Gallstone/ Cholelithiasis : How they are formed?

What is Gallstone/Cholelithiasis?

The gall bladder is a 3-5 inch long organ that lies under the liver below the diaphragm in the upper right of the abdomen. Gall bladder stores the bile produced from the liver releases it via common bile duct into duodenum (a part of the small intestine). Bile emulsifies fats thereby making it easier to absorb fats, absorption of fat-soluble vitamins (vitamin A, D, E, and K) and helps in digestion of fats. The liver always produces extra cholesterol. On the intake of high-fat food, the gallbladder is activated to squeeze out bile juice in small intestines.

Normally gallbladder consists of:

  • 10% cholesterol
  • 5% phospholipids
  • 5% of proteins
  • 1% bilirubin
  • 70% bile salts and acids which are products of cholesterol metabolism
  • Water, electrolytes, bicarbonates, etc


What are gall stones?

Stones are solid mass (aggregate of precipitated salts). Gall stones are aggregated solid mass in the gall bladder.

There are broadly two types of gall stones:

  1. Cholesterol stones

Cholesterol precipitates and aggregates to form stone because bile supersaturates in the gallbladder. Also when there is not enough bile, phospholipids, and salts to keep bile in solution, then more bile precipitates. These are the most common and 70-90% people having gallstones have cholesterol stones.

2.Pigmented stones

Pigmented stones are more common in people suffering from cirrhosis and blood disorders.

  • Brown gall stones indicate infectious condition, leakage in the bile duct. They are formed when bacterial enzymes work upon unconjugated bilirubin and phospholipids.

These are mainly yellow colored bilirubin stones. Non-conjugated bilirubin forms a salt with calcium and precipitates. Bilirubin is a product of hemoglobin metabolism.                                                                     When calcium carbonate is also present then these stones become opaque and are visible in X-ray.

  • Gall stones are not caused by consuming too much cholesterol, but not producing sufficient bile to break cholesterol results in stone formation. This condition may be there for years and may be lifelong.

11-15% of adults in the world have gall stones.

People don’t even know that they have gallstones until these stones prevent the flow of fluids from a bile duct which produces symptoms like severe pain in the abdomen. Stones stay and cause no problem. A problem arises when they struck in the path and block common bile duct which releases bile. The contraction of the gallbladder causes severe pain.

Causes and risk factors of gall stones

The cause of gallstone formation is not very clear. They may be due to chemical imbalances in gallbladder because of unknown reasons. Some of the risk factors of having gall stones are:

  • family history of having gall stones/ liver stones/ kidney stones
  • Rapid Weight loss and crash dieting quickly reduce lipids which increase the risk of having gall stones.
  • No physical activity
  • Contraceptive pills
  • People above 60years of age and women are at more risk than men as estrogens increase the risk of increasing cholesterol.
  • Women near their menopause
  • Diabetes
  • Hypothyroidism
  • Obesity


What are the signs of a bad gall bladder?

Realizing the signs and symptoms indicated by the body is very important. Following are the indications that you may have some gallbladder problem:

  • Burping a lot
  • Difficulty indigestion which may cause constipation
  • Persistent Bitter taste in the mouth
  • Gas and bloating
  • Nausea after eating
  • Sore tongue and taste bud imbalance
  • Itching in rectal
  • Severe pain in the upper right abdomen which may extend to the back of the right shoulder
  • Pain and discomfort
  • Restlessness and sweating excessively

Risks associated with bad gall bladder are Gallstone i.e. Cholelithiasis, Infection jaundice, pancreatitis (inflammation in pancreas), Cholecystitis (inflammation of the gallbladder).

What are the gallbladder attacks?

A gallbladder attack is also called biliary colic. When sudden severe pain (colic) occurs due to contraction of gall bladder when the stone is stuck in the bile duct; it is a gallbladder attack.

Gallbladder attacks cause severe discomfort and require immediate action.

Stone may temporarily block the bile duct. The contraction of the gallbladder causes severe pain in the right upper abdomen.

These attacks are more severe at night and occur repeatedly.

There are more chances of having a gall bladder attack after heavy meals.  Gall bladder attacks may be triggered by some foods, so it’s advised to avoid them.

Foods to avoid if you have gallstone and foods triggering gallstone attacks

Gall bladder attacks may be triggered by some foods, so it’s advised to avoid them.

Also, certain dietary restrictions may reduce the intensity of pain and discomfort caused by gallstones.

  • Foods high in saturated fats like cheese
  • Alcohol
  • Coffee
  • Stop having Meats
  • Avoid having Poultry like egg, turkey, etc
  • Dairy
  • Sugar
  • Refined foods
  • Sodas and carbonated drinks
  • Grains like corn, peanuts
  • Processed sausage foods
  • Onion
  • Turnip
  • cabbage
  • Avoid high-fat food to prevent further growth of gallstone
  • Avoid eating seeds
  • Avoid crash diet and excessive weight loss
  • Non-Vegetarian diet


Best foods to eat when the gall bladder isn’t functioning optimally

  • Lemon
  • tomatoes
  • Cherries
  • Salads: carrot, radish, kale, celery, broccoli
  • Steamed vegetables
  • Fresh fruits especially apple, pear
  • Sweet potato
  • Squash
  • Juice therapy
  • Berries: Blackberries, blueberries, raspberries
  • Low-fat high fiber diet is preventive
  • Nuts
  • Vegetarian diet as they are at very low risk than non-vegetarian


Best ways to dissolve it

Whether gall stone can be dissolved or not depends on the stage of the condition and size of the gall stone.

Stone dissolve in only 50% of the cases and even if dissolve; chances of recurrence are always there. No drug directly acts on gall stones and claims of melting it via drugs are false.

If it is in lithogenesis stage (less than 1 cm) then medical management can be done only if there are no symptoms like abdominal pain, nausea, heartburn, indigestion, bloating, vomiting, etc.

Medical management of gall stones is done by Bile salt therapy with bile sequestering agent ursodeoxycholic acid. Drug work by reducing cholesterol absorption and reduce cholesterol formation in the liver which reduces crystallization. This slowly utilizes bile and cholesterol from stone. It takes 6 months to 2 years and chances of recurrence are always there.

With gallstone of size, more than 2 cm, the risk of cancer is high and size more than 3cm are highly at cancer risk and require surgery.

If there are no symptoms of gallstones and gallbladder is not working properly then surgery i.e. cholecystectomy (removal of gallbladder surgically) is performed.

Other options of treatment are:

  • Endoscopic retrograde cholangiopancreatography ERCP
  • ESWL i.e. extracorporeal shock wave therapy called lithotripsy not for calcified only for cholesterol stones. Small sized and pass through stool.
  • Acupressure Although many gall stones are of unknown cause and genetic factors play a major role still Diet and lifestyle changes help and prevention is better than cure.

Hence, we can always take a preventive measure to avoid the occurrence of gall stones. It is advisable to seek help from a Dietitian/Nutritionist to get a Balanced diet plan.

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