The Gallbladder and Gallstones: Facts, Functions, and Problems
A Helpful Organ
The gallbladder is a small but useful organ. It's located under the liver on the right side of the upper abdomen. It stores a liquid called bile, which is made by the liver. When fat from food enters the small intestine, the gallbladder contracts and sends bile into the intestine through a duct. The bile emulsifies the fat, breaking it up into small droplets. Emulsification makes it easier for enzymes to digest the fat.
Although the gallbladder is a helpful organ, it can cause problems in some people. While bile is stored, water is removed and the remaining liquid becomes concentrated. This may lead to the formation of solid lumps known as gallstones. The presence of these lumps can lead to a very painful condition known as a gallbladder attack.
The pain of a gallbladder attack may occur while the gallstones are in the gallbladder. It's more likely to develop if a stone leaves the gallbladder and enters one of the bile ducts, however. Fortunately, the condition can be treated.
The Gallbladder and Bile Ducts
The gallbladder is shaped like a pear and can hold about 50 ml of bile. When full, it's about 8 cm (3.2 inches) long and 4 cm (1.6 inches) wide. It's connected to ducts, or tubes, which transport the bile to where it's needed. These ducts are shown in the illustration above.
The tube that transports bile out of the gallbladder is called the cystic duct. This joins with the hepatic duct, which transports bile out of the liver, forming the common bile duct. The common bile duct then joins with the pancreatic duct coming from the pancreas and sends the bile into the duodenum, which is the first section of the small intestine. The small intestine is known as the small bowel in some countries.
Bile can flow in either direction in the cystic duct—either into the gallbladder from the liver or out of the gallbladder towards the small intestine.
Gallstones are often referred to as simply "stones", although they are made of a different material from stones outside the body. The technical name for the presence of gallstones in the gallbladder is cholelithiasis.
Bile is a watery solution that contains bile salts, cholesterol, fats, a small amount of protein, and bilrubin. Bilirubin is a yellow pigment formed from the breakdown of hemoglobin from old or damaged red blood cells.
Two types of gallstones are produced from bile—cholesterol stones and pigment stones. About eighty percent of gallstones are made of solidified cholesterol and are known as cholesterol stones. Pigment stones are made of solidified bilrubin.
Cholesterol stones are often yellow in color, but if they contain other substances as well as cholesterol they may be greenish yellow or brownish yellow. Pigment stones are black or dark brown. Black pigment stones form in the gallbladder. Brown pigment stones often form in the bile ducts and may be related to infections. Gallstones may be tiny or as large as a golf ball.
The cause of gallstones isn't completely understood. Stone formation seems to be due to a combination of factors. It’s thought that heredity plays a role, but lifestyle may also affect the possibility of developing stones.
Doctors and researchers do know that certain factors increase the probability of gallstone formation. For example, if the gallbladder has a decreased ability to contract and release its bile, the likelihood of gallstone formation increases.
Another factor that may be important is the composition of the bile. Bile contains bile salts or very similar compounds called bile acids. These chemicals are responsible for emulsifying fats in the duodenum. They also break up some of the cholesterol in the bile. Therefore if the bile doesn’t contain enough bile salts, gallstones may form. Yet another possible cause of stones is the presence of too much bilirubin in the bile.
Some Risk Factors
Risk factors for gallstone formation include:
- gender (woman are more susceptible than men)
- age (people over the age of sixty are more likely to develop gallstones than younger people)
- excess estrogen in the body (such as estrogen provided by birth control pills or hormone replacement therapy)
- pregnancy (since pregnant woman have a high level of estrogen in their body)
- diabetes (perhaps because diabetics often have a high level of triglycerides, or fats, in their blood)
- ethnicity (People of Native North American, Native South American, Hispanic, or Northern European descent have a higher tendency than other ethnic groups to develop gallstones. Asian people are more likely to develop brown pigment stones than other stone types.)
The Effect of Excess Weight
It’s important to maintain a healthy weight to reduce the chance of developing gallstones. Research has shown that being even moderately overweight increases the risk of stone formation.
If you’re trying to lose weight, the excess weight should be lost gradually. During rapid weight loss the liver excretes extra cholesterol into the bile (which is one mechanism by which excess cholesterol is removed from the body), increasing the risk of gallstones. Some medications prescribed to lower blood cholesterol cause the same effect by stimulating secretion of cholesterol into bile, which can result in stone formation.
Although weight gain should be avoided, regularly eating a small amount of fat helps to prevent gallstones because it stimulates the gallbladder to contract in order to release bile.
Steps That May Prevent Stone Formation
A high fiber diet appears to reduce the chance of gallstone formation. Soluble fiber from grains and other foods is believed to lower the blood cholesterol level. Oats and barley are good sources of this type of fiber. Several research studies have discovered that drinking caffeinated coffee regularly and ingesting vitamin C seem to reduce the risk of gallstone formation. Scientists are not ready to make definite claims that certain foods or nutrients are beneficial for the gallbladder, however.
It's always good to follow a healthy diet. It's important to keep in mind that ingesting a particular food or drink in excess or taking an excessive dose of a vitamin supplement may be harmful, however. Questions about the best diet to follow with respect to gallstones should be referred to a doctor.
