What is cholelithiasis? Cholelithiasis (ko-le-li-THI-ah-sis) is a condition where you have gallstones (stones in the gallbladder). The gallbladder is a pouch-like organ located just below the liver. The gallbladder acts as a storage area for bile. Bile is a green-colored fluid made by the liver. Bile passes through tubes called bile ducts and is released into the intestines when you eat. Bile helps in digesting fats and other substances. Many people may have gallbladder stones but may not know it. Pain in the abdomen (stomach) may happen when gallstones grow big and start blocking the bile ducts.
What causes cholelithiasis? Problems with the way bile is made and excreted (emptied) from the gallbladder may cause cholelithiasis. Bile is a balanced mixture of water, cholesterol (fat), bile salts and bilirubin (yellow pigment). Stones may be made from different bile materials. Cholesterol stones are formed when the bile has too much cholesterol and not enough bile salts. It is thought that liver and blood diseases, such as hepatitis and anemia, may cause pigment stones. Gallstones may also be formed when bile does not empty from the gallbladder as fast as it should. The following may increase the chances of having cholelithiasis:
Being overweight.
Certain medicines, such as estrogen, antibiotics, and cholesterol-lowering medicines.
Diabetes or previous surgery of the small intestines.
Fasting (going without food) or rapid weight loss.
Having another family member with cholelithiasis.
Pregnancy.
What are the signs and symptoms of cholelithiasis? The most common symptom of cholelithiasis is a severe, steady pain felt in the right upper abdomen. It is usually just below the right rib cage. The pain may also be felt in the right shoulder and between the shoulder blades. There may also be nausea (feeling sick to the stomach) and vomiting (throwing up). These symptoms may go away on their own, only to come back later, especially after a fatty meal. Other signs and symptoms may include:
Jaundice (yellowing of the skin or whites of the eyes).
Feeling bloated or having too much gas in the stomach.
Pale colored stools (bowel movements).
Dark colored urine.
How is cholelithiasis diagnosed? You may need one or more of the following tests:
Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
ERCP: ERCP is also called endoscopic retrograde cholangiopancreatography. This test is done during an endoscopy to find stones, tumors, or other problems. Dye is put into the endoscopy tube. The dye helps your pancreas and bile ducts show up better on x-rays. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to shellfish, dyes, or any medicines. If you have stones, they may be removed during ERCP.
Liver and gallbladder scan: This test may also be called a HIDA scan. This is a test to look at your liver and gallbladder. You are given a small amount of radioactive dye in your IV. Pictures are then taken by a special scanner that can "see" the dye in your body. Caregivers look at the pictures to see if your liver and gallbladder are working normally.
Oral cholecystography: Oral cholecystography is a test to look at your gallbladder and its ducts (passages). You are given pills to swallow that have a special dye in them. Then, x-rays are taken over time. The dye makes your gallbladder and its ducts show up on the x-rays. This may make it easier for your caregiver to see any stones or swelling in your gallbladder. Some people may be allergic to the kind of dye used in the pills. Tell caregivers if you are allergic to dye or shellfish (crab, lobster, or shrimp). It is also very important to tell your caregiver if there is any chance you could be pregnant. Your caregiver will tell you what you can and cannot eat before the test. It is important to follow your caregiver's instructions or the test may not work.
Abdominal ultrasound: An abdominal ultrasound is a test that is done to see inside your abdomen. Sound waves are used to show pictures of your abdomen on a TV-like screen.
How is cholelithiasis treated? You may have any of the following:
Surgical treatment: Surgery is often needed to treat cholelithiasis. This may be done by any of the following procedures:
Open cholecystectomy: Open cholecystectomy is surgery to remove your gallbladder through an incision (cut) under your right rib cage. Ask your caregiver for more information about open cholecystectomy.
Laparoscopic cholecystectomy: This procedure uses a laparoscope to take out the gallbladder. A laparoscope is a thin, lighted tube with a camera at the tip. Small incisions are made in the abdomen, where the laparoscope and other surgical instruments are inserted. Ask your caregiver for more information about laparoscopic cholecystectomy.
Non-surgical treatment: When surgery cannot be done, you may have any of the following treatments:
Lithotripsy: During lithotripsy, shock waves are used to break apart stones in your gallbladder, kidney, or other areas. You may be placed in a water bath or on a water-filled cushion. You may be given medicine to make you drowsy before the procedure. Shock waves are sent through the water and toward the stone or stones. The stones may break apart when the shock waves hit them. Pieces of the stones may then pass out of your body when you use the toilet. A lithotripsy, though seldom used, is an option that may be used in selected patients.
Oral dissolution therapy: These are medicines that can melt small cholesterol gallstones. Ask your caregiver for more information about using oral dissolution therapy for cholelithiasis.
With treatment, such as medicine and surgery, your symptoms may be relieved.
Where can I find more information? Accepting that you have cholelithiasis may be hard. You and those close to you may feel sad and frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Contact the following for more information:
National Digestive Diseases Information Clearinghouse (NDDIC) 2 Information Way Bethesda, MD 20892-3570 Phone: 1-800-8915389 Web Address: www.digestive.niddk.nih.gov
American College of Gastroenterology P.O. Box 342260 Bethesda, MD 20827-2260 Phone: 1-301- Web Address: http://www.acg.gi.org/
CARE AGREEMENT:
You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
