Gallstones

Oral and Gastrointestinal

Gallstones are hardened pieces of material that form in your gallbladder – a small organ just under the liver and next to your pancreas. The gallbladder secretes bile from your liver into your intestines to aid in the digestion of fats. Sometimes, for reasons unknown, the bile fluid (along with other substances) form into gallstones that either sit inside the gallbladder or they can be ejected into the common bile duct. This can cause blockages in the bile duct or the opening to the pancreas triggering a gallbladder attack. During a gallbladder attack, a person may suffer from intense pain with nausea and vomiting. These attacks often happen after a high-fat meal, with caffeine intake, or randomly for no clear reason. Usually occurring during the evening or night, the pain can last from 20 minutes to a few hours, and even a few days. Gallstones with no symptoms are usually not surgically treated but can be managed with a strict diet to prevent more from forming. Untreated gallstones accompanied by symptoms can cause severe complications that may require surgical intervention and gallbladder removal.

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Symptoms

A mild case of gallstones may be symptomless. When the stones become large or begin to spill out of the gallbladder, symptoms begin to occur including:

  • Severe pain in the upper right abdominal area that comes on suddenly
  • Pain in the middle of the abdomen that may radiate to the back
  • Pain in between the shoulders
  • Right shoulder pain
  • Nausea
  • Vomiting
  • Fever (a sign to get emergency medical attention)

The pain with gallbladder attacks can last a few minutes to a few days. If you have the following signs, go to your nearest emergency room:

  • Yellow skin and/or eyes
  • Severe abdominal pain that does not go away
  • Fever with chills
  • Throwing up bile (yellow and very acidic)

Risk Factors

There are several risk factors associated with gallstones and gallbladder disease. These include:

  • Family History
  • Females
  • Pregnancy (hormones cause slowing of bile duct movement)
  • High-fat diet
  • Obesity
  • Diabetes
  • Native American or Hispanic ethnicity

Diagnosis

If you have symptoms of gallstones, see your doctor as soon as possible. The tests for gallstones include:

CT scan. The doctor may order a CT scan with contrast to create a picture of your gallbladder and bile ducts for measurements.

Ultrasound. This can be used to check the measurements of your bile ducts, which will be enlarged if there are stones present.

Hepatobiliary iminodiacetic acid (HIDA). The radiologist will give you a tracer in your arm that is attracted to the bile in the bile duct. When the scanner picks up the tracer, it can see the movement of the bile.

Endoscopic retrograde cholangiopancreatography (ERCP). The doctor sends a scope down your esophagus, through your stomach, and into the biliary tract. They can see the actual stones and remove them if necessary.

Laboratory tests. The doctor will run tests to check your blood count for signs of infection, liver panels, and check your pancreatic enzymes to make sure you don’t have pancreatitis.

Treatments

Gallstones can only be treated, but once you develop gallbladder disease it is permanent. Treatments are aimed at reducing gallstones and preventing them from growing. It can also reduce symptoms. Here are the treatments for gallstones:

Extracorporeal shockwave lithotripsy (ESWL). The doctor can use shockwaves during ERCP to break up any large stones. They can then move easily through the biliary tract and be passed from the body. Pain may increase shortly after treatment and then subside after the stones are passed.

Medications. Some medications can help dissolve gallstones. These drugs take a long time to be effective and recurrence is common. This is not a common treatment, but an option for those who are at risk of complications from surgery. Cholesterol-type gallstones are treated with these medications and you may experience diarrhea while taking them.

Surgery. If you have severe gallbladder disease, you may need to have your gallbladder removed in an organ removal surgery known as a cholecystectomy. The good news is you can live without a gall bladder. The liver takes over the work of the gallbladder and the bile moves straight from your liver into your digestive system. This surgery almost completely stops gallstones from forming, but there is a small chance they may still occur.

If a gallstone blocks the opening to your pancreas and you develop pancreatitis, then you will need to wait for the infection to clear before surgery can be done.

Alternative Treatments and Home Remedies

There are a few alternative remedies that may be helpful for gallstones. This needs to be done as part of your treatment plan that you and your doctor decide on. Alternative remedies should always be discussed with your doctor. Gallstones can have serious complications and should always be evaluated by your doctor. Here are some alternative remedies that may help:

Rowachol. Is a plant-based treatment consisting of purified plant essential oils derived from peppermint, eucalyptus, pine, or rosemary oils. This treatment may shrink or completely dissolve gallstones. It has been effective in some cases and studies are ongoing.

Lecithin. Taking soy lecithin may help dissolve stones of the cholesterol type. It may also be more effective if taken with rowachol.

Gallbladder flushing. Gallbladder flushes are done with both lubricant and acidic substances that are consumed as a liquid. Most recipes call for olive oil and lemon juice. These recipes are supported by folk medicine and some alternative medicine practitioners.  The medical community questions if this treatment is safe since gallstones may break free and cause blockage in other areas.

Lifestyle Changes

Dietary changes can relieve the pain of gallstones and prevent new ones from developing. If you still have your gallbladder and have symptoms, avoid these foods:

  • Foods high in cholesterol
  • Refined sugars
  • Beans
  • Onions or bell pepper
  • Fried foods
  • Foods high in saturated fat (ie., butter, fatty meats, whole milk)
  • Caffeine – stimulates gallbladder contractions

Include these foods in your diet:

  • Foods high in fiber
  • Nuts
  • Fresh fruits and vegetables
  • Just 1 to 2 glasses daily can lower the risk
  • Healthy oils. Olive oil, fish oils

Weight cycling (losing or regaining weight repeatedly) can lead to gallstones and stimulate gallbladder attacks. Physicians advise if you are trying to lose weight, avoid “crash diets” that push rapid weight loss, and set a goal to lose weight at a slower rate. The weight is more prone to stay off and you will avoid possible gallbladder attacks.

References

Abraham, S., et. al. (2014, May 15). Surgical and nonsurgical management of gallstones. American Family Physician, 89(10), 795-802. Retrieved from: https://www.aafp.org/afp/2014/0515/afp20140515p795.pdf

Amigo, L. et. al. (1999). Risk factors and pathogenesis of cholesterol gallstones: state of the Art. European Review for Medical and Pharmacological Sciences, 23, 241-246. Retrieved from: http://www.europeanreview.org/wp/wp-content/uploads/257.pdf

Hopkins Medicine Writing Staff. (2013). Gallstone disease: Introduction. Retrieved from: https://www.hopkinsmedicine.org/gastroenterology_hepatology/_pdfs/pancreas_biliary_tract/gallstone_disease.pdf

National Institute of Diabetes and Digestive and Kidney Diseases. (2017, November). Eating, diet, and nutrition for gallstones. Retrieved from: https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones/eating-diet-nutrition#:~:text=Experts%20recommend%20the%20following%20to%20help%20prevent%20gallstones%3A,gallbladder%20contract%20and%20empty%20on%20a%20regular%20basis

National Institute of Diabetes and Digestive and Kidney Diseases. (2017, November). Symptoms and causes of gallstones. Retrieved from:

https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones/symptoms-causes

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