Cholelithiasis

Signs and Symptoms of Cholelithiasis (Gallstones)

In the right upper quadrant of the abdominal cavity, the liver produces bile, which is a liquid that digests fats like oils, greasy foods, butter and other products. The main bile duct, or tube, runs from the liver to the small intestine; it sends a constant flow of bile into the digestive system when we eat. If you eat a lot of fats in one meal, like a greasy burger and fries, the body signals the gallbladder—which sits against and just below the liver and is a storage bag for bile off of the main duct—to release extra bile into the system, and it squeezes out more to digest the extra fat. In some people, the bile solution is not in balance, and stones can form in the gallbladder from cholesterol or other substances. When the gallbladder tries to squeeze out bile, if a stone blocks the exit to the cystic (gallbladder) duct, it can cause pain and blockage of the bile system. Sometimes, this blockage is temporary, and the pain gets better within minutes or hours. This is referred to as biliary colic, or a gallbladder attack, and generally occurs after a meal high in fats. Other times, the blockage and pain persist, and the gallbladder wall becomes inflamed and swollen. This is known as cholecystitis. For most patients, the pain is felt in the upper right abdomen and sometimes in the middle upper abdomen as well. Some patients with pain or inflammation related to gallstones feel like throwing up, whether they do or not.

Diagnosis of Cholelithiasis (Gallstones)

The doctor will take a careful history, asking about when and how your symptoms started, like pain and where it is located, and whether there have been changes since it started. A physical examination enables your doctor to evaluate for presence and degree of tenderness, and blood may be drawn to check labs related to liver function, infection, and other possible causes of your symptoms. Imaging may be performed, most commonly an ultrasound, which can show the presence of stones in the gallbladder. If the gallbladder wall is inflamed, or if blockage of the bile duct is suspected, the stones may be causing cholecystitis or a more severe condition. On CT scan, the doctor may also be able to see stones, dilated or swollen ducts or other signs of inflammation or infection, but ultrasound is the most reliable way to see gallstones. If you have stones associated with pain, but no inflammatory changes or evidence of cholecystitis, the diagnosis is usually biliary colic.

Treatment for Cholelithiasis (Gallstones)

Simply because gallstones are present does not mean that any specific treatment is needed. A low-fat diet is often recommended to minimize symptoms related to gallstones. If you are still having pain from biliary colic, an operation to remove the gallbladder may be appropriate—this is called cholecystectomy. In most cases, surgery can be performed laparoscopically, with a few small incisions, through which a special camera and instruments are used to take out the gallbladder. Carbon dioxide is introduced into the abdominal cavity, which expands, allowing the surgeon to see the gallbladder and liver clearly. An anesthesiologist puts the patient to sleep for the operation, and wakes them up afterward. Pain from the incisions is managed with oral medication, and you should be able to eat again soon after surgery. Recovery time is usually shorter than with a longer incision directly over the gallbladder (“open” cholecystectomy), although one may still be necessary in some cases.

Without a gallbladder, bile still flows from the liver to the intestine, and fats still get digested. But a meal which is very high in fat may overwhelm the system, since there is no longer a storage reservoir to provide extra bile. Early after gallbladder surgery, if a patient does eat too much fat in one meal, they may experience bloating, gas, cramps and diarrhea, as the undigested fat moves through the intestines. Most patients’ bodies slowly adjust to the absence of the gallbladder, and they are eventually able to eat much as they did before their surgery. But if they do overdo it with a fatty meal, it is easy to recognize and correct by moderating the fat content the next time.