What are Gallstones?
Have you ever had pain in the right upper quadrant of your abdomen under your rib cage? Or pain in the upper abdomen after you eat? If so, you may have had symptoms from gallstones. Gallstones are actual stones that form in the gallbladder. The gallbladder is a pear-shaped organ that rests beneath the right side of the liver. The purpose of the gallbladder is to collect and concentrate a digestive liquid (bile) produced by the liver. Bile is released from the gallbladder when food arrives is eaten, travels through the bile ducts, and this aids digestion of food in the intestine. Removal of the gallbladder is usually not associated with any impairment of digestion.
Gallbladder problems are usually caused by gallstones which form due to an imbalance of cholesterol and bile salts. Gallstones are more common as you get older, more often occur in certain families and ethnic groups, and are risk of pregnancy and rapid weight loss. These stones may block the flow of bile out of the gallbladder which causes it to swell. This can result in abdominal pain – most often in the right upper abdomen, usually under the rib cage , but the pain can also radiate to the upper mid abdomen, sometimes in a band-like fashion, or even to the back. Some patients feel it in the chest and worry that it is a heart attack. Nausea, vomiting, fever, bloating, heartburn, and other symptoms may occur. Sometimes gallbladder symptoms occur without gallstones being obvious, and occasionally other problems can develop such as a stone blocking the bile duct causing jaundice, or inflammation of the pancreas (pancreatitis).
If the pain persists, you have high fever, or difficulty breathing, you should go to the Emergency Room for immediate evaluation and you may require more urgent surgery to remove your gallbladder. Complications from gallstones can include inflammation or infection of the gallbladder, bile ducts, or even pancreas.
Gallstones are best detected by ultrasound. Ultrasound is not painful and does not use radiation but can look at the gallbladder to see if it has stones in it, or if the gallbladder itself is inflamed. Sometimes more testing is needed to pin down the diagnosis.
Patients who have gallstones and also have symptoms from them are best treated with surgery to remove the gallbladder. Gallstones cannot be blasted like kidney stones, nor effectively dissolved. There are home “remedies” you may read about on the internet about how to “flush” out your gallstones but beware of them as they may cause you to have a very bad bout of gallbladder infection, landing you in the hospital requiring urgent surgery and antibiotics.
Gallbladder surgery is best done before the stones cause blockage and inflammation of the gallbladder. Traditionally gallbladders were removed with a large incision in the right upper abdomen under the rib cage. Now the standard is to remove the gallbladder with minimally invasive/laparoscopic techniques. This is done with one to three (sometimes four) small incisions in the abdomen, or a single larger incision at the umbilicus, using a laparoscope. Most elective gallbladder surgeries are done on an outpatient basis where you go home the same day if your surgeon feels you do not need more observation for your safety. Patients can expect tapering abdominal discomfort up to about two weeks with return to regular activity thereafter.
Because the gallbladder is just a sac that holds bile (which is made in the liver) and releases it when eating fatty meals, the gallbladder is not an essential life-sustaining organ and can be removed with little effect on bodily function. When it has stones, it does not function properly and your gut has already partly adapted your digestion to the gallbladder not functioning properly.
If you have noticed right upper abdominal pain, heartburn, discomfort after eating, you may indeed have gallstones, and should see your physician .
Dr. Charleen Kim is a board certified general surgeon who is a Diplomate of the American College of Surgeons. She practices with West Coast Surgical Associates -- offices in Walnut Creek, San Ramon, and Concord. Call 925- 933-0984 to schedule an appointment.