Gallstones are a common disorder of the digestive system characterized by the formation of solid stones within the gallbladder or bile ducts. These stones are formed by the excessive precipitation of cholesterol, bilirubin, or calcium salts in bile. According to statistics, approximately 10-15% of the global population are affected by this condition, with a significantly higher incidence in women, especially those over 40 years old. The severity of the disease varies greatly; some patients may remain asymptomatic for life, while others may experience severe pain or complications due to bile duct obstruction caused by stones.
With advancements in medical technology, the diagnosis and treatment of gallstones have become more precise, but the potential risks cannot be ignored. Stones blocking the bile ducts can lead to serious complications such as acute cholecystitis, pancreatitis, or sepsis. Therefore, understanding the etiology, symptom interpretation, and modern medical diagnostic and treatment procedures is crucial for early detection and effective management. Modern medicine has developed various non-invasive diagnostic techniques, such as ultrasound, allowing detection of issues even in asymptomatic stages. Treatment options range from medication observation to minimally invasive surgery, with choices based on stone size, symptom severity, and overall health status of the patient.
The formation of gallstones is mainly related to an imbalance in bile composition. When there is excess cholesterol or insufficient bile salts in bile, supersaturated bile leads to solid precipitation. Cholesterol stones account for 80%-90% of cases and are usually associated with abnormal gallbladder motility or bile composition imbalance. Another type, bilirubin stones, are often related to hemolytic diseases or chronic infections.
Genetic factors play an important role in the pathogenesis, with a family history increasing risk by 3-5 times. Other key risk factors include:
Dietary habits also influence the risk of development; high-fat, high-cholesterol diets may increase the likelihood of cholesterol stone formation. Conversely, diets lacking in fiber can affect bile composition balance. Notably, the proportion of bilirubin stones is higher among Asian populations compared to Western populations, indicating a complex interaction between genetic background and dietary habits.
Approximately 50-70% of patients are asymptomatic at diagnosis, with these stones often incidentally discovered during abdominal examinations. When stones obstruct the bile duct, they trigger acute and chronic symptoms. The most typical symptom is "biliary colic," characterized by severe right upper abdominal pain that may radiate to the right shoulder, lasting from several hours to days. This pain is usually induced after high-fat meals and is related to gallbladder contractions and stone movement.
Complication-related symptoms include:
Chronic symptoms may include indigestion, bloating after meals, or even misdiagnosed as gastric ulcers. Serious complications such as stone migration to the common bile duct can cause complete bile flow obstruction, leading to abnormal liver function or liver infection. The severity of symptoms is closely related to stone size, location, and the patient’s overall health status.
Initial diagnosis mainly relies on imaging examinations. Abdominal ultrasound is the first-line method, non-invasive, painless, with an accuracy rate exceeding 95%, capable of precisely measuring stone size and gallbladder function. When complications are suspected, further examinations may be needed:
Blood tests can evaluate liver function abnormalities or infection indicators; elevated white blood cell count may suggest acute inflammation. In special cases, nuclear medicine scans (HIDA scan) may be performed to assess gallbladder contractile function. The diagnostic process should combine imaging, laboratory data, and clinical symptoms to develop an individualized treatment plan.
Ultrasound can show stone size, number, and gallbladder wall changes. When thickening of the gallbladder wall or surrounding fluid is observed, it suggests possible acute inflammation. This method is not only suitable for diagnosis but also for monitoring stone changes.
The treatment strategy depends on the severity of symptoms and the presence of complications. Asymptomatic patients may only require regular follow-up, while those with severe symptoms or complications need active treatment. Modern medicine offers various options, from medication dissolution to minimally invasive surgery, with treatment decisions based on age, overall health, and stone characteristics.
Medication mainly targets specific types of stones, such as using ursodeoxycholic acid (UDCA) to dissolve cholesterol stones. However, this therapy takes 6-18 months to show effects, and about 30-50% may relapse after stopping medication. It is usually used for high-risk patients unable to undergo surgery.
Laparoscopic cholecystectomy (LC) is the most common treatment, involving 3-4 small incisions of 0.5-1 cm to remove the entire gallbladder using endoscopic instruments. This procedure results in small scars, quick recovery, and a short hospital stay of about 24 hours, making it the first-line treatment for symptomatic patients.
