The presence of gallstones in the gallbladder is a very common medical problem known as cholelithiasis. Gallstones are formed when bile, which is stored in the gallbladder, becomes overconcentrated and hardens into pebble-like substances. Bile enables the body to break up fat and gives stool its yellowish-brown color. There are three types of gallstones: cholesterol, brown pigment and black pigment stone. The cholesterol type composed of cholesterol and calcium bilirubinate is the most common.
Signs and Symptoms
The classic symptom that is seen in symptomatic patients is biliary pain or "colic." This constant abdominal pain increases quickly and lasts from about 30 minutes to several hours. Sometimes the pain is felt in the back or under the right shoulder. It is sometimes observed with nausea. These attacks usually occur after fatty meals and may take place at night. People usually have clay-colored stools and might see a yellow color in their skin or whites of their eyes.
Diagnosis
As a physician presses lightly on the patient's abdomen on deep inspiration, there is usually no tenderness felt, which followed by pain in the right upper quadrant on deep inspiration. If there is an accompanying bacterial infection, the gallbladder will be enlarged and palpable.
Ultrasonography is usually performed to further confirm the diagnosis of gallstones. It is a noninvasive first line of diagnosis used to diagnose gallstones. Because of the calcium content seen in some gallstones, they are sometimes evident on plain abdominal radiographs as well. An oral cholecystogram is also a very accurate diagnosis test that is not used as often as ultrasonography because it involves ingestion of oral contrast at least 12 hours before the radiograph examination. A scintigraphy can be conducted, in which a technetium-labeled iminodracetic acid is injected and the isotope is taken up by the gallbladder. A gamma camera is used to measure the gallbladder ejection fraction to indicate abnormality and disease.
Treatment
Patients are sometimes asymptomatic with the exception of pain in the right upper abdomen, known as Murphy's sign. In asymptomatic patients, no treatment is needed, but treatment is required in diabetic patients to prevent further complications.
When patients present in the emergency room with an acute attack of biliary colic, they are given opioids to help alleviate the pain. Surgery known as cholecystectomy is often performed to remove the gallbladder. Cholelithiasis usually precedes choleduocholithiasis, which involves an obstruction of the cystic bile duct by enlarged gallstones and involves severe abdominal pain.
