Gallstones are not stones in real sense but rather a solid or pieces of solid or lumpy physical structures that may form inside the gallbladder during the process of concentration of bile. These stones are not something that can be retained. Since the gallstones cannot be removed, the entire gallbladder removal surgery is performed. The gallbladder removal surgery prevents further complications.
The Production and Flow of Bile into the Gallbladder
Bile is continuously secreted by the liver. Every day about 800 – 1000 ml of bile is secreted by the liver. There is a duct that runs from the liver to the duodenum that transports the bile produced. But there is a branch in that duct also that diverts into the Gallbladder. Gallbladder is the place where the bile, a potent digestive juice produced by the liver is stored in a very concentrated form. So the bile secreted by the liver can flow either way into any of the two ducts.
Bile is not always transported to gallbladder after production. Whenever a meal is consumed, the bile produced by the liver at that point directly flows into the duodenum of the small intestine.
But when there is no meal consumed (during fasting or in the interval between two meals), the bile continuously secreted by the liver does not flow into the duodenum. Instead, it flows into the Gallbladder. This bile is converted to a concentrated form. The bile is removed of its water content to get converted into a concentrated form.
The Flow of Bile from the Gallbladder
We consume heavy to very heavy meal during a festival or feasts. The instances of having heavy meals has actually increased. The heavy meals so consumed may be oily or fatty and may be rich in fat. These are the occasions where the role of gallbladder comes into play. The heavy meal so consumed need not be meat based or non-vegetarian food. Even vegetarian food like cheese, avacado, etc., sometimes can be heavy in fat and can warrant the role of gallbladdder in digestion.
During such heavy meals, the duodenum releases a hormone called cholecystokinin. This hormone stimulates the Gallbladder to release the concentrated bile into the duodenum.
The Formation of Gallstones
The concentrated bile has to be periodically emptied by the gallbladder to remain healthy. But sometimes this does not happen due to unknown reasons. So in other words, if the bile becomes over concentrated and is not drained properly, gallstones may be formed.
So logically speaking if the concentrated bile is drained out periodically, the chances of gallstone formation is remote. But this logic also is defied in many instances. When rapid weight loss is achieved, some people develop gallstones in the process. This condition proves that the process of gallstone formation is fully not understood yet.
The Three Types of Gallstones
There are three types of gallstones, the cholesterol stones, the pigment stones and the mixed stones (having both cholesterol stones and pigment stones).
Cholesterol stone of the gallbladder is a direct result of the excess cholesterol in the bile than the required quantity. This excess cholesterol does not drain out of the gallbladder. They solidify further and further only to remain inside the gallbladder to cause the gallstone.
Similarly sometimes when there are some blood disorders, the liver produces more bilirubin. This excess bilirubin gets stored in the gallbladder. The gallbladder is unable to process this excess bilirubin which then gets converted to pigment stones.
Presence of both the above conditions can result in the formation of both the type of gallstones in the gallbladder. That is why they are called Mixed stones.
Risk Factors for Getting Gallstones
There are many risk factors that contribute to the gallstones. They are
– The biggest risk group is women because of the female sex hormones, estrogen and progesterone. It is said that estrogen increases the amount of cholesterol in the bile. Progesterone slows down the process of emptying the gallbladder.
– Sometimes it may be due to hereditory factor, blame it on your gene
– Being obese definitely poses a greater risk
– Eating more fatty and oily food that is rich in cholesterol
– Rapid weight loss
The FFFF Factor
If you are a Female, Forty Years, Fatty, and Flatulent you may run a higher chance of getting gallstones in the gallbladder. It may be noted that women are 5 times more prone to gallstones than men.
It is said that female hormones, estrogen and progesterone play a major role in gallstone formation. Dr. Maran, a gallbladder specialist, who regularly performs gallbladder removal surgery in Chennai, talks about the link between the female hormones and gallstones in his video. The link to the video is below. He also has written a brief article on the same and you can find the link to the article here.
Complications of Gallstones
Gallstones inside the Gallbladder
Most times the gallstones in the gallbladder is asymptomatic. This means they are present but do not cause any symptoms or harm. They just float around inside the gallbladder and do nothing. This is usually referred as “silent stones”.
