Gallstones are stones that form in the gallbladder.

The stones can vary in size from small particles to large stones that occupy the entire gallbladder.

Gallstones are mainly composed of cholesterol or certain pigments.

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What causes it?

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It is not known exactly why stones develop, but there are factors that increase the risk of these collections of solid material forming.

• It is slightly more common in women

• It is more common in patients older than 40 years but can occur at any age.

• Family history of gallstones

• Certain conditions are associated with this condition such as: pregnancy, obesity, sudden weight loss, diabetes mellitus, lack of exercise, some medications, etc.

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Symptoms

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Most patients with gallstones do not have any symptoms and are usually diagnosed when an ultrasound or CT scan is performed for some other reason.

Asymptomatic patients do not need any specific treatment but should be aware of the symptoms and, if present, seek medical evaluation.

• Biliary colic: Abdominal pain typically below the right costal margin, usually occurring after eating greasy food. It may be accompanied by nausea, vomiting, or pain in the right shoulder. The pain is self-limited.

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complications

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• Acute cholecystitis: This occurs when the gallbladder becomes inflamed secondary to a total obstruction of the duct that drains the gallbladder. The symptoms are similar to  al biliary colic but the pain is not self-limited and may be accompanied by fever. This condition requires immediate medical attention.

• Choledocholithiasis: It results when a stone inside the gallbladder migrates to the duct that drains the bile to the intestine.  The symptoms of this complication are jaundice (yellowing of the skin and eyes) or the appearance of acute cholangitis which is the infection of the bile ducts and presents as pain, fever and/or chills and jaundice.  Prompt resolution of the obstruction is important.

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Diagnosis

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In case the symptoms suggest the presence of stones, the method of choice to diagnose this problem is abdominal ultrasound. 

Blood tests are also useful to find out if there is obstruction of the bile duct.

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Treatment

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The treatment of this disease will depend on the type of complication. 

In case of presenting as acute cholecystitis, treatment is with antibiotics and surgical removal of the gallbladder. 

In case of presenting as choledocholithiasis, the treatment of choice is the endoscopic removal of the stone that is obstructing, this procedure is called endoscopic retrograde cholangiography.