Gallstones are created in the gallbladder, a “bag” in which a bile is accumulated. The bile is a liquid, rich in fatty substances – especially cholesterol – which the liver creates from the blood. The liver plays an important role in metabolism; about 50% of all fat transformation processes are performed in the liver. In fat conversion, the lover performs oxidation of fatty acids, lipoprotein production, cholesterol and phospholipid formation, converting carbohydrates and proteins into fat.
Cholesterol is largely used to produce bile salts, but about 20% of the cholesterol produced is transmitted to the blood (mostly via the lipoprotein). Lipoproteins also contain phospholipids and triglycerides. Most cell membranes in the body contain cholesterol, phospholipids and triglycerides. The liver also contains an enzyme that breaks the lipid protein linkage.
The bile contains bilirubin, a pigment that is produced by the decomposition of worn red blood cells. The gall bladder begins to develop as a small, solid particle in the gall bladder. As more and more substances shorten around this particle, it increases. The process of the development of gallstones, and the reason why in some people only one gallstone develops while in other there are more than one, is not entirely clarified. There is no solid evidence to prove the link between gallstones and atherosclerosis, i.e. a condition in which blood cholesterol levels are higher than normal, although gallstones are known to occur most frequently in people with extremely high levels of cholesterol in the blood.
In 30 to 50% of cases gallstones do not cause any symptoms, but simply “lie” in the gallbladder. However, some gallstones ”travel” with a bile through the gallbladder, where they can clog. If this occurs, a person will feel intense pain in the right upper part of the abdominal cavity (or, sometimes, between the shoulder blades). The pains are getting stronger, they last for a few hours and then relax; the pain causes nausea and vomiting. The pain will completely go away if the gallstone returns to the gallbladder or if it passes to duodenum.
An additional gallbladder symptoms include flatulence (gasses) and discomfort in the abdominal cavity after abundant and fatty meals. These symptoms are often called dyspepsia due to gallstones.
Approximately 10% of UK residents have gallstones (one or more); the data in Croatia is the same. The likelihood of developing gallstones grows with age – up to 30% of older people have gallstones. The gallstones are four times more common in women.
If the gallstone sticks in the choledochus (common bile duct), it will prevent the flow of bile and cause yellowing of skin and sclera, characteristic of the jaundice. Additional danger is a possible inflammation, maybe even gallbladder infection. In this case, a special therapy is required (see cholecystitis article). In addition, people with gallstones are more susceptible to acute pancreatitis.
What to do?
If you feel severe pain, such as the ones described in the article, contact a doctor who will examine you and inquire closely about the type of pain, and take a blood sample for tests. You may also be advised to go to the hospital to take an X-ray of the abdominal cavity, several hours after you have taken a special tablet (contrast agent) that better displays the gallbladder. Gallstones can sometimes be detected by ultrasonography.
Self-help: be reasonable and moderate in the meal. Avoid excessive amounts, as well as any food that can cause you pain (especially fatty and very spicy food). Take antacids if you are suffering from poor digestion.
If the pain occurs, get in bed, take two analgesic tablets (pain reliever) and do not eat – take only a sip of water from time to time. If the pain lasts for longer than three hours, you should call the doctor.
Professional help: the doctor will prescribe for you a stronger pain relief. However, if the tests show that the gallstone has passed to the duodenum (and, therefore, probably left the body), and that the disorder probably might be repeated, your doctor will advise you on the operation – removing the gallstones (if there are any left in the body) and the gallbladder. The surgical procedure is also recommended for frequent cases of gallstones. In some cases, gallstones can be dissolved with a henodeoxycholic acid (naturally occurring in the bile); it is taken in a form of a tablet. However, this type of treatment is rare.