Coping with Gallstones
You have pain below your breastbone that radiates to your right shoulder. You have been experiencing this pain in your abdomen for some time now. You could have gallstones.
Gallstones are stone-like objects that develop in the gallbladder or bile ducts (the pipe-like system within the liver). Gallstones begin with bile, a substance that helps with the digestion of fats and the absorption of certain vitamins. Bile is made in the liver and carried to the gallbladder, a small pear-shaped organ that concentrates bile and stores it until its needed. The fat in food triggers the release of a hormone that causes the gallbladder to contract and release bile into the intestine.
Gallstones are solid particles that develop when the stored bile crystallizes. Most are less than an inch in diameter, but they can be as small as a grain of sand and as large as a golf ball. Most gallstones are composed of cholesterol. Some people develop one gallstone while others develop many gallstones at the same time.
Gallstones may not cause signs or symptoms. But if a gallstone lodges in a duct and causes a blockage, some signs and symptoms that may show up are sudden and rapidly intensifying pain in the upper right portion of your abdomen; sudden and rapidly intensifying pain in the center of your abdomen, just below your breastbone; back pain between your shoulder blades; pain in your right shoulder; and nausea or vomiting.
Gallstone pain may last several minutes to a few hours. These episodes generally subside after one to three hours. People who have these painful attacks are not in medical jeopardy.
There are two types of gallstones: cholesterol and pigment stones. Cholesterol is made up of fatty substances in the blood. These are the most common type of gallstones. Gallstones made of cholesterol tend to be green in color. Pigment stones (mainly made of bilirubin, a substance found in liver’s bile) are created when red blood cells break down in the liver. Too much bilirubin can actually leak into the bloodstream and cause the skin and eyes to turn yellow (jaundice).
Gallstones can develop for several reasons including forming when there is a critical concentration of cholesterol or bilirubin in the bile; developing if the gallbladder is lazy and does not completely empty itself of bile; occurring in people with other conditions like cirrhosis of the liver or blood disorders; during pregnancy; and when you rapidly lose weight.
Gallstones can cause acute cholecystitis which is a more serious condition where the gallbladder is actually inflamed. This happens if a stone blocks off the cystic duct, which increases the pressure within the gallbladder. This condition requires antibiotics, hospitalization, and even surgery. Stones that pass out of the gallbladder and into the common duct can cause a complete blockage of the duct with jaundice, infection and pancreatitis. You may feel pain in several different places including upper part of the abdomen on the right side, between the shoulder blades, and under the right shoulder.
When people experience pain with gallstones, it is sometimes referred to as a gallbladder attack or biliary colic. There are two conditions that could mimic gallstone symptoms. First, some gallbladders contain a thick sludge, which hasn’t turned into stones. Sometimes sludge is felt to cause symptoms similar to gallstone pain. Secondly, there is an uncommon condition called acalculous cholecystitis, when the gallbladder becomes inflamed, with no stones present. This is generally treated with surgical removal of the gallbladder.
In diagnosing gallstones, your doctor may require an abdominal ultrasound, a commonly used test to check for gallstones. Abdominal ultrasound involves moving a device (transducer) across your stomach back and forth. Another choice is the endoscopic ultrasound which is used to identify smaller stones that might have been missed with the abdominal ultrasound. During this procedure, your doctor will pass a thin, flexible tube through your mouth and through your digestive tract. A small ultrasound transducer in the tube produces sound waves that create an image of surrounding tissue.
Your doctor may also perform other imaging tests such as oral cholecystography, a hepatobiliary iminodiacetic acid (HIDA) scan, computerized tomography (CT), magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP). Gallstones discovered using the ERCP may be removed during that procedure. In addition, your doctor may run blood tests to check for infection, jaundice, pancreatitis, or other complications caused by gallstones.
In most instances, some people with gallstones will never need treatment. Your doctor will determine whether or not treatment for gallstones is indicated based on your symptoms and results of diagnostic testing. Treatment options for gallstones include surgery to remove the gallbladder (cholecystectomy). Since gallstones frequently recur your doctor may recommend this surgery. The other option is medications to dissolve gallstones. It may take months or years to dissolve gallstones in this way and the gallstones could return if treatment is stopped. Some medications don’t work. This option is reserved for people who can’t undergo surgery.
As always, speak with your doctor concerning your symptoms and the right treatment options for you. Just know that you don’t have to suffer in agony with gallstones. You can successfully manage your symptoms with the proper course of actions.
