Gallbladder stones

Gallbladder stones symptoms differ from person to person, depending on the size and location of gallstones. The most prominent and visible symptoms include sudden intensifying abdominal pain and other related digestive problems. For many individuals, gallstones may remain silent and not show any signs or symptoms. These silent gallstones typically do not pose significant health risks. However, if the gallstones block or enter the bile duct, they may lead to other health complications. Therefore, it is advisable to consult a physician immediately for early diagnosis and treatment.

Common signs and symptoms of gallbladder stones include:

• Sudden Intensifying Pain in the Stomach: This is the most common symptom of gallbladder stones. The pain usually occurs in the upper right portion of the abdomen and may radiate to other areas. Increased pressure within the gallbladder or a blockage in the bile duct due to gallstones can cause this abdominal pain, which may last for approximately 20 minutes to several hours.
• Flatulence: Some individuals with gallstones may experience flatulence. An increased amount of gas secretion or gas buildup in the digestive system due to underlying health conditions such as gallbladder stones can trigger flatulence.
• Nausea and Vomiting: Another common symptom associated with gallbladder stones is nausea and vomiting. Increased pressure in the gallbladder caused by gallstones may lead to fluid imbalance in the stomach, resulting in nausea and vomiting.

Other symptoms may include:

• Pale or yellowish skin
• Loss of appetite
• Abdominal bloating
• Chest pain
• Radiating pain in the right shoulder
• Fever
• Clay-colored stools

Warning symptoms that require urgent medical care include:

• Severe or radiating abdominal pain
• Yellowing of the skin or whites of the eyes
• Stomach bloating

Many of the symptoms of gallbladder stones may resemble other gastrointestinal problems, such as ulcers, appendicitis, or pancreatitis. Therefore, early recognition and treatment of gallbladder stones are crucial to reducing associated risks. It is important to note that kidney stones are not the same as gallstones.

The exact causes of gallbladder stones are not clearly understood. However, several factors are believed to contribute to the development of gallstones. Some possible causes of gallbladder stones include:

1. Imbalance of bilirubin in the bile: Elevated levels of bilirubin, a pigment secreted by the liver, may cause the accumulation of excess bilirubin in body tissues. This, in turn, may contribute to the formation of gallstones.
2. Excessive secretion of cholesterol: Gallbladder stones develop when the liver secretes excessive cholesterol, resulting in the formation of cholesterol crystals that develop into gallstones.
3. Improper emptying of the gallbladder: Improper emptying of the gallbladder over time may lead to the formation of mucus-like gallbladder sludge, which may eventually develop into gallstones.
4. Insufficient bile salt concentration: Insufficient or imbalanced bile salt concentration correlates with an increased risk of developing gallbladder stones.
5. Diet and lifestyle: Certain lifestyle factors and improper dietary practices may also lead to the formation of stones in the gallbladder. These include:
   • Regular consumption of highly processed and fried foods
   • Alcohol consumption
   • Stress
   • Obesity
   • Inactive or sedentary lifestyle

Gallstones develop due to an imbalance in the chemical composition of the bile inside the gallbladder. The accumulation of high levels of cholesterol in the bile over time may form small crystals (gallstones), causing abdominal pain. Some of the most common risk factors associated with gallbladder stones include:

• Smoking
• Men older than the age of 60
• Sedentary lifestyle
• Pregnancy
• Oral contraceptives
• Rapid weight loss
• Liver disease
• Diabetes
• Obesity
• Metabolic disorders such as hyperparathyroidism (excessive secretion of thyroid hormone)
• Individuals with a family or medical history of gallstones
• Eating a low-fiber diet
• Taking certain medications that have anticholinergic effects
• Crohn's disease, ileal resection, or other diseases of the ileum that decrease bile salt reabsorption and increase the risk of gallstone formation
• Other illnesses or states that predispose to gallstone formation, including burns, use of total parenteral nutrition, paralysis, ICU care, and major trauma

If you are experiencing any symptoms of gallbladder stones, such as intense abdominal pain, extreme fatigue, flatulence, or stomach bloating, it is wise to consult a gastroenterologist or primary care physician. Early diagnosis and prompt treatment for gallstones reduce the risks associated with their complications.

