Gallstones — your risk, treatment and pain management

LOCATED on the right side of your abdomen, just beneath your liver, the gallbladder is a small pear-shaped organ responsible for storing bile — a green-yellow liquid that aids with digestion. According to Dr Samantha Nicholson, medical internist at Imani Medical Centre, Papine Plaza, gallstones — which is a build-up of solid, stone-like material in the gallbladder — are most often formed when the bile contains too much cholesterol. However, high levels of calcium and bilirubin in the bile contribute to the forming of other types of pigment stones seen most often in people with liver disease or blood diseases such as in the case of patients with hemolytic anaemia like sickle cell anaemia.

“Gallstones are a very common condition. Having gallstones per se is not generally a major issue since the condition is asymptomatic in at least 80 per cent of people, even those with clusters of stones. However, if the patient develops complications, it may not only be painful but life-threatening,” Dr Nicholson advised.

She pointed out that among the complications and associated risks of gallstones is biliary colic. This condition, also known as gallbladder attack or a gallstone attack, describes a period of pain and discomfort which occurs due to a gallstone temporarily blocking the bile duct. The pain is generally felt in the right upper part of the abdomen, usually under the right side of the rib cage, and in some cases may travel to the shoulders as well. Patients may also experience nausea and vomiting.

Secondly, there is Choledocholithiasis, also called bile duct stones or gallstones in the bile duct. In this case, the gallstones present in the gallbladder block the bile duct and as such obstruct the flow of bile to the intestines.

“This can result in a number of things, including clay-coloured stool, lack of appetite, jaundice, as well as it can lead to Cholangitis whereby the duct becomes infected. Cholangitis can lead to sepsis, overwhelming infection and death,” Dr Nicholson said.

Another complication that may be observed in patients who have gallstones is Cholecystitis. This is where the gallbladder becomes inflamed and infected, a direct result of a gallstone becoming lodged in the neck of the gallbladder.

“This condition is associated with severe pain and fever. Gallstones and recurrent Cholecystitis are associated with gallbladder cancer, a rare but horrible cancer,” Dr Nicholson said.

But who really is at risk?

Gallstones, according to Dr Nicholson, affect a wide cross section of people; however, there are certain groups of people who are at an increased risk of developing this condition. These are most notably obese fertile women over 40, which she describes as a classic case. Others at a higher risk include:

•Anyone over age 40

•Being female

•Being overweight or obese

•Being sedentary

•Being pregnant

•Eating a high-cholesterol diet

•Having a family history of gallstones

•Having diabetes

•Taking medications that contain oestrogen, such as oral contraceptives or hormone therapy drugs

•Having liver disease.

And while you may be predisposed to the condition based on your lifestyle choices or by virtue of the way you were born, there are ways that you can manage the condition naturally if you do not have the complications, or keep it at bay. You can:

1. Change your diet

Since high cholesterol, fatty and greasy foods contribute the amount of cholesterol in your body, choosing healthier foods may reduce the possibility of gallstone formation.

2. Start exercising

A sedentary lifestyle is often associated with obesity, both of which are noted areas which increase your risk for gallstones. With exercise and certainly a more balanced diet, you should also reduce the possibility of gallstone formation.

In cases where gallstones are causing a problem, whether it is merely abdominal pain or other major complications, treatment is necessary.

“One of the most common recommendations when there are gallbladder complications is to remove it if the stones won’t pass on their own. The procedure is referred to as a cholecystectomy. It is nowadays done laparoscopically, which means that it is done with minimal scarring and requires a short recovery time,” Dr Nicholson explained.

In some cases medication may be given to dissolve gallstones, but this may take months or even years and this may not hinder the formation of gallstones.

In the case where the stone is in the bile duct, Dr Nicholson said that it can be retrieved endoscopically or surgically.