Gallstones

Stones that form in the Gallbladder are mostly cholesterol stones. The liver makes bile that contains cholesterol, a form of fat, that is kept in solution by bile salts. In the gallbladder, in some patients the amount of cholesterol far exceeds the bile salts resulting in crystallization of cholesterol as Gallstones. Some patients form pigment stones that are dark and hard (calcium bilirubinate).

What are symptoms due to Gallstones?

In the vast majority of patients, Gallstones cause no symptoms. However, in some patients gallstones can cause severe upper abdominal pain in the Right Upper Quadrant or Epigastrium (midline area of the abdomen) that can last 10-15 minutes often associated with nausea and occasionally vomiting (Biliary Colic). When a gallstone blocks the cystic duct (the tube that connects the gallbladder with the common bile duct) patients develop inflammation in the Gallbladder call Acute Cholecystitis. Sometimes, a stone can pass through the cystic duct and enter the common bile duct and cause obstruction leading to jaundice (Obstructive jaundice) and at other times, stones pass into the duodenum causing transient obstruction to the pancreatic duct producing Biliary Pancreatitis.

How are Gallstones diagnosed?

Ultrasound Exam remains the procedure of choice in detecting gallstones with a 90% accuracy rate. Stones that have entered the common bile duct may require MRCP (MRI test) or ERCP (endoscopic test) with the latter capable of extracting the stones. Nuclear Medicine studies (HIDA) may be helpful in establishing acute cholecystitis.

How are Gallstones treated?

Patients with symptomatic gallstones are treated by Laparoscopic Cholecystectomy where the gallbladder is removed using a laparascope and 2-3 small button hole incisions in the abdomen. Patients who have stones in the Common bile Duct require ERCP (Endoscopic Retrograde Cholangio-Pancreatography), an endoscopic procedute to confirm the diagnoses and remove the stones.