Gallstones, better known as gallstones, are small stones that form inside the gallbladder. While some stones are the size of a grain of sand, others can be as large as a golf ball.

Biliary calculi are deposits of cholesterol or other substances released by the liver. The stones consist of cholesterol in 80% of cases, according to Health Insurance. In 20% of cases, they are made up of bile pigments alone. The smallest stones are evacuated through the stool, but the largest remain stuck in the bile ducts. Surgery is then necessary. In most cases, gallstones do not cause any symptoms. However, they can lead to biliary colic, also known as hepatic colic.

1. Definition of gallstones

Gallstones are small crystals in the gallbladder. The gallbladder is the organ that stores bile in the liver. The pear-shaped gallbladder contains bile, an enzymatic liquid that helps break down foods with high-fat content. During digestion, the gallbladder contracts, releasing a small amount of bile through the cystic duct. The bile exits through the gallbladder via the bile ducts. Gallstones can enter the ducts and cause symptoms. The bile ducts consist of channels in the liver, which collect bile. Bile consists of water, cholesterol, fat, bile salts, and bilirubin.

Generally, gallstones go unnoticed and do not cause any discomfort. According to Health Insurance, in 80% of cases, gallstones do not cause any symptoms. These asymptomatic stones may nevertheless be discovered during an abdominal ultrasound for another reason. However, in some cases, gallstones cause biliary colic. The patient suffers from a sudden abdominal pain radiating to the right shoulder, as well as nausea and vomiting. The attack ceases within a few hours, but a doctor must be consulted. In the United States, it is estimated that 16 to 20 million people suffer from gallstones, according to the Vaud University Hospital.

2. Symptoms of gallstones

Gallstones cause symptoms as they move through the cystic duct. They can cause biliary colic, with sudden abdominal pain that can radiate to the right shoulder, the tip of the shoulder blade and the back, but also nausea and vomiting. The pain is sudden, and is located in the pit of the stomach, or under the ribs on the right side. It intensifies rapidly and may become constant. Liver colic lasts between 30 minutes and a few hours. It stops once the stone has moved and is no longer blocking the bile duct. Other symptoms may also appear:

jaundice;
whitish stools
red urine;
persistent abdominal pain.

3. Causes of gallstones

Gallstones are caused by cholesterol in the bile, but also by other substances released by the liver. Certain factors favour the formation of gallstones, including

the age of the patient: older people are more likely to develop gallstones, because of a decrease in the motor skills of the gallbladder;
The sex of the person, as female hormones generally increase the concentration of cholesterol in the bile. In this sense, women are more likely to develop gallstones than men, especially if they have had several children because pregnancy decreases the motility of the gallbladder;
pregnancy;
being overweight or obese: being overweight favours gallstones, and in particular a low-calorie, high-fat diet;
a family history;
taking certain estrogen-based drugs or drugs for hypertriglyceridemia;
certain pathologies such as Crohn's disease, cystic fibrosis, or diabetes;
prolonged fasting.

The main factor in biliary lithiasis is an excess of cholesterol secretion in the bile.

4. Biliary lithiasis: when to consult?

It is essential to consult a doctor in case of liver colic. You should therefore go to a doctor if you have symptoms of an attack, manifested by violent pain in the stomach, nausea and vomiting. If there are no symptoms, no consultation is necessary, even if you have gallstones. Indeed, in the majority of cases, gallstones remain asymptomatic and do not cause any particular complications.

5. Examination and diagnosis of gallstones

The doctor first interviews the patient and then palpates the abdomen in the epigastric area. An abdominal ultrasound is necessary to detect gallstones in the gallbladder. This examination is usually sufficient to confirm the diagnosis. Other tests may be performed to find gallstones in the bile ducts, such as an endoscopy.

6. Treatments for gallstones

Treatment is needed for patients with hepatic colic or other complications, such as acute pancreatitis, acute cholecystitis, or angiocholitis. In the case of acute cholecystitis, inflammation is caused by obstruction of the cystic bile duct. This leads to a fever and severe pain. The stones also increase the risk of angiocholitis, a serious infection of the bile duct. Acute pancreatitis occurs when the bile duct is blocked by a stone. Gallstones can be treated with medication or by surgery. To relieve a gallstone attack, the doctor may prescribe painkillers, anti-inflammatory drugs, or antispasmodics. The doctor usually refers the patient to a digestive surgeon, who may recommend the removal of the gallbladder. The gallbladder is then removed by laparoscopy through a small opening in the abdomen. Small incisions are made in the abdominal wall. In this case, the hospital stay is short and the convalescence is short.

If laparoscopy is contraindicated, a laparotomy may be necessary. The abdominal wall is then opened under the ribs, an operation that requires a longer hospital stay and convalescence. Recovery is usually rapid and complications are rare. Eating is normally resumed the same evening or the day after the operation, without any special diet. If left untreated, the risk of recurrence of liver colic is high. According to Health Insurance, two times out of three, a new crisis is triggered. In the absence of a gallbladder, bile is no longer stored, but the bile flow is preserved and becomes more continuous. Digestion is not affected. In rare cases, the absence of the gallbladder causes diarrhoea, as the bile has a laxative effect on the colonic mucosa.

7. How to prevent gallstones

In order to prevent gallstones, it is recommended that you first eat a balanced diet, choosing foods that are low in fat and high in fibre. Reduce your consumption of animal fats such as butter, meat and cheese. Hydrogenated fats should also be avoided: they are present in many industrial foods. Obesity and overweight considerably increase the risk of gallstones. According to Vidal, the risk is doubled in overweight people. On the contrary, the consumption of certain foods is recommended to promote good health: the consumption of fruit and vegetables has a protective effect against many diseases; a diet rich in fibre reduces the risk of gallstones and cancers. Eat three meals a day, and learn to read the labels on the products you eat, looking for the amount of sugar and fat.

Regular exercise is also recommended. Regular exercise can reduce the risk of gallstones. To avoid being overweight, try to include physical activity in your daily life:

walk as often as possible, especially to work or to the shops;
If you take the bus, get off one stop before your destination;
Use the stairs instead of the lift or escalator;
Limit screen time;
Work in your garden if you have one;
Walk your dog often if you have one.

For Children, have their body mass index monitored from an early age. Be vigilant if you see signs of overweight in your child. Offer them a varied and balanced diet, encourage them to play sports, and limit their screen time. Prolonged fasting is not recommended, as it encourages bile stagnation and the formation of stones. Similarly, diets that make you lose weight too quickly increase the risk of biliary colic. Alternating phases of weight loss and weight gain increase the risk of stone formation. If you want to lose weight, seek professional advice and choose a diet that will help you lose weight gently. You should also be aware that smoking increases the risk of complications after surgery. Quitting smoking 6-8 weeks before surgery eliminates these risks.