If your symptoms are mild, your physician might not recommend any tests. However, if your symptoms do not improve post-treatment or if you experience symptoms such as nausea or bloody stools, then your physician might recommend further investigation. The tests include:

• Physical examination of the abdomen: If you experience any symptoms, your physician might perform a physical examination of your abdomen. Assessment of your abdomen may provide critical information about the internal organs. Some common physical examination findings for gallstones include:
• Evaluation of physical appearances, such as yellow discoloration of the skin and sclera (the white layer of the eye).
• Checking vital signs such as blood pressure, body temperature, heart rhythm, and other signs of gallstones in the body.
• Examination of the abdomen for tenderness and distension.
• Abdominal ultrasound: Ultrasound, a non-invasive imaging procedure, is commonly used to diagnose the signs of gallstones. This test uses high-frequency sound waves to visualize the organs and structures within the abdomen.
• Endoscopic ultrasound: Endoscopic ultrasound (EUS) is an accurate and relatively noninvasive technique to identify stones in the distal common bile duct. The sensitivity and specificity of CBD stone detection are reported in the range of 85%-100%.
• Complete blood count (CBC): This blood test may help reveal the cause of gastrointestinal obstruction. Elevated levels of bilirubin and cholesterol in the blood test may also help detect infection, pancreatitis, and other related abnormalities in the gallbladder.
• Magnetic resonance imaging (MRI): An MRI scan of the abdomen can help detect stones in the gallbladder. This test uses strong magnetic fields and radio waves to create images of the internal organs and is usually an outpatient procedure, allowing you to go home the same day.
• Cholangiogram: Also known as a DISIDA (diisopropyl iminodiacetic acid) scan or gallbladder radionuclide scan, this procedure uses radioactive dye and a special scanning probe to detect small stones that may be missed on other imaging techniques. This method is commonly used to detect and locate blocks in the bile.
• Computed tomography (CT) abdomen scan: During this procedure, your doctor uses a special x-ray probe and a computer to create cross-sectional images of the gallbladder. These images may help physicians spot ruptures (tears in the gallbladder wall) and infections in the gallbladder.

Other imaging tests include:

• Abdominal X-ray
• Oral cholecystography
• Hepatobiliary iminodiacetic acid (HIDA) scan
• Endoscopic retrograde cholangiopancreatography (ERCP)

To get the right diagnosis, it is important to consult the appropriate doctor. Consult India’s best doctors online.

Although there are no definite steps to prevent gallbladder stones completely, some preventive measures may help you manage the condition and reduce its implications.

• Consume a balanced diet: The food we eat significantly impacts the health of the gallbladder. A 2020 study on the association of diet with symptomatic gallstones reported that high consumption of saturated fats increases the risk of gallstones. Therefore, eating a healthy diet rich in essential nutrients is crucial for preventing gallstone formation.
• Maintain a healthy body weight: Being obese or overweight puts you at a higher risk of developing gallbladder stones. Consult a nutritionist or doctor to help you create an appropriate diet plan to reduce the frequency of the disease.
• Don't skip meals: Regularly skipping meals can have adverse effects on health. For individuals with gallbladder diseases, skipping meals may cause stress buildup in the bladder, potentially leading to serious health complications. It is generally advised to adhere to regular mealtimes each day.
• Be active: A sedentary lifestyle or physical inactivity can contribute to the development of gallstones and other health complications. Incorporate moderate exercises such as jogging, stretching, and yoga to reduce your risk of gallstones.
• Try to lose weight gradually: Rapid weight loss may trigger cholesterol secretion in the body. For obese patients who have undergone bariatric surgery, sudden weight loss may increase the risk of developing gallstones. It is important to lose weight in a healthy, safe, and gradual manner.
• Take preventive medication if necessary: Gallbladder stones have a multifactorial etiology and share similar symptoms with other gastrointestinal disorders. However, if symptoms are recognized early, interventions can reduce the risk of complications.

