Gallstones and Other Gallbladder Problems

Gallstones, also known as cholelithiasis, are a very common gallbladder problem.

The gallbladder is a sac that stores a substance called bile, which is produced by the liver.

After meals, the gallbladder contracts and releases bile into the small intestine to aid in digestion.

Gallstones occur when one or more of the substances that make up the bile (usually cholesterol or a waste product called bilirubin) becomes too concentrated and forms a hard stone.

Often gallstones just sit in the gallbladder and don't cause problems. But sometimes they block the exit from the gallbladder, called the cystic duct.

When this occurs, the gallbladder goes into spasms and becomes inflamed, a condition called cholecystitis.

An episode of cholecystitis may go away on its own, or it may progress to a more serious condition involving a bacterial infection of theinflamed gallbladder。(1,2)

It’s not always clear why gallstones form in a given person, nor do doctors know all the factors that contribute to the formation of gallstones. Some possible causes include:

• Excess bilirubin, a chemical produced when your body breaks down red blood cells, in the bile
• Excess cholesterol in the bile
• Improper emptying of the gallbladder, causing bile to become concentrated (2)

Factors that increase your risk of developing gallstones include:

• 胆结石的家族史
• 久坐的生活方式
• Being female
• Being age 40 or older
• Being of Native American or Mexican-American descent
• Having diabetes
• Havingliver disease
• Being pregnant
• Beingoverweight or obese
• Rapid weight loss
• Takingbirth control pillsor estrogen-based hormone replacement therapy
• A diet rich in fat and cholesterol, or without enough fiber (2)

It's not uncommon for gallstones to cause no symptoms at all. In this case, they may be discovered while you're being screened or tested for some other health problem.

But in many people, gallstones can causesymptoms of cholecystitis(inflamed gallbladder). These symptoms may include:

• Abdominal painin the upper right part or center of your abdomen (often comes on suddenly and gets worse quickly)
• Back pain, especially between your shoulder blades
• Pain beneath your right shoulder blade
• Fever with chills
• Vomiting and nausea
• 黄疸(yellowing of your skin and whites of your eyes)
• 粘土色的凳子，深色尿液或两者（胆管阻塞的迹象）
• Pain that strikes after eating a heavy or fatty meal
• Indigestion,bloating, and gas (2,3)

If you have any of these symptoms, it's possible that胆结石可能要怪。It's important to see your doctor promptly for an exam and to get started on treatment.

In rare cases, gallstones may also be an indication ofgallbladder cancer, so it's best to get the problem diagnosed right away. (1)

If your symptoms indicate that you may have gallstones, yourdoctor may order an imaging test, such as:

• Ultrasound, which uses sound waves to visualize the area
• Computed tomography(CT), which used radiation to create a detailed image
• Magnetic resonance imaging (MRI), which uses magnetic fields and radio waves to create an image (2)

Another less commonly used procedure, called a hepatobiliary iminodiacetic acid (HIDA) scan, involves injecting a small amount of a harmless radioactive substance into your arm.

A device called agammacamera is then used to create images as this substance travels from your bloodstream to your liver, gallbladder, bile ducts, and small intestine. (4)

Gallstones can also be diagnosed usingendoscopic retrograde cholangiopancreatography(ERCP), in which a flexible tube is inserted down your throat and into your digestive tract. This procedure is typically used to fix other problems with your bile or pancreatic ducts, but gallstones may be discovered in the process. (5)

There are a couple treatment options for gallstones, which may be chosen based on how frequent or severe your symptoms are. These include:

MedicationA few types of medication, including oral bile salt therapy, work to slowly break down small gallstones to reduce pain and other symptoms.

这些药物可能需要几个月甚至数年的时间才能分解胆结石，有时它们根本无效。一旦您停止服用它们，胆结石也可能会返回。

For these reasons, medication to remove gallstones is usually reserved for cases in which surgery isn’t an option. (2)

止痛药，包括非甾体类抗炎药（NSAIDS), may be used to help control pain during an acute attack of cholecystitis. (6)

SurgeryIf you experience severe symptoms, your doctor may recommend removing your gallbladder.

Once your gallbladder is removed, bile will flow directly from your liver into your small intestine. This可能引起消化症状，包括腹泻, which are usually temporary.

Significant advances have been made in胆囊去除手术(cholecystectomy). It's now a minimally invasive procedure that useslaparoscopic technology。

Tiny incisions are made, recovery is quick, and you may not even need to spend the night in the hospital following your surgery. (2)

It’s possible toexperience symptoms in your gallbladderor bile ducts that aren’t caused by gallstones.

Conditions that can cause similar symptoms include:

Acalculous Biliary PainThis refers to pain in the bile ducts that isn’t followed by any gallstones appearing in imaging tests.

It may be due to improper emptying of the gallbladder, overly sensitive bile ducts or small intestine, or gallstones that are too small to be seen on imaging scans or passed through already.

Surgery to remove the gallbladder is often successful at remedying pain without gallstones. (7)

与艾滋病相关的胆管狭窄Inpeople with AIDS, a weakened immune system can lead to frequent and widespread infections, some of which can result in the bile ducts narrowing. (7)

原发性硬化性胆管炎This refers to inflammation that causes scarring and narrowing of the bile ducts, and isn’t caused by any other known condition.

While the causes of primary sclerosing cholangitis aren’t completely understood, doctors believe that it’s most likely an autoimmune disorder, in which the immune system attacks the body’s own tissues. (7)

Additional reporting by Quinn Phillips