Gallstones are a kind of crystals that form in the gallbladder. They can be very painful but usually do not cause any serious illness. The pain sits under the ribs on the right side and usually comes in turns. Many people who have gallstones have no problems at all.
Symptoms of gallstones
You do not need to notice that you have gallstones as it is unusual for them to cause symptoms.
If you have gallstones, they often come after meals, especially if you have eaten fatty foods. You may then be in pain for a few minutes to several hours.
Gallstones can consist of several symptoms:
- You get hurt in a cutting or spasmodic way under the ribs on the right side. The pain can also be more dull and persistent.
- It can hurt high up in the stomach at the middle.
- The pain radiates to the back and right shoulder blades.
- The pain comes in attacks with moments in between as it hurts less.
- It can hurt when you press under the right rib arch.
- You feel bloated and bubbly in your stomach.
- You feel nauseous and cold-sweaty. You may also vomit.
The pain decreases as you move. Therefore, you have a hard time being still.
Gallstones can cause inflammation
The gallstones may infect the gallbladder, the bile ducts or the pancreas. Then you get a fever and sudden pain under the right rib arch, and the pain becomes more persistent.
Inflammation of the pancreas can be a life-threatening condition. Then you may need intensive care. Read more about acute inflammation of the pancreas here.
A gallstone can also get stuck in a bile duct and prevent the bile from reaching the intestine. It can cause you to get some kind of jaundice. In jaundice you get one or more of the following symptoms:
- The skin and the whites of the eyes turn yellowish.
- Your kiss will be dark-colored.
- The buoy gets a grayish-white color.
- You get stomach pain, under the right rib arch.
- It itches all over the body.
A clogged bile duct can also become infected. Then you also get a high fever.
When and where should I seek care?
Contact a health care center if you think you have gallstones. You can contact many receptions by logging in.
Contact a health care center or an on-call reception immediately if any of the following applies to you:
- You suspect you have jaundice due to gallstones.
- You suddenly get a lot of pain under the right rib arch.
- You get a lot of stomach and fever pain.
If closed, seek care at an emergency room.
What can I do for myself?
You can often relieve the symptoms yourself if you have had gallstones before and recognize the symptoms.
Use either painkillers and anticonvulsants that you have been prescribed or non-prescription medicines that you have been recommended by your doctor to buy at a pharmacy.
How can I prevent it?
Gallstones often come back again and again.
You can reduce the risk of getting back the trouble by not eating food that you suspect will cause you pain. What to avoid varies from person to person, but the general advice is to eat little or none of the following:
- Fat, smoked, fried or cholesterol-rich foods such as eggs.
- Apples and cucumbers.
- Some drugs, including painkillers containing codeine.
Investigations
You may get stomach aches for reasons other than gallstones. Therefore, it is important that you be properly examined, especially if the symptoms are not typical of gallstones.
When you see your doctor you will be told about your complaints, how long you have had them and how they feel. Many times the doctor can tell what is wrong based on your description because gallstone attacks are often easy to recognize.
The doctor then examines the stomach by feeling and listening to it. Your doctor may want to examine you more, and they will then send a referral to the exam (s) needed.
Blood sample
You may have a blood sample sent for analysis. It is to see how the liver works.
Ultrasonography
You can be examined with ultrasound to see if you have gallstones in the gallbladder. With ultrasound, the doctor can also see how the liver and gallbladder look.
ERCP
You may be examined with ERCP technology if your doctor suspects you have stones in the bile ducts. ERCP is an X-ray examination where the doctor examines you with an endoscope. It is a flexible tubular instrument with a camera lens at the front.
Gastroscopy and colonoscopy
During a gastroscopy, the doctor examines the esophagus, stomach, and duodenum. A colonoscopy, the doctor examines the colon.
You may be examined with gastroscopy or colonoscopy if your doctor is unsure what your complaints are.
Computer tomography and examination with a magnetic camera
Sometimes you may need to be examined with computer tomography or with a magnetic camera.
Magnetic cameras can show if you have constrictions or stones in the bile ducts. The study is then called MRCP, an abbreviation for the English name magnetic resonance cholangitis-pancreaticography.
PTC
PTC is a form of x-ray where the doctor only x-rays the bile duct.
The doctor inserts a needle into the liver and into a bile duct. The needle allows the doctor to place a thin plastic tube in the bile duct, and through it, contrast fluid can be sprayed. The contrast fluid is needed for the X-ray examination. Through the plastic tube, the doctor can also remove stones in the bile duct.
You will be anesthetized during the examination. Because it is a major procedure, you stay in the hospital overnight, sometimes longer.
