Gallstones are called “silent stones” because very often they do not cause any symptoms. A person usually learns he or she has gallstones while being examined for another illness.
When symptoms do appear, they may include upper abdomen and upper back pain lasting for several hours, nausea, vomiting, bloating, indigestion, heartburn, and gas.
Do I have Gallstones?
If your physician suspects you have gallstones, they will do a physical examination and may perform other tests including the following:
• Blood tests to check for signs of infection or obstruction and to rule out other conditions.
• Ultrasound to produce images and identify gallstones.
• CAT scan (specialized x-ray) to create cross-section images of organs and body tissues.
• MRCP (magnetic field and pulses of radio wave energy) to get pictures of structures inside the body, including the liver and the gallbladder.
• HIDA scan to determine whether the gallbladder is contracting properly.
• Endoscopic ultrasound to combine ultrasound and endoscopy to look for gallstones.
• ERCP (insertion of an endoscope through the mouth down to the small intestine and injection of a dye) to allow the bile ducts to be seen. This procedure often allows removal of any gallstones that have moved into the ducts.
I have Gallstones – what are my treatment options?
Gallstones are usually treated with cholecystectomy, which is surgery to remove the gallbladder from your body. The traditional operation is called an open cholecystectomy. The newer method is called a laparoscopic cholecystectomy, also known as keyhole surgery or minimally invasive surgery. The laparoscopic approach is less invasive, has fewer complications, and is used more often. Surgery to remove the gallbladder or any stones in the gallbladder has high success rates. The types of surgery and other treatments for gallstones include:
• Laparoscopic cholecystectomy: General anesthesia is required and three to four incisions are made on your abdomen. Instruments, a light, and a camera are passed through these small cuts in the abdomen. The surgeon views the contents of the abdominal cavity by looking at a video monitor and carefully removes the gallbladder from your body. Keyhole surgery is the most commonly used method of gallbladder removal. After the surgery, the patient usually needs to spend one night in the hospital and recovers in about a week.
• Open cholecystectomy: If the gallbladder is severely inflamed, an open surgery may be required. This is a more invasive procedure in which the surgeon makes a large cut in the abdomen to remove the gallbladder. The hospital stay and recovery time is longer. The patient usually stays in the hospital for a few days after the surgery.
• ERCP (endoscopic retrograde cholangiopancreatography): If gallstones are present in the bile duct, this procedure may be used to find and remove them either before or during gallbladder surgery. ERCP requires a local anesthetic. A flexible fiber-optic camera (endoscope) goes down your mouth, through the digestive system, into the gallbladder. An electrically heated wire widens the opening of the bile duct and the stones are removed or left to pass into the intestine.
• ESWL (shock wave lithotripsy): Shock waves are aimed at the gallstones, which break them up into smaller fragments. If they become small enough, they can then pass safely and painlessly in your stool. This type of treatment is not very common and is used when there are only a few gallstones present.
What if I don’t want surgery?
If your doctor feels that other coexisting medical conditions preclude you from having gallstone surgery or general anesthetic, or if you are unwilling to undergo surgery, you may be prescribed medications called ursodiol (brand name Actigall) or chenodiol (brand name Chenix). These drugs work by dissolving the cholesterol stones. They are not effective against pigment stones. A common side effect of both these medications is mild diarrhea. The drawback and inconvenience is that both these medications take years (up to 24 months) to completely dissolve the stones. In addition, the stones may form again after you stop taking the drug.