Gallstones form when the concentration of bile allows formation of solid. Most stones are made from cholesterol with a smaller amount composed of bilirubin. About 20% of women and 10% of men will have gallstones by the age of 60. Risk factors include pregnancy, birth control pills, obesity, diabetes, rapid weight loss and a diet high in saturated fats. It can be hereditary.
Usually, symptoms of right upper abdominal pain after fatty meals prompts the evaluation. The combination of a history of pain with stones often leads to consultation for surgery. Pain from the gall bladder can present in many ways. Bloating, bandlike distribution under the rib cage, dull pains, sharp pains, right mid backaches are some examples.
Ultrasound can effectively evaluate the gallbladder and liver ducts. Ultrasound can show stones or inflammation to secure the diagnosis. Blood tests to evaluate the liver are helpful as elevation of liver enzymes or bilirubin can indicate stones or sludge passing from the gallbladder into the liver duct (choledocholithiasis).
- Bile Duct stones. Gallstones or sludge can pass from the gallbladder to the bile duct. On rare occasion, stones can form in the bile duct themselves, usually in older individuals who had the gallbladder removed years ago. The opening at the end of the bile duct as it meets the intestine is small and some stones in the bile duct will be trapped. Bile flow to the intestine is blocked causing bile to backup into the bloodstream. The skin can become jaundiced (yellow), the white portion of the eyes yellow (icteric), stool color becomes very pale and urine becomes dark orange. This condition requires treatment to remove stones from the duct. The complexities of this situation are best discussed with the surgeon.
- Pancreatitis. The pancreatic duct often empties into the lower part of the bile duct as it enters the intestine. Blockage here by stones or sludge (described above) can cause inflammation of the pancreas. This condition can range from mild pain for a day to a very serious life threatening illness.