Gallstones (Part Two)

Who is at risk of having gallstones?

• women
• people over 60
• overweight men and women
• sudden weight loss
• pregnant women,
• women on hormone replacement therapy,
• women using oral contraceptives.

What are the symptoms (signs)?

The symptomatology of gallstones is often called a "gallstone attack" because they occur quite suddenly.

A typical attack causes:

• Constant pain in the upper part of the abdomen, which increases immediately and lasts from 30 minutes to several hours.
• Back pain between the shoulder blades
• Pain under the right shoulder blade
• Nausea and vomiting
• Often the gallstone attack occurs after a fatty meal and can happen during the night.

Other signs may include:

• Bloating
• Repeated intolerance to fatty foods
• Colic-like pain
• Rumbling
• Gas
• Indigestion

People who also have any of the following symptoms should see a doctor immediately:

• shivering
• mild fever
• jaundice of the skin and eyes
• light-colored stools

Many people with gallstones do not have symptoms. These are called asymptomatic patients and their stones are called "silent stones". They do not interfere with the function of the gallbladder, liver, and pancreas and do not require treatment.

How are gallstones diagnosed?

Many gallstones, especially the silent ones, are discovered accidentally during exams for other problems. However, when gallstones are suspected to be the cause of symptoms, an abdominal ultrasound is required.

Ultrasound uses sound waves to detect the presence and to locate the stones. Ultrasound is the most sensitive and specific way to diagnose gallstones. For the most accurate examination, the patient should be fasting (not have eaten) so that the bladder is filled, allowing full visualization and localization of the stones.

Other diagnostic tests that may be used include:

Computed tomography (CT) scan which shows the presence of stones or possible complications.

Magnetic resonance cholangiography which can diagnose blocked bile ducts

Cholescintigraphy (HIDA scan) which is used to diagnose abnormalities in the contractions of the gallbladder and obstructions. In this test, a radioactive material is injected into a vein that goes to the gallbladder, which is then stimulated to contract.

Endoscopic retrograde cholangiopancreatography (ERCP):
- the first phase of the examination is carried out similarly to gastroscopy, and when the doctor reaches the beginning of the small intestine, he injects a special dye that temporarily stays in the ducts of the biliary system.

ERCP is used to locate and remove stones in the ducts.