For most people, eating a large, fatty meal can result in temporary discomfort and mild abdominal pain. However, a sudden intense pain in the upper right area of the abdomen may indicate a serious condition. The pain, which can last from several minutes to a few hours, can even radiate out to the breastbone, in between the shoulder blades, or up the right shoulder and be accompanied by feelings of nausea and indigestion. These symptoms may indicate a blockage in the digestive system caused by gallstones.

What Are Gallstones?

Gallstones are solid crystallized deposits of cholesterol, salts, and components of digestive fluid (bile). They form in the gallbladder, a small organ that is part of the digestive system. The gallbladder is located on the right side of the abdomen just below the liver and stores and releases bile into the small intestine to help break down fats from food.

It is believed that cholesterol gallstones – which make up the majority of gallstone cases – are created when the liver excretes more cholesterol than the bile is able to break down. These stones are mostly made of hardened cholesterol along with several other components.

Fewer patients have pigment stones, which have been linked to certain diseases and blood disorders. This type indicates that the body is breaking down old red blood cells and producing too much bilirubin in the process, which leads to the formation of gallstones.

Gallstones can also form when the gallbladder does not empty its bile in full or often enough, causing the bile to concentrate and form stones.

The gallbladder can produce hundreds of tiny stones the size of sand, one or two large stones, or a combination of the two. A medical emergency occurs when these gallstones cause a blockage or lead to inflammation of the gallbladder.

Am I At Risk?

Some people are more likely than others to develop gallstones. This is due to both controllable factors such as lifestyle choices and non-controllable factors such as genetics.

Controllable Factors
Obesity : Having excess body weight typically coincides with high cholesterol levels. It also makes it more difficult for the gallbladder to empty regularly and completely.

High levels of estrogen : Consuming oral contraceptives, taking hormonal therapy for menopause treatments, and becoming pregnant can affect estrogen levels. Higher estrogen levels can increase cholesterol levels and make it more difficult for the gallbladder to contract and properly empty itself.

Diabetes : Diabetics have a higher level of triglycerides (a type of fat in the blood) than non-diabetics that increase the likelihood of gallstone formation.

Diet : Eating foods low in fiber but high in fat and cholesterol are believed to increase the risk of developing gallstones.

Rapid weight loss : Rapid weight loss through extreme dieting or fasting can increase the cholesterol levels excreted into the bile as the body breaks down fat reserves.

Non-controllable Factors
Women : Due to the higher levels of estrogen that occur in women as compared to men, women are more likely to develop gallstones.
 

Age : The risk of developing gallstones increases with age, particularly in people over the age of 60.

Doctors at Bumrungrad’s Liver Center can determine the presence of gallstones through a variety of tests. Treatment is not typically required if there is no sign of a blockage. However, if blockage has occurred, specialists often recommend surgery to remove the gallbladder entirely. Non-surgical treatments, such as oral medications that slowly dissolve the gallstones, can be offered to patients who cannot undergo surgery.
 

By Dr. Yudhtana Sattawatthamrong, Gastroenterologist, Digestive Disease Center, Bumrungrad Hospital

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