Have you ever had gallstones? If you have, I feel for you. You know firsthand just how painful that they can be. This is part two on our series about the gallbladder. Part one focused on some general anatomy of the gallbladder as well as what the gallbladder does for our body and digestion. Part two of our series is are about a complication that arises in about 10%-20% of the United States population and is responsible for many surgeries, infections, and in some cases, death: gallstones.

Gallbladder Basics

Part one of our series focused on some gallbladder basics. Let’s recap:

-the gallbladder is a small pear shaped organ that sites in the right upper side of your abdomen
-the liver produces bile which drains via a bile duct to your intestines
-when you don’t need bile, your gallbladder stores bile made in the liver and releases it for digestion
-bile is responsible for breaking down mostly fats
-bile is released through a bile duct that passes through the pancreas
-as bile sits in our gallbladder it can become concentrated and form salts which turn can turn to stones

Alright, let’s move forward.

Here is an example of a severe case of gallstones in a removed gallbladder.

Here is an example of a severe case of gallstones in a removed gallbladder.

What The Heck Are Gallstones?

Gallstones are stones that form in the gallbladder. Why do they form? If bile sits in the gallbladder for two long bad things can happen. Bile goes through chemical changes. Water gets displaced from the bile and what that means is that the components that make up the bile become more and more concentrated.

As the bile becomes more concentrated small clumps of bile salt can form. If these small clumps of bile salts don’t get released during digestion they end up sitting in our gallbladder. What happens next is like a snowball rolling down a hill: it can get bigger and bigger over time. Eventually these salts become bigger and they become calcified forming small stones. Some stones are still small enough to pass through the bile duct and out into the intestine where they can get passed out in your stool. For bigger stones, they can become stuck in the bile duct as the stones pass their way by the pancreas and into the upper part of your small intestine. When your duct gets clogged, bad things can happen.

Problems That Can Arise From Gallstones

In this simple picture you can see how the gallbladder feeds into the small intestine through the pancreas. Inflammation or infection caused by a gallstone anywhere in this area can cause problems with the gallbladder, pancreas, and liver.

There are several things that can arise from gallstones. Here are some things to become familiar with. Ignore the fancy medical talk. Chole means bile and cholecyst means gallbladder.

Cholelithiasis: Formation of gallstones

Cholecystitis: Inflammation of the gallbladder. For this purpose we’re only referring to inflammation caused by obstruction of the bile duct caused by gallstones.

Pancreatitis: Inflammation of the pancreas caused by an obstruction of gallstones as the bile duct passes through the pancreas.

Cholangitis: This is an infection of the bile duct caused by stagnant bile sitting above the obstruction. Often times bile is exposed to bacteria from the small intestine and if bile is stuck, it’s the perfect environment to cause an infection. Cholangitis is considered a medical emergency as it can potentially lead to sepsis which is a life threatening condition.

Signs You Might Be Having Gallstones

There’s generally two different kind of gallstone symptoms: asymptomatic vs symptomatic. There’s a good chance most of us have had a gallstone small enough to pass through our bile duct without causing any symptoms. For the other percent of us, you likely know that you’ve had a gallstone because it has been one of the most unbearable types of pain you’ve ever had. Here are some general signs and symptoms that you should look out for that could indicate you’re having gallstones:

Pain: The pain is generally located in the right upper area of your abdomen right under your rib cage. Sometimes taking a deep breath can make the pain worse because the diaphragm expands lower and puts pressure on the liver and gallbladder. If the gallbladder is inflamed the movement on your diaphragm downward can cause more irritation and pain. Sometimes the pain will also be worse if you put your fingers under your rib cage and take a deep breath while putting pressure with your hand in the area. Pain can also sometimes be worse after a meal when the gallbladder is contracting and working harder causing more irritation.
Abdominal Tenderness: Tenderness when pressing to the right upper area of your abdomen.

Signs you could be developing a severe complication/infection from gallstones:

Less than normal bowel sounds
Sharp pain on the left upper area of your abdomen with tenderness to touch in the left upper abdomen (a sign that your pancreas is infected/inflamed also
Heart rate faster than 100
Blood pressure with a systolic less than 90

Needless to say, if you’re having any of the above symptoms you should at least call your doctor or go to the nearest urgent care or emergency room for further evaluation.

Now that we’ve touched on what gallstones are, how they’re formed, and signs and symptoms that you might be having them, we’ll be taking a look at gallstone treatment and prevention options. That will be coming up in our next post on our series about the gallbladder.

How Gallbladder Problems are Diagnosed

You will usually need some type of radiology type of scan. Gallstones are pretty well visualized with an ultrasound and this is the preferred method of diagnosis because an ultrasound is radiation free unlike a CT scan. The unfortunate problem is that an ultrasound isn’t as accurate as a CT scan. So if your symptoms and blood tests are screaming gallbladder problems, and your ultrasound is negative, your provider will likely order a CT scan of your abdomen. The CT scan is given with a contrast dye to help highlight your soft tissues and make it easier for the radiologist to see. Even CT scans are not one hundred percent but they’re pretty close to it for diagnosing gallbladder disease. In rare cases people may go as far as to have an MRI.