People who have silent gallbladder stones (asymptomatic gallstones) show mild symptoms and may not require any treatment. However, for individuals with gallstone complications and intense abdominal pain, the following treatments may be necessary:

Nonsurgical treatments

• Medications: The medications used to treat gallbladder stones either work by breaking down cholesterol accumulation in the stomach acids or by decreasing cholesterol secretion in the bile. The most commonly used medications for gallbladder stones include:
• Ursodeoxycholic acid: Ursodeoxycholic acid, or ursodiol, is a naturally occurring bile acid effective in preventing gallstones. It works by dissolving excess cholesterol or gallstone crystals in the gut. This class of medications is FDA-approved for the treatment of gallstones but may require a longer time to work. Therefore, their use is considered only for mild and less serious cases.
• Chenodiol: Chenodiol, or chenodeoxycholic acid, is also a naturally occurring bile acid used to treat gallstones. It works by preventing the secretion of excess cholesterol in the liver that leads to gallstone formation. However, the use of this medication does not guarantee immediate recovery or results. It is commonly used by individuals who cannot undergo gallbladder surgery.
• Other non-FDA approved medications:
  • Actigall
  • Reltone
• Extracorporeal shock wave lithotripsy: This non-invasive procedure uses pressured waves to break gallstones externally. However, it involves high-tech equipment and is rarely used in conjunction with other treatment methods.

Surgical treatments

• Open cholecystectomy: One effective method to cure gallstones is surgery, which usually involves the removal of the gallbladder to prevent recurrence. However, like any surgery, gallbladder surgery carries risks of complications, such as internal bleeding, injury to the bile ducts, and infection. Additional operations may be required to repair the bile ducts.
• Laparoscopic surgery (cholecystectomy): Laparoscopic surgery, often referred to as keyhole surgery, is a highly effective technique used to treat gallbladder stones. It involves the use of a special probe to access internal organs. The main advantage of laparoscopic surgery over traditional open surgery is that it requires minimal opening and a small incision, thereby reducing major risks such as infection, internal bleeding, or delayed recovery.
• Endoscopic gallbladder stenting: This procedure is effective for elderly patients with gallbladder diseases who are poor surgical candidates. It uses stents (metal or plastic tube inserts) to keep the bile duct narrowed by gallstones open and may help alleviate symptoms caused by gallstones.

Diet plays a crucial role in the management and treatment of gallbladder stones. Here are some dos and don'ts you need to follow to help your body manage gallstone symptoms:

Dos

• Consume food rich in fiber, such as vegetables and fruits.
• Don’t miss out on micronutrients; consume a well-rounded diet including legumes and whole grains.
• Keep your blood pressure under control.
• Break large meals into smaller portions; for example, instead of eating one large meal, divide it into three small meals.
• Practice low-intensity stretching exercises to aid digestion.
• Chew your food slowly and thoroughly.
• Stay hydrated by drinking plenty of water.
• Herbs such as Saindhava lavanam and peppermint may help manage the signs of gallstones.

Don'ts

• Avoid excessive consumption of fried, spicy, or pre-packaged foods such as pasta, noodles, polished rice, and sugar.
• Limit intake of aerated drinks like soda and iced beverages.
• Do not smoke or consume alcohol.
• Avoid high-intensity physical activities such as weight lifting, sprinting, or boxing.
• Steer clear of high-fat or calcium-rich foods.
• Do not self-medicate.

