Cholelithiasis

Cholelithiasis is a disease in which gallstones form in the gallbladder. The gallbladder is an organ that stores bile. Bile is a fluid that helps to digest fats. Gallstones begin as small crystals and can slowly grow into stones. They may cause no symptoms until they block the gallbladder duct, or cystic duct, when the gallbladder tightens (contracts) after food is eaten. This can cause pain and is known as a gallbladder attack, or biliary colic.

• Cholesterol stones. These are the most common type of gallstone. These stones are made of hardened cholesterol and are usually yellow-green in color. Cholesterol is a fat-like substance that is made in the liver.
• Pigment stones. These are dark in color and are made of a red-yellow substance, called bilirubin,that forms when hemoglobin from red blood cells breaks down.

What are the causes?

• Has too much bilirubin. This can happen in certain blood diseases, such as sickle cell anemia.
• Has too much cholesterol.
• Does not have enough bile salts. These salts help the body absorb and digest fats.

In some cases, this condition can also be caused by the gallbladder not emptying completely or often enough. This is common during pregnancy.

What increases the risk?

• Being female.
• Having multiple pregnancies. Health care providers sometimes advise removing diseased gallbladders before future pregnancies.
• Eating a diet that is heavy in fried foods, fat, and refined carbohydrates, such as white bread and white rice.
• Being obese.
• Being older than age 40.
• Using medicines that contain female hormones (estrogen) for a long time.
• Losing weight quickly.
• Having a family history of gallstones.
• Having certain medical problems, such as:
  • Diabetes mellitus.
  • Cystic fibrosis.
  • Crohn's disease.
  • Cirrhosis or other long-term (chronic) liver disease.
  • Certain blood diseases, such as sickle cell anemia or leukemia.

What are the signs or symptoms?

• Usually comes at night or after eating.
• Can last for one hour or more.
• Can spread to your right shoulder, back, or chest.
• Can feel like indigestion. This is discomfort, burning, or fullness in your upper abdomen.

• Nausea or vomiting.
• Bloating.
• Pain in your abdomen that lasts for 5 hours or longer.
• Tenderness in your upper abdomen, often in the upper right section and under your rib cage.
• Fever or chills.
• Skin or the white parts of your eyes turning yellow (jaundice). This usually happens when a stone has blocked bile from passing through the common bile duct.
• Dark urine or light-colored stools.

How is this diagnosed?

• A physical exam.
• Your medical history.
• Ultrasound.
• CT scan.
• MRI.

• Blood tests to check for signs of an infection or inflammation.
• Cholescintigraphy, or HIDA scan. This is a scan of your gallbladder and bile ducts (biliary system) using non-harmful radioactive material and special cameras that can see the radioactive material.
• Endoscopic retrograde cholangiopancreatogram. This involves inserting a small tube with a camera on the end (endoscope) through your mouth to look at bile ducts and check for blockages.

How is this treated?

• Home care, if symptoms are not severe.
  • During a simple gallbladder attack, stop eating and drinking for 12–24 hours (except for water and clear liquids). This helps to "cool down" your gallbladder. After 1 or 2 days, you can start to eat a diet of simple or clear foods, such as broths and crackers.
  • You may also need medicines for pain or nausea or both.
  • If you have cholecystitis and an infection, you will need antibiotics.
• A hospital stay, if needed for pain control or for cholecystitis with severe infection.
• Cholecystectomy, or surgery to remove your gallbladder. This is the most common treatment if all other treatments have not worked.
• Medicines to break up gallstones. These are most effective at treating small gallstones. Medicines may be used for up to 6–12 months.
• Endoscopic retrograde cholangiopancreatogram. A small basket can be attached to the endoscope and used to capture and remove gallstones, mainly those that are in the common bile duct.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Ask your health care provider if the medicine prescribed to you requires you to avoid driving or using machinery.

Eating and drinking

• Drink enough fluid to keep your urine pale yellow. This is important during a gallbladder attack. Water and clear liquids are preferred.
• Follow a healthy diet. This includes:
  • Reducing fatty foods, such as fried food and foods high in cholesterol.
  • Reducing refined carbohydrates, such as white bread and white rice.
  • Eating more fiber. Aim for foods such as almonds, fruit, and beans.

Alcohol use

• If you drink alcohol:
  • Limit how much you use to:
    • 0–1 drink a day for nonpregnant women.
    • 0–2 drinks a day for men.
  • Be aware of how much alcohol is in your drink. In the U.S., one drink equals one 12 oz bottle of beer (355 mL), one 5 oz glass of wine (148 mL), or one 1½ oz glass of hard liquor (44 mL).

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes, e-cigarettes, and chewing tobacco. If you need help quitting, ask your health care provider.
• Maintain a healthy weight.
• Keep all follow-up visits as told by your health care provider. These may include consultations with a surgeon or specialist. This is important.

Where to find more information

• National Institute of Diabetes and Digestive and Kidney Diseases: www.niddk.nih.gov

Contact a health care provider if:

• You think you have had a gallbladder attack.
• You have been diagnosed with silent gallstones and you develop pain in your abdomen or indigestion.
• You begin to have attacks more often.
• You have dark urine or light-colored stools.

Get help right away if:

• You have pain from a gallbladder attack that lasts for more than 2 hours.
• You have pain in your abdomen that lasts for more than 5 hours or is getting worse.
• You have a fever or chills.
• You have nausea and vomiting that do not go away.
• You develop jaundice.

Summary

• Cholelithiasis is a disease in which gallstones form in the gallbladder.
• This condition may be caused by an imbalance in the different parts that make bile. This can happen if your bile has too much bilirubin or cholesterol, or does not have enough bile salts.
• Treatment for gallstones depends on the severity of the condition. Silent gallstones do not need treatment.
• If gallstones cause a gallbladder attack or other symptoms, treatment usually involves not eating or drinking anything. Treatment may also include pain medicines and antibiotics, and it sometimes includes a hospital stay.
• Surgery to remove the gallbladder is common if all other treatments have not worked.