A particular symptom can be caused by many different disorders. In addition, a person with a specific disorder may not have all of the common symptoms for that condition and may have some unusual ones. Anyone with symptoms that concern them should visit a doctor.
Some Possible Symptoms
If gallstones move out of the gallbladder they can block any of the passageways in the biliary system, including the cystic duct, the hepatic duct, and the common bile duct. Gallstones may also enter the pancreatic duct.
While gallstones are in the gallbladder there may be no symptoms, although there may be pain after eating a fatty meal if many stones are present or if they are large. If gallstones move into the tubes that conduct bile and block them, however, a person may experience the symptoms of a gallbladder attack, also known as biliary colic.
Symptoms of biliary colic may include pain in the middle of the upper abdomen, in the upper right abdomen, under the right shoulder, and between the shoulder blades. The pain may be severe. It usually starts shortly after eating and may last for several hours. Nausea and vomiting may be additional symptoms. Gallbladder attacks may be recurrent.
In some people, blocked bile ducts or a blocked pancreatic duct can lead to complications such as inflammation of the gallbladder (cholecystitis), inflammation of the pancreas (pancreatitis), and infections. Yellow skin and whites of the eyes (jaundice) may result when the bile ducts are obstructed by gallstones, causing bilirubin from the trapped bile to collect in the body. Although jaundice itself is generally not serious, it may have a serious cause. Abdominal pain that does not go away or abdominal pain accompanied by fever, chills, or jaundice requires immediate medical attention.
Anyone who has unexplained abdominal pain or suspects that they have gallstones must visit a doctor for a diagnosis. Some treatments are described below, but the treatment that is right for a particular patient must be prescribed by a physician.
Some Nonsurgical Treatments
Gallstones that stay in the gallbladder and don’t cause any problems are known as silent gallstones. These are generally not treated, although a doctor's advice is needed if the stones are discovered.
The body may be able to deal with small gallstones that leave the gallbladder by itself. These gallstones move with the bile into the duodenum. From here, the stones travel through the rest of the small intestine, into the large intestine, and then out of the body in the feces. Larger gallstones or gallstones that block passageways are more problematic.
Some nonsurgical methods to treat gallstones have been used, but unfortunately they don't seem to be very effective. If they do work, gallstones often reappear in the future. One of these methods is the ingestion of bile acids. Ursodiol (also known as ursodeoxycholic acid) is a bile acid prescribed to break up cholesterol gallstones. Ursodiol works best with small stones. However, it needs to be taken for months before it starts to work and may need to be taken for up to two years. For fifty percent of patients, gallstones reappear within five years of stopping the ursodiol treatment.
Extracorporeal shock wave lithotripsy (ESWL) is the use of high energy sound waves to break up gallstones. It works best with small, single stones. Lithotripsy is not used very much nowadays. It can cause serious side effects, such as broken fragments of gallstones from the gallbladder becoming trapped in bile ducts. There is also a high risk of gallstone recurrence.
Some Surgical Treatments
At the moment, the most effective way of solving a gallstone problem seems to be removal of the gallbladder. We don’t need the organ to survive. Some bile normally flows directly from the liver through the hepatic duct towards the duodenum. If a person lacks a gallbladder, all the bile flows from the liver to the duodenum.
Unless a person has other health problems that may make surgery dangerous, most doctors recommend that gallstones be removed surgically. Traditional surgery to remove the gallbladder is called a cholecystectomy.
Another method of removing the gallbladder used today is known as a laparoscopy. This is sometimes known as "keyhole surgery" and is minimally invasive. In this type of surgery, several very small incisions are made. A tiny camera attached to a tube is inserted through one incision so that the surgeon can see inside the body. Surgical instruments are inserted through other incisions to remove the gallbladder.
Gallbladder Cleanse or Flush
There are many recipes on the Internet for gallbladder cleanses or flushes to remove gallstones. These generally include some combination of apples, apple juice, apple cider vinegar, lemon or grapefruit juice, magnesium (usually in the form of Epsom salts), and a large quantity of olive oil.
Components of the apple juice are supposed to soften the stones and the olive oil is supposed to force the gallbladder to contract and push the softened gallstones into the intestine.
Ingesting a gallbladder flush recipe often causes the appearance of solid lumps in the feces, often in large numbers, even in people with no symptoms of gallstones. Scientists have analyzed the lumps released from some people who have undergone a flush, however, and have found that they aren’t gallstones but are derived from olive oil. In general, medical doctors consider gallbladder flushes to be ineffective for removing gallstones.
Treatment in the Future
Scientists still have a lot to learn about the factors that cause and prevent gallstone formation. Hopefully in the near future they will understand the stones and their production better and will have improved treatment methods that don't require removal of the gallbladder. Modern surgical techniques for removing the gallbladder are efficient and we can live well without the organ. It would be nice if stones could be removed without surgery and if the gallbladder could be left in the body, though.
Gallbladder and biliary tract from the Merck Manual
Information about gallstones from the NIH (National Institutes of Health)
Facts about gallstone treatment from the NHS (National Health Service)
Eating guidelines for gallbladder disease from HealthLinkBC (a Government of British Columbia website)
Gallbladder diet from WebMD
Lithotripsy information from the University of Michigan
An assessment of a gallbladder cleanse for gallstones from the Mayo Clinic
Questions & Answers
© 2010 Linda Crampton