What are Gallstones?

Gallstones are hard deposits that form inside the gallbladder. The gallbladder is a small organ located under the liver that stores bile. Bile helps in digestion, especially of fatty foods.

Stones can vary in size and number — some people may have a single large stone, while others may have multiple small stones.

Types of Gallstones

There are three main types of gallstones:

1. Cholesterol Stones: The most common type among Nepalis. These are yellowish and mostly made of cholesterol.
2. Pigment Stones: These are dark-colored and formed from a substance called bilirubin, which results from the breakdown of red blood cells.
3. Mixed Stones: These contain both cholesterol and pigment substances.

Causes of Gallstones

The exact cause of gallstones is not fully understood, but the following are known risk factors:

• Diet: High cholesterol and fatty foods, low in fiber
• Being female: Women have double the risk compared to men
• Age: People above 40 years
• Obesity: Being overweight
• Genetics: Family history of gallstones
• Rapid weight loss: Losing a lot of weight quickly
• Pregnancy: Pregnant women
• Diabetes: High blood sugar levels
• Liver diseases: Various liver-related problems
• Blood disorders: Especially hemolytic anemia

Symptoms of Gallstones

Many people with gallstones do not show any symptoms. This condition is known as "silent stones." However, when complications arise, the following symptoms may appear:

• Discomfort after eating fatty foods
• Pain on the right side of the abdomen (especially after eating fatty food)
• Nausea or vomiting
• Bloating or gas problems
• Sometimes jaundice
• Loss of appetite and indigestion

Symptoms in Severe Cases

If a gallstone blocks the bile duct, it can lead to serious problems:

• Severe pain
• High fever
• Jaundice (yellowing of the skin and eyes)
• Vomiting and weakness
• Abdominal stiffness or pain under the ribs

How is it Diagnosed? (Investigation Methods)

• Ultrasound: Most common and affordable method
• CT Scan or MRI: Used in complex cases
• Liver Function Test (LFT): Helps detect bile duct blockage
• MRCP: A special imaging technique to assess bile ducts

Treatment Options

The permanent solution for gallstones is the surgical removal of the gallbladder.

1. Laparoscopic Surgery (Laparoscopic Cholecystectomy)

This is the safest, least painful, and quickest recovery method. It is done using 3–4 small incisions through which a camera and instruments are inserted. In most cases, patients are discharged within 24 hours.

2. Open Surgery (Open Cholecystectomy)

This is performed if there is infection, severe adhesions, or suspicion of cancer in the gallbladder.

3. Medication

In patients who are unfit for surgery, sometimes medication is used, but this is not a permanent solution. It may take years, and stones may return.

What Happens if Gallstones Are Not Treated?

Gallstones are common but can be serious if not treated in time. Without timely treatment, several complications can occur:

1. Acute Cholecystitis

Sudden inflammation of the gallbladder, causing severe pain in the upper right abdomen, fever, and nausea.

2. Bile Duct Obstruction

Stones can block the bile duct leading to jaundice (yellow eyes and skin), pain, and infection.

3. Pancreatitis

Blockage of the pancreatic duct by a stone can lead to serious pancreatitis, which may be life-threatening.

4. Gallbladder Rupture

Chronic infection and swelling can lead to rupture of the gallbladder, causing peritonitis (infection inside the abdomen).

5. Chronic Cholecystitis

Repeated episodes can permanently damage the gallbladder.

6. Gallbladder Cancer

Rarely, long-term gallstones can increase the risk of cancer.