Cholelithiasis

Cholelithiasis is the medical term for gallstones, which are hard, pebble-like deposits that form in the gallbladder. The gallbladder is a small organ located beneath the liver that stores bile, a digestive fluid produced by the liver. Gallstones are often asymptomatic, or "silent," and don't interfere with the gallbladder, liver, or pancreas. However, when gallstones block the bile ducts, they can cause a sudden, intense gallbladder attack that requires medical attention. 

Common causes

Gallstones form when the bile stored in the gallbladder hardens and crystallizes. This can occur if the bile contains too much cholesterol, too much bilirubin, or not enough bile salts. 

  • Cholesterol gallstones: These are the most common type and are yellow in color. They can form when:

    • Your liver produces too much cholesterol, and your bile is unable to dissolve it.

    • The gallbladder doesn't empty completely or frequently enough, causing the bile to become overly concentrated.

  • Pigment gallstones: These dark brown or black stones form when bile contains too much bilirubin, a byproduct of red blood cell breakdown. They are more common in people with:

    • Liver cirrhosis

    • Biliary tract infections

    • Blood disorders, such as sickle cell anemia 

Signs and symptoms

While many people with gallstones don't have any symptoms, a "gallbladder attack" or biliary colic can happen when a gallstone blocks one of the ducts. 

  • Pain: The most common symptom is a sudden, severe pain in the upper right or center of the abdomen, just below the ribs. This pain, which can be steady or come and go, may also radiate to the back or right shoulder. It often occurs after a heavy or fatty meal, when the gallbladder contracts.

  • Digestive issues: Nausea, vomiting, bloating, belching, indigestion, and intolerance of fatty foods are common.

  • Jaundice: A yellowing of the skin and whites of the eyes can occur if a gallstone blocks the common bile duct(CBD).

  • Other signs of severe blockage: High fever, chills, rapid heart rate, and clay-colored stools can signal a more serious infection or inflammation. 

Diagnosis

To diagnose cholelithiasis and rule out other conditions, doctors use several methods: 

  • Abdominal ultrasound: This is the most common and accurate noninvasive test to detect gallstones in the gallbladder.

  • Blood tests: These can check for signs of infection, jaundice, or complications affecting the liver or pancreas.

  • Endoscopic ultrasound (EUS): This may be used to identify smaller gallstones that are not visible on a standard abdominal ultrasound.

  • Other imaging tests: Depending on the situation, a CT scan, MRI, or a specialized HIDA scan may also be used to get a clearer picture of the biliary system. 

Treatment

Treatment is only necessary for gallstones that are causing symptoms. 

  • Surgical removal of the gallbladder (cholecystectomy): For recurrent or symptomatic gallstones, surgery to remove the gallbladder is the most common and effective treatment. The procedure is most often performed laparoscopically, which is a minimally invasive surgery with a fast recovery time. The gallbladder is not a necessary organ, and bile will simply flow directly from the liver to the small intestine.

  • Medications: Oral medications may be used in certain situations to dissolve cholesterol gallstones, but they can take months or years to work and the stones often return. This treatment is generally reserved for people who cannot undergo surgery.

  • Managing complications: If a gallstone is stuck in the common bile duct, a procedure called an Endoscopic Retrograde Cholangiopancreatography (ERCP) may be performed to locate and remove the stone. 

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