Gallstones are hard deposits that develop in the gallbladder due to accumulation of bile components. It can affect any age group and up to 60% of cases seen in the United States is in people over the age of 60 years. Gallstones can remain in gall bladder in which case it is known medically as cholelithiasis or can be impacted in the common bile duct when it is then referred to as choledocholithiasis. It may be silent (no symptoms) or may present with sudden onset upper abdominal pain often associated with nausea and vomiting. Gall stones in the common bile duct may lead to two serious complications pancreatitis and ascending cholangitis. Treatment in the form of surgery is recommended only in symptomatic cases and the entire gallbladder is often removed.
Gallstones may be asymptomatic. Symptoms arise if the gallstones become impacted in the gallbladder, block the outlet from gall bladder (cystic duct), or become lodged in the common bile duct. Symptoms of impacted gallstones in the gallbladder include :
Gallstones present in the gallbladder may erode the walls of the gallbladder and adjoining bowel causing obstruction of intestine (gallstone ileus) characterized by :
Symptoms of a blocked common bile duct by gallstone may lead to :
Pancreatitis, due to abnormal activation of digestive enzymes in the pancreas causing autodigestion of pancreatic tissue, presents with abdominal pain, nausea, vomiting, fever, jaundice and weight loss. Pancreatitis may lead to pancreatic cancer and diabetes.
Ascending cholangitis is an infection ascending from the first part of the small bowel to the site of impacted stone at the common bile duct. It is characterized by abdominal pain, fever with chill and rigor, jaundice, body ache, mental confusion and low blood pressure due to septic shock.
Bile contains cholesterol and bile salts which enhance the solubility of cholesterol. When these components precipitate in the gallbladder it forms biliary sludge which can then develop into gallstones. The interplay of following factors usually leads to gallstones :
Gallstones are of the following types :
Common risk factors include :
No treatment is required in the case of asymptomatic gallstone. Treatment options include :