The causes of gallstones in adults is not exactly known, but it seems that stagnant bile plays a major role.
Our liver makes bile, which is needed to break down and burn fats.
As a whole, causes of gallstones in adults are still unknown, though stagnant bile plays an important role. If bile residue is left for too long in the gallbladder, it hardens and turns to stone. Pain occurs when a gallstone gets stuck in the bile duct between the gallbladder and main bile duct.
Bile is temporarily stored in the gallbladder before traveling through the bile ducts to the intestines.
The bile fluid may begin to thicken if bile sits stagnant in the gallbladder for an extended period or if there is an infection in the gallbladder.
This thickened bile can eventually turn to stone and form gallstones. Gallstones usually form in the gallbladder but can also occur in the bile ducts.
Read on for more detailed information about gallstones, causes, signs, symptoms, diagnosis, and treatment.
Table of Contents
Causes of gallstones in adults: Introduction
Sometimes gallstones are tiny, but they can also be as big as marbles. There are several types of gallstones, depending on the substance they are made of.
For example, cholesterol stones are most common. There are also pigment stones that get their color from the yellow dye from the bile (bilirubin).
The liver
The liver stores vitamins and minerals and produces bile fluid. It also produces many vital substances such as proteins and fats.
In addition, the liver renders toxins and drugs harmless, and this organ plays an essential role in energy metabolism.
The liver recovers incredibly well and also has a large reserve capacity. The liver lies in the upper right of the abdominal cavity, against the diaphragm, and below the ribs.
The gallbladder
The gallbladder is a small, pear-shaped sac that temporarily stores bile fluid.
Bile is made by the liver. Bile fluid enters the gallbladder through the bile ducts,
When fatty food leaves the stomach, the gallbladder contracts. Bile fluid then enters the duodenum through the bile ducts, where the fats are broken down.
The gallbladder location is in the upper right of the abdominal cavity, under the liver.
Cause of gallstones
It is unclear exactly how gallstones form, though it is known that stagnant bile plays an important role. Every time the gallbladder squeezes to send bile to the intestines, there may be a residue of bile left behind.
If the same bile is left repeatedly, it can start to thicken and slowly turn to stone.
For example, this can happen if the gallbladder does not squeeze itself completely empty at meals.
Bile contains cholesterol. And if there is a lot of cholesterol in the bile, then there seems to be a greater chance of cholesterol stones.
Cholesterol stones, by the way, are more common in women than in men. Female hormones probably play a role here.
Gallstones are also more common during pregnancy.
Being overweight, obese, hereditary factors, and losing weight quickly also increase the risk of gallstones.
Signs and symptoms of gallstones
Many people have gallstones without ever experiencing any symptoms from it.
Symptoms arise only when a gallstone becomes obstructed because the bile fluid can no longer flow properly.
Severe abdominal pain due to gallstones
When a gallstone gets stuck in the bile duct between the gallbladder and main bile duct, it often causes severe abdominal pain.
Biliary colic or colic pain
The gallbladder will try to clear the blockage and allow the gallstone to flow through. The gallbladder does this by contracting violently.
This can cause severe pain in the upper right abdomen, also known as biliary colic. This colic pain often shows up in attacks and may last for several hours.
People usually cannot sit still during a gallstone attack and may up rolling or twisting in bed, crawling on the floor, or pacing back and forth in pain.
The pain may be there for a few minutes and then go away. But the pain can also be present for more extended periods many times in a row.
The pain can often recur, and you may feel nauseous from this pain and even have to vomit.
Discolored (beige) stools as a symptom of gallstones
Do you suffer from discolored stools? This is a sign that bile is not reaching the intestine. And this can be a result of gallstones.
Bile fluid causes the brown color of the stool. When the bile fluid no longer flows properly, the stool loses its brown color and becomes beige in color.
Jaundice
If a gallstone is stuck in the main bile duct, the bile produced by the liver has nowhere to go.
The bile fluid then accumulates in the liver. This can cause bile dye to enter your blood. Your skin and the whites of your eyes then turn yellow, and your urine turns dark.
Possible complications
If a gallstone remains stuck in the bile ducts for an extended period, several complications can arise:
- Inflammation of the bile ducts or gallbladder (cholangitis or cholecystitis). A stuck gallstone can cause your bile ducts and/or gallbladder to become inflamed. You will feel sick, and you may also have a fever.
