Gallstones or cholelithiasis, comes about when the components of bile: fatty acids and other lipids, cholesterol, bile salts, bilirubin, electrolytes and water, are imbalanced and out of proportion. If the concentration of these components changes, they may precipitate from solution and form gallstones. Frequently it is when cholesterol is imbalanced that stones arise. There are 2 main types of gallstones: cholesterol stones which are hard, crystalline stones that contain more than 50% cholesterol plus varying amounts of protein and calcium salts. They predominate (>85%) in the Western world. Pigment stones are less common and are composed of minerals such as calcium.
Approximately 10% of all adults have gallstones. The risk of developing gallstones tends to increase with age. Approximately one-fifth of men and one-third of women will eventually develop cholelithiasis. Heredity appears to play a part in the development of gallstones and there is frequently a family history of the disease. Women develop gallstones more commonly than men and at a younger age. Certain women are more at risk than others: Caucasian, middle aged, fertile females with an increased risk in pregnancy.
Other factors that increase the risk of developing gallstones include: being overweight, eating a diet high in dairy products and animal fats, being diabetic, and taking cholesterol-lowering medications.
The gall bladder can also contain ‘sludge’ which may not form into stones but still can be a factor in gall bladder disease. The sludge contains cholesterol, bile salts and the glycoprotein mucin. Sludge can be seen via ultrasound but not x-rays. Sludge can be caused the same things as stones, and can cause the same type of pain. Sludge can also be without pain and disappear.
Most patients (80%) with gallstones never develop symptoms. Problems, if they do occur, usually arise in the form of gall bladder or abdominal pain during the first 5 to 10 years. Complications are from stones obstructing: the cystic duct, leading to inflammation of the gallbladder (cholecystitis): this begins as a chemical inflammation and later may become complicated by bacterial invasion; or the common duct, causing gall bladder obstruction (cholestasis), sometimes accompanied by bacterial infection in the ductal system (cholangitis).
Symptoms of Gall Stones
Gall stones can create steady, severe pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours. The pain can be in the back between the shoulder blades or under the right shoulder. Belching, bloating, fullness and nausea after meals, especially fatty meals, are common, vomiting can also occur. Sometimes the pain from gallstones is so severe it may be mistaken for a heart attack.