What are gallstones (cholelithiasis)
The most common disease of the gallbladder is gallstones, also known as cholelithiasis. The gallbladder is an organ located in the upper right abdomen that collects and stores the bile that is produced by the liver. Bile is sent into the intestine by way of the common bile duct and is used to digest fats. Gallstones are solid formations made of bile salts, cholesterol (fats) and the breakdown product of red blood cells (bilirubin). The stones may become trapped in the neck of the gallbladder and block the flow of bile, which can cause inflammation or swelling of the gallbladder. This inflammation is known as cholecystitis.
Gallstones can range in size from very small to very large (approximately the size of a golf ball). Patients can have one stone or many small stones.
Risk factors for gallstones include:
- Oral contraceptives
- Being obese or overweight
- Abnormal red blood cell production
- Family history
- Diets high in fat and cholesterol
- Recent rapid weight loss
Signs and symptoms of gallstones
The swelling of the gallbladder causes pain in the right upper abdomen, usually after eating, especially after eating foods high in fat. Patients may also have nausea, vomiting, and fever. The gallbladder can become infected (cholecystitis) or the gallstone can block the entire biliary system, causing jaundice (yellow skin and eyes), dark urine, and light stools. This can lead to cholangitis (inflammation of bile ducts) and pancreatitis (inflammation of the pancreas).
The symptoms of gallstones can be similar to the pain caused by another gallbladder condition, in which gallstones are not present, known as biliary dyskinesia. Biliary dyskinesia is a motility disorder that affects the ability of the gallbladder to release bile. It is characterized by altered tone of the sphincter of Oddi (the sphincter which opens to allow flow of bile). The altered tone causes a disturbance in the coordination of contraction of the biliary ducts and/or a reduction in the speed of emptying of the gallbladder.
Gallstones and related gallbladder disorders are typically diagnosed by ultrasound but may also be diagnosed by:
- Computed tomography (CT scan)
- Endoscopic retrograde cholangiopancreatography (ERCP) — ERCP is an endoscopic procedure that allows the physician to diagnose, evaluate and sometimes treat problems in the liver, gallbladder, bile ducts and pancreas. The procedure combines X-ray and the use of an endoscope.
- Magnetic resonance cholangiopancreatography (MRCP) — MRCP is a noninvasive imaging technique that uses magnetic resonance imaging (MRI) to visualize the biliary and pancreatic ducts and determine if gallstones are lodged in any of the ducts surrounding the gallbladder.
- DISIDA (hepatobiliary) scan — A DISIDA scan, also known as a hepatobiliary scan, is an exam of the gallbladder and the hepatobiliary system (the ducts connecting the gallbladder to the liver and the small bowel). The scan requires the use of a radiopharmaceutical through an IV catheter.
Gallstones are typically treated by removing the gallbladder with a surgical procedure known as a cholecystectomy. In most cases the gallbladder surgery is performed by a minimally invasive method known as laparoscopic cholecystectomy. Some children might require an open cholecystectomy. Both procedures are performed in the operating room under general anesthesia.
Sometimes surgery is not an option because the patient is too sick or for other reasons. In these cases, an interventional radiologist may perform a cholecystostomy, a procedure in which a drainage catheter is placed in the gallbladder. This catheter keeps the gallbladder from getting too swollen, until your child is well enough for surgery.
After the operation, your child will go to the recovery room until she is awake and comfortable. She will then go to a hospital room to recover. If the procedure was done laparoscopically, your child will go home the next day. If your child had open gallbladder surgery, she will be discharged from the hospital in approximately 2 to 4 days. Your child’s surgeon and care team will discuss her recovery and expected discharge with the family.
Once home, your child can gradually return to her normal activities as tolerated. Children without a gallbladder are able to digest foods normally, but they may have loose, softer stools for a short time.
Reviewed by Alan W. Flake, MD, FACS, FAAP,