Gallstones and Biliary Tract Diseases

Gallstones are hardened deposits that form in the gallbladder or bile ducts. They are made up of cholesterol, bilirubin (a pigment produced during the breakdown of red blood cells), and other substances found in bile. Gallstones can vary in size and number, ranging from a single large stone to multiple smaller ones.

Cholesterol stones are the most common type of gallstone. They are primarily composed of cholesterol. When there is an imbalance in the components of bile, particularly an excess of cholesterol, it can crystallize and form stones. Cholesterol stones may vary in size and can be yellowish or greenish in color.

Pigment stones are composed of bilirubin, a pigment that is produced during the breakdown of red blood cells. Certain conditions, such as liver cirrhosis, hemolytic anemia, or certain inherited disorders, can lead to the formation of pigment stones. They are usually smaller and darker in color, ranging from brown to black.

The exact mechanisms of gallstone formation are not fully understood, but several risk factors contribute to their development:

1. Excess cholesterol: When there is an imbalance between cholesterol and bile salts in the bile, it can lead to the formation of cholesterol stones.
2. Impaired gallbladder emptying: If the gallbladder does not empty regularly or efficiently, the bile becomes concentrated, increasing the risk of stone formation.
3. Excessive bilirubin: Conditions that cause an overproduction or impaired elimination of bilirubin can contribute to the formation of pigment stones.
4. Other risk factors: Obesity, a high-fat diet, rapid weight loss, certain medications (e.g., hormone replacement therapy), and a family history of gallstones are additional risk factors for gallstone formation.

Many times gallstones do not cause symptoms. However, when they obstruct the flow of bile or pass into the bile ducts, it can lead to symptoms such as abdominal pain, nausea, vomiting, and jaundice.

Gallstones are often discovered incidentally during tests or procedures conducted for unrelated reasons. Even in the absence of symptoms, gallstones can be detected through various diagnostic testing for other conditions such as abdominal X-rays, during surgery for unrelated conditions, or through routine health screenings.

If there are symptoms, your Rockford GI doctor will ask about your symptoms, review your medical history and evaluate your risk factors for gallstones. They will also perform a physical exam to assess for signs of gallbladder disease, such as abdominal tenderness.

They may order imaging studies including:

• An abdominal ultrasound can diagnose gallstones.
• An abdominal CT scan can provide more details about the bile ducts, the gallbladder and adjacent structures.
• Magnetic Resonance Cholangiopancreatography (MRCP) is non-invasive imaging technique that uses magnetic resonance imaging (MRI) to visualize the bile ducts and gallbladder, allowing for the detection of gallstones.
• Endoscopic Retrograde Cholangiopancreatography (ERCP) combines an endoscopy and X-ray imaging to examine the bile ducts. It can help identify and remove gallstones lodged in the ducts.

Your Rockford GI doctor will also order blood tests to evaluate liver function and check for signs of infection or inflammation. These tests can help determine if the gallstones have led to complications such as gallbladder inflammation (cholecystitis) or infection (choledocholithiasis).

Additional diagnostic procedures include:

• Cholescintigraphy (HIDA scan) is test that involves injecting a radioactive tracer into your bloodstream, which is then taken up by the liver and excreted into the bile. The movement of the tracer can be tracked to evaluate gallbladder function and identify any blockage caused by gallstones.
• Endoscopic ultrasound (EUS) procedure combines endoscopy and ultrasound to obtain detailed images of the gallbladder and bile ducts. It can help detect small gallstones and evaluate the surrounding structures.