In emergency situations, such as acute bile duct obstruction, endoscopic sphincterotomy (ERCP) may be performed to relieve the obstruction. For patients unable to undergo immediate surgery, temporary placement of a nasobiliary drain can alleviate symptoms. Postoperative dietary adjustments are recommended, but not all patients require strict dietary restrictions; adjustments should be tailored to individual responses.
Although genetic factors cannot be changed, lifestyle modifications can reduce the risk of development. Maintaining a healthy weight, avoiding BMI over 25, and preventing weight loss exceeding 10 kg within six months are advised. A balanced diet including water-soluble fiber (such as oats and onions) and limiting daily fat intake to less than 30% of total calories are recommended.
High-risk groups should undergo abdominal ultrasound screening every 2-3 years. Pregnant women or women with multiple pregnancies should be especially vigilant, as hormonal changes may promote stone formation. Regular health check-ups can help detect asymptomatic stones early and prevent complications.
Seek medical attention immediately if you experience:
Chronic symptoms such as recurrent upper abdominal discomfort, fatty stools, or unexplained weight loss should also be evaluated professionally. Even without obvious symptoms, if ultrasound reveals stones larger than 2 cm, preventive treatment may be recommended to avoid obstruction. Regular follow-up examinations are crucial for asymptomatic patients, with imaging recommended every 6-12 months.
For patients suspected of developing pancreatitis, urgent blood amylase testing and abdominal CT scans are necessary. Timely medical attention can prevent acute complications induced by stones, especially if pain is accompanied by shortness of breath or palpitations, which may indicate peritonitis or other severe complications requiring immediate hospitalization.
Seek emergency care if:
Doctors will prioritize treatment based on symptom urgency, possibly performing urgent endoscopic stone removal first, followed by subsequent treatments. Early diagnosis significantly improves treatment outcomes and prevents organ damage caused by stones.
Children require special attention for congenital biliary anomalies, which should be evaluated by pediatric hepatobiliary specialists. Elderly patients may have comorbid arteriosclerosis; surgical risk assessments should include cardiovascular status. Pregnant women with symptoms may need immediate treatment, as hormonal changes can worsen symptoms.
Diabetic patients should strengthen blood sugar control, as hyperglycemia may promote stone formation. Patients with hemolytic anemia are prone to pigment stones and should have regular liver function monitoring. For familial hypercholesterolemia, dietary management should start from adolescence.
Patients should avoid high-fat, high-cholesterol, and greasy foods, opting for a low-fat, high-fiber diet such as vegetables, whole grains, and lean meats. Eating smaller, more frequent meals can reduce gallbladder over-contraction, and avoiding binge eating or excessive refined sugar intake can help control symptoms. If right upper abdominal pain or indigestion occurs, dietary adjustments and medical consultation are recommended.
Is surgery always necessary for gallstones?Not necessarily. If the patient is asymptomatic and the stones do not obstruct the bile duct, regular monitoring is usually advised. Surgery is only considered if recurrent inflammation, jaundice, or obstruction occurs. Although medication can dissolve some cholesterol stones, it is slower and has a higher recurrence rate, so case-by-case evaluation is necessary.
If there are no symptoms, is treatment needed?Asymptomatic gallstones generally do not require immediate treatment but should be monitored with ultrasound every 6-12 months. If the patient has diabetes, gallbladder wall thickening, or stones larger than 3 cm, preventive surgery may be recommended to reduce future complication risks.
How can lifestyle habits reduce the risk of gallstones?Maintaining a healthy weight and avoiding rapid weight loss are key, as sudden weight loss can increase cholesterol stone risk. Regular eating, avoiding prolonged fasting, and increasing dietary fiber intake can promote cholesterol metabolism. Managing metabolic diseases such as hypertriglyceridemia and diabetes also lowers the incidence.
How can pain caused by gallstones be alleviated?Acute pain can be initially relieved with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, but drugs that induce gallbladder contraction should be avoided. If pain is severe or accompanied by fever or jaundice, it indicates possible cholecystitis or obstruction, and urgent medical treatment is necessary without delaying surgery.
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