Gallstones and Bile Duct Stones

04 May 2024
Gallstones and Bile Duct Stones

Gallstones, which are created in the gallbladder, form when substances in the bile create hard, crystal-like particles. Cholesterol stones, as the name implies, are made of cholesterol and appear light in color. Eighty percent of gallstones are formed this way.

Pigment stones are small, dark stones made of bilirubin and calcium salts that are found in bile. About twenty percent of gallstones are pigment stones. Risk factors for pigment stones include:
- cirrhosis of the liver
- biliary tract infections
- hereditary blood cell disorders (such as sickle cell anemia)

Gallstones can be as small as a grain of salt or as large as a golf ball. The gallbladder may develop many smaller stones, or a single, often large one. It may even develop several thousand stones.

Gallstones that move out of the gallbladder can pass into your stomach. However, a stone may become lodged in your bile duct due to the size of the stone or the anatomy of the biliary tree. Thus, bile duct stones are gallbladder stones that have become lodged in the bile duct. Stones that become stuck in the ducts that lead to the duodenum can be both agonizing and dangerous.

Causes of the gallstones

Advancements have been made in better understanding the gallstone formation process. Gallstones may be caused by:
- inherited body chemistry
- body weight
- gallbladder movement (the gallbladder is a muscular sack that contracts)
- diet and lifestyle

Cholesterol gallstones

When the bile contains too much cholesterol and not enough bile salts, cholesterol gallstones may develop. Aside from a high concentration of cholesterol, there are two other factors that seem to be of importance in causing gallstones.

Movement of the gallbladder is referred to as gallbladder motility. This small but muscular organ squeezes to force bile into the bile duct. If the gallbladder does not perform as it should, the bile may not be able to makes its way into the bile duct, instead becoming concentrated and forming small crystals.

Gallstones may also be created by proteins in the liver and bile. These proteins may either promote cholesterol crystallization into gallstones.

Other factors also seem to play a role in causing gallstones but how is not clear.
- Obesity
- Low calorie, and rapid weight-loss diets
- Prolonged fasting
- Increased levels estrogen as a result of pregnancy
- Hormone therapy
- Birth control pills

No clear relationship has been proven between gallstone formation and a particular diet.

Risk factors

Gallstones affect approximately one million people every year, with women being twice as likely to become afflicted than men. They will join the estimated 20 million Americans —roughly 10 percent of the population— who already have gallstones.

Those who are most likely to develop gallstones are:
- Women, ages 20 – 60
- Men and women, ages 60+
- Men and women who are overweight
- Men and women who go on "crash" diets or who lose of lot of weight quickly
- Pregnant women, or women who have used birth control pills or estrogen replacement therapy
- Native Americans
- Mexican-Americans

Symptoms of the gallstones

A person with gallstones may have what are called "silent stones". Studies show that most people with silent stones may not experience any symptoms at all for awhile, remaining symptom-free for years and requiring no treatment. Silent stones may go undiagnosed until they begin to cause discomfort.

For those that are not quite so lucky, the symptoms my include:
- Acute pain, possibly very severe, that occurs very suddenly. It may last a few minutes, or many hours
- Pain is usually located behind your breastbone, but may occur in the upper right abdominal area
- Pain between your shoulder-blades
- Chills and fever
- Jaundice
- Nausea and vomiting

It is not uncommon for attacks to be separated by weeks, months, or even years.

Diagnosis of the gallstones

Diagnostic methods for detecting gallstones may include:
- ultrasound
- barium exam
- CT scan

When actually looking for gallstones, the most common diagnostic tool is ultrasound. An ultrasound examination, also known as ultrasonography, uses sound waves to create images of the various abdominal organs … &hel including the gallbladder. If stones are present, the sound waves will bounce off the stones, revealing their location.

Ultrasound has several advantages.
- It is a noninvasive technique - nothing is injected into or penetrates the body
- It is painless - there are no known side effects
- It does not involve radiation

Occassionaly, other tests needed to detect small stones, or verify their non-existance, may be required.
- MRI/MRCP — a painless, magnetic imaging technique
- endoscopic ultrasound — a minimally invasive procedure that can visualize tissue
- ERCP — for diagnosis and management of stones in the bile duct