This can manifest into symptoms in later stage of life and the chances are put at 20%. The symptoms cause pain that are symptomatic to gallstones. The episodes of pain are linked to the movement of gallstone from inside the gallbladder to outside. When the gallstones move, the various places where the gallstone can get lodged causes different types of problems. Let us analyse.
Gallstones causing Blockage of the Gallbladder neck by Gallstones
The formation of gallstones and the presence of the same is referred as Cholelithiasis. Sometimes episodes might occur and they begin to block the neck of the gallbladder. In such a scenario the bile could neither flow in nor flow out of the gallbladder. This condition causes episodes of pain.
Sometimes the gallstone so obstructing the neck of the gallbladder might fall back into the gallbladder once again. Once they fall back the pain might subside. But the mere episode of pain is a warning sign that the gallbladder needs to be removed. The probability of gallstones obstructing the neck of the gallbladder once again is very high. This despite the fact the gallstones have fallen back into the gallbladder.
Sometimes the gallstone so obstructing the neck of the gallbladder might move into the common bile duct. This movement causes next level complications.
Choledocholithiasis or Common Bile Duct Stone
As the common name indicates, it is the presence of the gallstones in the common bile duct. This duct is a narrow tube that transports bile from liver to the small intestine (duodenum). This typically happens when the smaller gallstones (that are notorious) formed inside the gallbladder travels outside and descends into the duct.
This can block the passage of bile and can very well lead to surgical jaundice. Then the bile flow is obstructed completely and can cause infection. Once the stone descends down, a simple treatment becomes complicated requiring more than 2 procedures. This can cause an emergency situation with a high mortality rate.
Gallstones causing Pancreatitis
The obstructing gallstone can sometimes further travel down the common bile duct and can lodge and block the pancreatic duct. This can disrupt the flow of pancreatic juice and can cause pancreatitis.
Gallstones causing Biliary Fistula
The gallstone that has passed into the common bile duct can rarely cause perforation in the CBD. This can trigger a bile leak which may flow into the abdomen cavity. It has to be noted that this is an extremely rare event.
Gallstones causing Duodenitis
The gallstone that has passed into the common bile duct can sometimes flow out inside the duodenum of the small intestine. So literally there is no blockage of common bile duct or Pancreatic duct. But the gallstones that have gotten inside the duodenum may block the passage of the intestine very rarely.
Gallstones causing Bowel Obstruction
The gallstone that has passed into the common bile duct can sometimes flow out inside the duodenum of the small intestine. Them the gallstones may reach the distal part of the small intestine (called bowel in simple terms). The gallstones that have passed the duodenum may block the passage of the intestine very rarely.
Gallstone Ileus is a rare form of condition that can cause a sort of paralysis of movement of the small intestine. This is caused by the gallstone that has reached the bowel. The reason attributed is the corrosive nature of the gallstone. The gallstone that has entered can get lodged anywhere in the gastrointestinal track to cause this condition.
Treatment for Gallstone and its complications – Gallbladder Surgery or Gallbladder Removal Surgery
Gallbladder removal surgery is the only recommended option. This is to avoid all the complications arising out of the presence of gallstones in the gallbladder. Once gallstones are formed inside the gallbladder the benefits of gallbladder removal surgery far outweighs the complications they can cause. Dr. Maran is of the firm opinion that removal of gallbladder do not cause any digestive problem after the gallbladder surgery. He routinely performs gallbladder removal surgery in Chennai. So Dr. M Maran bats for removing the gallstone affected gallbladder completely from the body. Sometimes gallbladders also develop certain ailments or diseases. This is independent of the gallstone problem. Whatever may be the problem, a gallbladder removal surgery is the recommended solution.
Dr Maran is an experienced Surgeon in the field of Gastro-enterology. He specializes in Advanced laparoscopic Surgery procedures of the gastro-intestinal (GI) tracts. Dr. Maran is also a leading Bariatric Surgeon in Chennai and has a penchant for addressing problems concerning Obesity.