Usually, asymptomatic gallstones do not cause any complications. However, if the symptoms are left untreated, they can lead to severe complications. According to the Nigerian Journal of Surgery, the medical complications associated with gallbladder stones are as follows:

• Inflammation of the gallbladder can lead to a more serious medical condition called cholecystitis.
• Blockage of the bile duct resulting in bile infection or jaundice.
• Gallbladder cancer.
• Blockage in the pancreatic duct leading to pancreatitis, a serious medical condition where the pancreas becomes inflamed due to the presence of blockage.
• Small bowel obstruction or gallstone ileus, a rare but serious complication where the intestine loses its ability to contract.
• Mirizzi's syndrome, a condition where a bile stone becomes impacted in the neck of the gallbladder.
• Internal bleeding or gastrointestinal distress.

Here are a few quick home remedies to control and get relief from gallstones.

• Turmeric (haldi): Turmeric has potent anti-inflammatory properties. The active compound of turmeric, curcumin, is scientifically proven to have health benefits.
  Tip: Take warm water or milk infused with 3 g of turmeric after meals. This drink can help with gut inflammation and gallstone problems.
• Aloe vera: Aloe vera leaves are enriched with antioxidants and vitamins.
  Tip: Extract the gel from aloe vera leaves. Boil a cup of leaf extract in water. Add salt to taste. Drink this concoction two times a day. This drink can help fight acid reflux, gas trouble, and other symptoms of gallstones.
• Gokshura: Gokshura is loaded with a variety of saponins that slow down the progression of gallstones.
  Tip: Taking Gokshura with Ashwagandha and Shilajit as Gokshura suranum or simply in powdered form can help detoxify the gallbladder.
• Black pepper (kali mirch): Black pepper neutralizes excess acid and helps regulate bile secretion in the liver. It also contains numerous medicinal compounds such as piperine, which improves the proper functioning of the gallbladder.
  Tip: Drink a glass of black pepper mixed with warm water every day after meals if you are prone to frequent stomach distress.
• Onion seeds (kalonji): Kalonji contains the antioxidant thymoquinone, which aids in reducing abdominal pain, infection, and gallstones.
  Tip: Add a teaspoon of Kalonji oil to around 2-3 glasses of water and boil. Strain it and drink this water at regular intervals post meals or breakfast for quick pain relief.
• Cucumber beet juice: People with gallstones may have increased bile or cholesterol secretion and suffer from indigestion problems. Cucumber beet juice serves as an excellent remedy for this.
  Tip: Mix equal volumes of cucumber, beetroot, and carrot. Dilute it by adding glasses of water. Drink this mixture at regular intervals post meals or breakfast to replenish your body.
• Dandelion tea: Dandelion tea has antibacterial and antimicrobial properties that help fight gastric infections. It also has numerous positive benefits for your digestive system.
  Tip: Add 10 g of dry dandelion leaves to around 2-3 glasses of water and boil. Strain it and drink. This boiled water can also be taken as a natural substitute for coffee.
• Pear: Pear is loaded with antioxidants and antimicrobial properties that help fight the symptoms of gallbladder stones.
  Tip: Make fresh pear juice, strain it, and drink. Drinking pear juice at regular intervals (weekly once) may reduce the formation of bile stones and cholesterol deposits.

Yoga for Gallbladder Stones

Some common yoga poses for gallbladder stones include the following:

• Bhujangasana (Cobra Pose)
• Dhanurasana (Bow Pose)
• Paschimottanasana (Seated Forward Bend)
• Sarvangasana (Shoulderstand)
• Shalabhasana (Locust Pose)

If you have been diagnosed with gallbladder stones, your physician will provide the right treatment plan. However, making significant diet and lifestyle changes along with medication is also crucial. With adequate treatment and care, gallstones can heal over time. You need to follow a high-fiber and low-salt diet to reduce the chances of relapse. In addition, here are a few tips that can help you manage and prevent gallbladder stones:

• Stop smoking
• Moderate alcohol consumption
• Maintain a healthy BMI (Body Mass Index)
• Stay hydrated
• Avoid eating unhealthy fats
• Don't skip meals
• Take all medications as recommended by your doctor
• Seek professional help if needed
• Participate in support groups