Most of the 20 million Americans with gallstones never know they have them. Even if a doctor discovers the stones, if the stones don’t cause any pain no treatment is needed. Gallstone treatment usually results in the surgical removal of the stones. The body quickly adapts to the loss of the gallbladder and digestion occurs as usual.
Two main types of gallstones, cholesterol and pigmented, can be found in the body. People tend to have one or the other type of gallstone, they usually do not have both types present. Studies have shown that the country in which the patient resides can contribute to the type of gallstone in the body. People from the U.S., Australia, England, Germany, South Africa, and Sweden tend to develop cholesterol stones whereas people from less industrialized countries more often develop pigmented gallstones.
The size of gallstones vary from person to person. They can be as small as a grain of sand and as large as a golf ball. The number of gallstones is equally as varied; the human body can produce a few hundred tiny gallstones, several moderate size gallstones, a few large gallstones, or any combination thereof. The only significant difference between large and small gallstones is that large ones tend to stay in one place whereas smaller gallstones are known to move around.
Cholesterol stones are a yellow-green color and are comprised of hardened cholesterol. Medical studies suggest that cholesterol stones form when the bile contains either too much bilirubin (a brownish yellow substance removed from the body through the stool), too much cholesterol, or insufficient bile salts. They can also form when the gallbladder doesn’t empty itself as regularly as it should. More than 80% of cholesterol gallstones are found in people living in developed countries. Smaller stones can travel through the digestive system and lodge themselves into the ducts that join the pancreas. That’s why cholesterol stones are sometimes associated with pancreatitis.
The other type of gallstone is pigment stones. These stones develop when the body sheds its old red blood cells either too frequently or too quickly. As a result, the body produces an excess amount of bilirubin, the primary cause of pigment stones. People with sicke-cell anemia or biliary tract infections tend to get pigment stones. Studies show that those with sicke-cell anemia tend to have pigment gallstone problems early in life.
Both cholesterol and pigment stones can become hardened (calcified) over time. Approximately 20% of all gallstones contain enough calcium to make them visible on regular x-rays. Because calcified stones are hardened efforts to dissolve them may not be successful.
One early indicator of gallstones is biliary sludge, a thick protein substance found in the gallbladder. Biliary sludge particles can sometimes get lodge in the ducts that lead into the intestine and cause abdominal pain. It can also lead to inflammation of the pancreas (pancreatitis) or gallbladder. Women who are pregnant can develop biliary sludge. Additionally, people who fast for long periods of time or those that experience rapid weight loss may build up biliary sludge.
Gallstones can sometimes be treated by having the stones themselves removed (endoscopic surgery) or by being dissolved. The symptoms of gallstones can sometimes be minimized by an adjustment in one’s diet. However, the most common and permanent procedure for removing gallstones is gallbladder removal surgery. As recently as ten years ago this required the surgeon to make a 5″-8″ incision in the abdominal area through which the gallbladder was removed. Presently, most gallbladders are removed laparoscopically, which just requires 4 small incisions through which tiny instruments (a small scope with a camera, a small scope with a cutting tool) are placed. This type of surgery greatly reduces the patient’s hospital stay – many patients return home a few hours after the surgery. Recovery time is also reduced. Approximately 500,000 Americans have their gallbladders removed each year making this surgical procedure one of the most common in the U.S.
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