PTC is an abbreviation for the English name percutaneous transhepatic cholangiography.
Gallblåseröntgen
Gallbladder radiographs are now very rarely used. The examination takes longer to do than an ultrasound examination, but an advantage is that it shows how the gallbladder works.
Before the study, you should take tablets with contrast agents. The contrast agent fills the gallbladder if it works properly and the doctor can see it on a monitor.
Gallstone treatment
Gallstones do not need to be treated unless they cause problems and are discovered by chance when you are examined for something else.
Drugs for pain
You will be given analgesic anti-inflammatory drugs that reduce or remove the pain, known as NSAIDs or cox inhibitors. Examples of these are drugs containing ibuprofen, diclofenac or naproxen. You can get stronger drugs for the pain if they do not help.
You can take the medicines as suppositories or with the help of syringes if you feel unwell and cannot swallow tablets.
You are also given advice on how to eat and drink to avoid the hassle of coming back. You will be called to a continued investigation if the doctor wants to examine you further.
Operation
Sometimes you may need surgery:
- If you often have problems, especially gallstones.
- If the gallbladder wall has been calcified.
- If you have had jaundice due to the gallstones.
- If the gallbladder, bile ducts or pancreas become inflamed due to gallstones.
In a gallbladder surgery, the doctor removes the entire gallbladder with the gallstones. Most often you are operated with so-called peephole technology.
Treatment for gallstones with ERCP
If you have bile duct stones, your doctor can remove them with ERCP technology. It can be done as a single procedure before a gallbladder operation, but also in connection with gallbladder surgery.
Other methods of treatment
There are other methods of treatment for gallstone, but they are very rarely used because they are not very effective:
- Medicines that can dissolve the stones.
- Shock waves from a special ultrasonic device that can crush the stones.
You may need hospital care
You need to be hospitalized and given antibiotics if you have an infection in a gallbladder due to gallstones.
Gallstones can come back
There is a certain risk that the trouble will continue, even though you have been treated with drugs or have been operated on. This is because the bile ducts remain. You can get cramps in those that hurt even if you have been operated on.
In that case, you can take the same analgesic and anticonvulsant drugs that you used before the surgery. You should also think about what you eat and try to avoid things that you have previously been bothered by.
Contact a doctor if you still do not get rid of the trouble. It is to find out if there may be other reasons why you are in pain.
What is a gallstone?
The bile is needed at the digestion to atomize the fat you get into the food. Then the fat is further broken down and can be absorbed from the intestine.
Bile forms in the liver. Each day, half to one liter of bile is formed. The newly formed bile leaves the liver and is stored in the gallbladder if it works properly.
From the gallbladder, the gallbladder duct merges with the liver passage from the liver and forms a common bile duct. It opens in the part of the small intestine called the duodenum, and here the bile empties out.
The bile only comes out in the duodenum when fatty food is to be broken down. A ring muscle at the opening of the small intestine prevents the bile from coming out at other times. The ring muscle is also called the sphincter.
A sick or disturbed gallbladder causes the bile to drain to the intestine at all times.
Stones form in the gallbladder
The bile is concentrated when stored in the gallbladder. Therefore, the content of bile salts and other substances can become so high that they form crystals. The crystals are built on so that they become larger and larger, thus forming gallstones.
The size of the gallstones can be from a few millimeters to a few centimeters. The color can be yellow-white or brown-black, depending on what the stones contain. You can have several stones at once, or a single large stone.
Small stones do not have to cause trouble
You can have small gallstones without feeling anything. They can accompany the bile into the intestine and leave the body as you poop.
Larger stones can cause problems in different ways, the most common being that you get hurt. When you have eaten fatty food, the gallbladder and bile ducts pull together to squeeze out bile. The pressure rises in the gallbladder and in the bile ducts if a stone is in the way and prevents the bile from coming out. The increased pressure causes you pain, a so-called gallstone attack.
The stones and the increased pressure can also irritate the walls of the gallbladder, causing inflammation of the gallbladder.
Can lead to jaundice
The stones can also become trapped in a bile duct and prevent the bile from passing through the bile ducts. It usually occurs at the mouth of the intestine where it is at its narrowest.
A stone that closes to the hepatic or common bile duct can cause you to have a form of jaundice. Jaundice passes when the obstacle decreases, often when the gallstone has been removed.
A clogged bile duct can get infected and you get a high fever. Then care is needed in hospitals and antibiotics. Often you have to have surgery or undergo an ERCP to remove the gallstone in the bile duct.
What is the cause of gallstones?
The reason why gallstones are formed in some but not in others is still unclear.