Understanding the ins and outs of gallstones and how to treat them.

Gallstones, and issues with the gallbladder, are more common than many people assume. There are about one million gallbladder removals performed each year in the U.S. Some patients might live with gallstones and never know it. But gallstones can be quite painful and dangerous if not treated.

 The gallbladder

This sack-like structure under the liver on the right side of the abdomen is often described as a partially filled water balloon. The gallbladder stores bile produced from the liver to use in the small intestine. Bile is transported from the liver via a tube called the bile duct. This bile helps digest and break down fat from food in the intestine to use for energy.

Bile is made of three components — bile salts, cholesterol and lecithin. If any of these components are out of balance or there is an abundance of one, then the leftover particles begin to stick together like grains of sand, and eventually form stones in the gallbladder.

These stones can range in size from grains of sand to that of a golf ball; however, the average gallstone is less than one centimeter, roughly the size of a pea. Although everyone is subject to developing gallstones, they do tend to be more prevalent in premenopausal women and people who are overweight. They also most commonly occur during middle age – 30s to 50s.

Symptoms

Interestingly, about half of patients who have gallstones will never know they have them. Gallstones cause pain and discomfort when they begin to move, or float. This pain happens because of two scenarios.

If stones float to the neck of the gallbladder where it joins the bile duct, they create a blockage. Usually after eating a fatty meal, patients will complain of a deep aching under the breastbone or on the right side of the abdomen under the rib cage. Sometimes this pain will extend into the back and even the shoulder blade. The pain will eventually subside, but can be severe. Some people confuse this with heartburn and may wait weeks before addressing the issue.

Stones can float out of the gallbladder and block both the bile duct and the pancreatic duct, causing pancreatitis. This pain is more severe than that of a gallbladder attack. It starts in the stomach and bores through the back. This pain will also stay, not come and go. Further symptoms from this issue can include jaundice if enough bile backs up.

If a patient is experiencing any of these issues, an ultrasound of the stomach is performed to look for inflammation of the gallbladder. A blood test to evaluate enzyme levels might also be performed.

Patients should listen to their bodies and not ignore systems.

 Treatment

Gallstones are treated by laparoscopically removing the gallbladder. The gallbladder is one of a handful of organs you can live without. When it is removed, the liver provides bile directly to the intestine, and patients usually adjust rather easily.

The surgery is rather simple and minimally invasive. It usually lasts about an hour to an hour and a half, patients are released that same day, and full recovery only takes about one week. There are occasions when the gallbladder can be very inflamed, making the operation challenging and putting the patient at a higher risk for complications. Patients should listen to their bodies and not ignore symptoms.

Brian J. Dunkin, M.D., FACP is the Head of the Section of Endoscopic Surgery and Medical Director of the Methodist Institute for Technology, Innovation & Education at the Houston Methodist Hospital. Dr. Dunkin is a biomedical engineer who did his surgical residency training at the George Washington University and a fellowship in advanced laparoscopy and surgical endoscopy at the Cleveland Clinic. He has been an Assistant Professor of Surgery at the University of Maryland, an Associate Professor at the University of Miami and is currently a Professor of Clinical Surgery at the Weill Cornell Medical College.