptoms, as gallstones tend to recur, and removing the gallbladder addresses the root cause of the problem. Here are two procedures that facilitate the surgical removal of gallstones:
- Laparoscopic cholecystectomy: Cholecystectomy, the surgical removal of the gallbladder, is a common and definitive gallstone treatment, especially if symptoms are recurrent or severe. In laparoscopic chlecystectomy, the surgeon carefully guides a small scope to reach and remove the gallstones and gallbladder through small incisions. The laparoscopic procedure offers a shorter recovery time compared to traditional open surgery.
- Open cholecystectomy: Open cholecystectomy involves a larger incision in the upper abdomen, providing direct access to the gallbladder. This approach may be chosen when laparoscopic surgery is technically challenging or when there are specific contraindications for the laparoscopic approach.
Medications
Medications are primarily used in the treatment of certain types of gallstones, specifically cholesterol gallstones. However, it’s important to note that medication options are limited, and their effectiveness can vary.
These medications are generally considered for patients who are not suitable candidates for surgery, either due to underlying health conditions or personal preferences. They are most effective for individuals with small, cholesterol-based gallstones. However, there are limitations to their use, and not all gallstones respond to medication.
Additionally, these medications may need to be taken for an extended period, and recurrence of gallstones after discontinuation is possible.
Shock wave lithotripsy
In rare situations, shock wave lithotripsy, a non-invasive medical procedure commonly used for the treatment of certain types of kidney stones, may be used to treat gallstones. This technique uses shock waves and is reserved for specific situations where surgical intervention may not be the first choice.
Conclusion
Hopefully, this blog was helpful in providing insights and clarifying any doubts about cholelithiasis treatments and causes. While online resources are informative, it is very crucial not to self-diagnose. Navigating health concerns requires personalised guidance. Don’t hesitate to seek professional advice. Consult with a Gastroenterologists to discuss your individual situation, get a definitive diagnosis, and explore the best gallstone treatment options for you. Take control, prioritise your well-being, and work together with your doctor to keep your health on track.
Disclaimer:
This article has been written for information purposes only, and is not a substitute for professional medical advice by a qualified doctor or other health care professional. The author is not responsible or liable, directly or indirectly, for any form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by the information in this article. Always consult a qualified healthcare provider for accurate diagnosis, personalised treatment, and recommendations tailored to your individual health needs.
