Gallstones

Signs and Symptoms

Many people do not experience any symptoms and are said to have "silent gallstones." Often the gallstones are found when a test is performed to evaluate some other problem. Treatment is only recommended if a person actually experiences symptoms of the condition.

A severe and steady pain in the upper abdomen or right side is the most common symptom of gallstones. The pain, which also may affect the shoulder blades or right shoulder, lasts anywhere from several minutes to hours. In addition, you may experience sweating or vomiting.

In its more advanced and severe stages, gallstones can cause prolonged pain and infection of the gallbladder. Stones that have passed into the bile duct usually result in pain, fever and jaundice, which is yellow discoloration of the eyes and skin.

Diagnosis

First your doctor will ask about your medical history, perform a physical examination and possibly blood and urine tests to check for gallstones. In order to make a definite diagnosis, the following imagining tests are commonly used.

• X-rays -- Gallstones only show up on regular X-rays 10 percent of the time, so in order to make them appear, you will ingest a dye-containing pill. This procedure is very effective and called an oral cholecystogram (OCG).

• Ultrasound -- This painless and safe test uses sound waves to produce images of your gallstones that appear on a video screen.

• Magnetic Resonance Cholangiopancreatography (MRCP) -- This is a newer, noninvasive imaging method, based on magnetic resonance imaging (MRI), which provides views of the biliary ducts in multiple planes. It is a definitive diagnosis test for gallstones in the bile ducts, but not in the gallbladder.

• Endoscopic Retrograde Cholangiopancreatography (ERCP) -- When gallstones have entered the bile duct, they are very difficult to diagnose using ultrasound or X-rays. In these instances, a test called an endoscopic retrograde cholangiopancreatography (ERCP) is used to locate and remove stones in the ducts. This procedure uses an endoscope -- a long, flexible, lighted tube connected to a computer and TV monitor. Your doctor will guide the endoscope through your stomach and into the small intestine. Then a special dye that temporarily stains the ducts in the biliary system is injected. The process of taking these X-rays is known as cholangiopancreatography.

  ERCP combines endoscopy and a method of X-ray imaging called fluoroscopy to obtain pictures of the ducts that drain your liver, gall bladder and pancreas. When obstructions or lesions are seen, they often can be diagnosed and treated at the time of your procedure when performed by trained experts. ERCP is a complex procedure, however, and carries increased risks over standard endoscopy and colonoscopy. It is important to understand these risks and the indications for this test, as well as possible alternatives to this procedure.

• Endoscopic Ultrasound (EUS) -- EUS involves passing a thin, flexible tube called an endoscope through the mouth or the anus to exam the lining and walls of the upper and lower gastrointestinal tract and nearby organs such as the pancreas and gall bladder. The endoscope is equipped with a small ultrasound transducer that produces sounds waves that create a viewable image of the digestive track. When combined with fine needle aspiration, EUS becomes a state-of-the-art, minimally invasive alternative to exploratory surgery to remove tissue samples from abdominal and other organs. It also may be used to determine the cause of symptoms such as abdominal pain, to evaluate a growth, to diagnose diseases of the pancreas, bile duct and gall bladder when other tests are inconclusive and to determine the extent of certain cancers of the lungs or digestive tract.

Treatment

Gallstones may be treated with surgery and medications.

Surgery

If surgery is required, the following procedures may be used:

• Cholecystectomy -- Surgical removal of the gallbladder, a procedure called cholecystectomy, is the most widely used therapy for gallstones, although this procedure is now mostly done laparoscopically. Though in some cases, due to infections or other surgeries, this traditional form of cholecystectomy will be performed. Four or five days of hospitalization are generally required for this procedure. Patients often do well after surgery and have no difficulty with digesting food.

• Laparoscopic Cholecystectomy -- UCSF Medical Center also offers a less-invasive procedure called laparoscopic cholecystectomy. During this procedure, the surgeon makes several incisions in the abdomen through which a tiny video camera and surgical instruments are passed. The video picture is viewed in the operating room on a TV screen, and the gallbladder can be removed by manipulating the surgical instruments. Because the abdominal muscles are not cut there is less postoperative pain, quicker healing, and better cosmetic results. You can usually go home from the hospital within a day and resume normal activities within a few days.

• Endoscopic Retrograde Cholangiopancreatography (ERCP) -- ERCP can be used to find stones in the bile duct, as described in the diagnosis section. When stones are detected, the doctor can widen the bile duct opening and pull the stones into the intestine. This is commonly done when the gallbladder is being removed laparoscopically or when a stone is found in the duct long after gallbladder surgery. If a patient is too frail to undergo gallbladder surgery, it also may be performed to relieve symptoms from a bile duct stone, even when other stones are present in the gallbladder.

Medications

Special chemicals, available in pill form, can be used to dissolve certain gallstones, such as those composed of cholesterol. However, due to a lack of medical research, the efficacy of these medications has not been proven yet.