The term “calculus of gallbladder” refers to the presence of gallstones, which are hardened deposits of digestive fluid that form within the gallbladder. This small, pear-shaped organ located beneath the liver stores and concentrates bile. When the chemical balance of bile is disrupted, these solid particles can precipitate, leading to a common condition medically known as cholelithiasis. Gallstones affect a significant portion of the global population, though many individuals remain unaware they have them.
How Gallbladder Stones Form and Their Composition
Gallstone formation begins when the balance of bile components shifts, leading to supersaturation. The most common type, cholesterol stones, account for approximately 80% of cases. They form when the bile contains more cholesterol than the available bile salts and phospholipids can dissolve, causing the excess cholesterol to precipitate into crystals.
These microscopic crystals combine with gallbladder mucin to form biliary sludge, which is a precursor to a solid stone. Impaired gallbladder motility allows the crystals to remain stagnant and aggregate into larger masses. Non-modifiable factors such as advanced age, female gender, and certain genetic predispositions increase the risk of this cholesterol imbalance.
A less common type, pigment stones, are composed primarily of calcium salts and bilirubin, a pigment created during the breakdown of red blood cells. These are categorized into black and brown stones. Black pigment stones often form with conditions like chronic hemolysis or cirrhosis. Brown pigment stones are typically linked to bacterial infection or stasis within the bile ducts, where bacterial enzymes chemically alter the bile components.
Recognizing the Symptoms of Gallbladder Calculus
Many people have “silent stones” that cause no symptoms and may be discovered incidentally during imaging for an unrelated issue. When a gallstone moves to temporarily block the cystic duct, it triggers the characteristic pain known as biliary colic. This pain is felt as a sudden, intense, dull pressure in the upper right quadrant or the upper middle abdomen.
The pain often begins shortly after eating a large or fatty meal, which stimulates the gallbladder to contract forcefully. This discomfort can last from 30 minutes to several hours and may radiate to the right shoulder blade or the back. Associated symptoms include nausea and vomiting.
Biliary colic resolves when the stone either passes or falls back into the gallbladder. Persistent pain lasting more than six hours may signal a more serious complication like acute cholecystitis, which involves inflammation of the gallbladder wall. Signs of acute inflammation include constant, severe pain, fever, and localized tenderness in the upper right abdomen. Jaundice, a yellowing of the skin and eyes, can occur if the stone blocks the main bile duct, requiring immediate medical attention.
Modifying Risk Factors and Prevention Strategies
Lifestyle adjustments can significantly reduce the risk of gallstone formation. Maintaining a healthy body weight is helpful, but avoid rapid weight loss, which triggers the liver to secrete excess cholesterol into the bile. Losing weight slowly prevents sudden cholesterol saturation and gallbladder stasis.
Dietary changes focus on increasing fiber intake through whole grains, fruits, and vegetables, which helps lower cholesterol concentration in the bile. Limiting the consumption of refined carbohydrates and sugars is important, as is reducing unhealthy saturated and trans fats found in processed foods. Consuming healthy fats, such as those found in olive oil and fish, is beneficial because they stimulate the gallbladder to contract and empty regularly.
Diagnosis and Medical Management Options
Diagnosis of gallbladder calculus begins with a review of symptoms and a physical exam, but it is confirmed using imaging and blood tests. The primary diagnostic tool is the abdominal ultrasound, which is a non-invasive, highly accurate method that visualizes the stones. Gallstones appear as bright, reflective objects that characteristically create a shadow, known as acoustic shadowing, behind them on the image.
Blood tests are used to check for complications and inflammation. A complete blood count may reveal an elevated white blood cell count, suggesting an infection or acute inflammation. Liver function tests, including bilirubin and alkaline phosphatase levels, are monitored for signs of bile duct obstruction. Elevated amylase and lipase levels would suggest a serious complication involving the pancreas.
For patients with asymptomatic gallstones, the medical approach is expectant management, which involves monitoring the condition without immediate treatment. Once stones become symptomatic, the definitive treatment is surgical removal of the gallbladder, known as a cholecystectomy. The gold standard procedure is laparoscopic cholecystectomy, where the gallbladder is removed through several small incisions.
Laparoscopic removal offers a shorter hospital stay, often allowing the patient to go home the same day or the next, with a recovery period of about two weeks. An open cholecystectomy, requiring a larger single incision, is reserved for complicated cases, resulting in a hospital stay of several days and a longer recovery time of six to eight weeks. Non-surgical options, such as oral dissolution therapy using bile acid medications like ursodeoxycholic acid, are available only for a small group of patients with very small, uncalcified cholesterol stones, but this method is slow and carries a high stone recurrence rate of up to 50% within five years.