- Acute pancreatitis (pancreatitis). Sometimes the pancreas can also become inflamed with gallstones. You then feel very ill, have a fever, and experience persistent pain deep in your upper abdomen and possibly even in your back.
Diagnosis of gallstones
The family doctor can usually diagnose gallstones, based on your symptoms.
Further investigation is required to ascertain the diagnosis, for which you will be referred to a gastrointestinal liver specialist in the hospital.
You may then need to undergo:
Ultrasound
In most cases, calcific gallstones can be diagnosed with ultrasound, an examination that uses sound waves. Tp be noted that non-calcium gallstones are usually not seen on an ultrasound.
MRI scan
An MRI scan allows the doctor to detect all types of gallstones in the gallbladder and especially in the bile ducts by using a strong magnetic field.
Sometimes, the doctor cannot find the gallstone with either examination (ultrasound + MRI scan). The gallstone may have already been expelled from the body along a stool.
The diagnosis can often be made anyway because the doctor sees other gallstones in your gallbladder or observes dilated bile ducts.
Treatment of gallstones
If gallstones do not cause any symptoms, treatment is usually not necessary.
In practice, gallstones are often found by chance when an abdominal examination is done for other reasons. For example, even if it is just one gallstone attack and you have no symptoms after that, you usually do not need treatment.
If you continue to have symptoms or the pain attacks keep coming back, the gallbladder can be removed with surgery, and if this is not an option, another treatment may be chosen.
Surgery to remove the gallbladder
The most effective treatment for gallstones is the removal of the gallbladder with surgery.
This is also called a gallbladder resection or cholecystectomy. Because most gallstones originate in the gallbladder, the risk of new gallstones after this surgery is low.
You can live well without a gallbladder. Sometimes your body needs some time to get used to the new situation, so you may experience temporary thinner stools.
The gallbladder can be removed in two ways: with keyhole surgery (laparoscopy) or open abdominal surgery.
ERCP: Endoscopic Retrograde Cholangiopancreatography
Gallstones in the bile ducts can sometimes be removed through the bowel with a keyhole examination called Endoscopic Retrograde Cholangiopancreatography (ERCP).
These gallstones have almost reached the intestine through the bile duct but got stuck at the last bit.
In an ERCP, the doctor goes through the mouth, esophagus, and stomach to the duodenum (the first part of the small intestine) with a flexible tube (endoscope).
Inside the intestine, the main bile pathway is then wiped clean with a balloon so that the stone falls into the intestine and leaves the body with the stool.
Gallstones that are in the gallbladder cannot be removed with an ERCP.
An ERCP is a good solution for an acute gallstone attack. In the longer term, an ERCP visual examination is often less effective.
This is because new gallstones can still form in the gallbladder. And if new gallstones develop, surgery to remove the gallbladder is often required.
Medications for gallstones
Painkillers can help alleviate pain caused by gallstones.
In some cases, the doctor prescribes medication as a treatment for the gallstones themselves.
Some medications can make small gallstones dissolve, but this isn’t always successful.
New gallstones may also form after this treatment so it is less effective than surgery. However, your doctor can tell you more about these medications.
Pulverization of gallstones
Sometimes (especially large) gallstones are pulverized as is done for kidney stones. Crushing causes the gallstone to disintegrate into small stones and grit, these particles can then be removed with an ERCP (keyhole examination).
Pulverization can be done externally, with the same device used to pulverize kidney stones, or internally through an ERCP.
What can I do? Tips and advice for gallstones
If you suffer from a lot of diarrhea, it is essential to drink plenty of fluids and get enough salt to compensate for the loss of fluid and salts through the stool and prevent dehydration.
Consider an Oral Rehydration Solution (powder) to dissolve in water to replenish all necessary salts.
A healthy weight is important
You can reduce the risk of gallstones in adults by achieving and maintaining a healthy weight.
Are you overweight? A dietitian can help you lose weight healthily and gradually but be careful as hose who lose a lot of weight too quickly are more likely to get gallstones.
It is essential to eat a healthy and varied diet and be careful with fatty foods. There is no special diet to prevent gallstones.
Causes of gallstones in adults: Conclusion
While the causes of gallstones in adults is not yet exactly pinpointed, it is known that bile, or stagnant bile, plays an important role in their formation.
This article has outlined where they come from, symptoms and treatments, but as always, your best bet is to see a doctor.
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