Bile is required for the proper digestion of food in the small intestine. Bile is produced in an individual’s gallbladder and stored there until it is needed in the small intestine.
When food hits the small intestine, a hormone is released that causes bile to move from the gallbladder to the small intestine. Gallstones are caused by an imbalance of substances in an individual’s bile, where they exceed their solubility threshold and begin to particulate and form into crystals.
Gallstones are diagnosed with tests such as a physical examination, ultrasound, abdominal CT scan, gallbladder radionuclide scan, endoscopic retrograde cholangiopancreatography, and blood tests.
Treatment for gallstones may include surgery, medication to dissolve the stones, shock wave lithotripsy, diet changes, and weight loss.
Signs and Symptoms of Gallstones
Get familiar with the major signs and symptoms of gallstones now.
1. Back Pain
The most common type of back pain due to gallstones is referred to as interscapular pain, or pain that occurs between the shoulder blades. Individuals who have gallstones tend to feel this referred pain after they consume a meal high in fat.
Episodic attacks of back pain may occur when a gallstone begins to obstruct the bile duct or grows too large. These episodic attacks include a severe and steady pain that radiates from the upper abdomen to the middle and upper back in between the shoulders.
Gallstones can also produce pancreatitis when they move into the pancreatic duct and stop digestive enzymes from reaching the small intestine.
When the digestive enzymes are produced by the pancreas, they have a certain amount of time where they stay inactivated. By the time they travel to the small intestine, they become activated to do their job.
When the enzymes activate prematurely, they cause corrosive inflammation of the pancreatic tissues, producing pain in the upper abdomen and back.
2. Abdominal Pain
The gallbladder is located in the top right-hand quadrant of the abdomen, sitting just underneath the liver behind the stomach. The abdomen contains numerous organs that fit into a tight compartment comprised of connective tissue that keeps everything in its place.
While this connective tissue fascia can expand to a certain extent, it is only so flexible. Gallstones can cause infection and inflammation of the gallbladder when they fully or partially obstruct the bile ducts.
Pancreatic tissues may also become inflamed if the gallstone stops the digestive enzymes from leaving the pancreatic tissues before they become activated and corrosive. The liver can become enlarged when the gallstones block bile from reaching the small intestine and causes it to accumulate in the organ.
When these abdominal organs become swollen and inflamed, they also become compressed inside of the abdominal fascia.
This mechanism compresses and irritates numerous nerves in the abdomen that send signals to the brain. The signals from these nerves are what causes an individual to experience abdominal pain due to gallstones.
3. Nausea and Vomiting
Vomiting is the mechanical action of food coming up from the stomach and being expelled from the mouth. Nausea is feeling the need to vomit (but not vomiting). One of the most common symptoms of gallstones are nausea and vomiting.
An obstruction in the ducts that carry bile and digestive enzymes to the intestine can cause difficulties with digestion and absorption of food, allowing an overgrowth of bacteria in the gut.
Bacteria in the intestines can produce toxins when it grows out of control, which causes inflammation of the tissues and surrounding nerves.
The irritated nerves send signals to the brain, causing the activation of the individual’s nausea center. Problems with digestion due to a bile duct blockage by a gallstone can also cause the food to stagnate in the digestive tract.
This stagnation allows the food to ferment before it is digested and eliminated. The fermentation of stagnated food in the digestive tract is known to produce nausea and vomiting.
Jaundice is a condition where an individual’s white of the eye and skin take on an abnormal yellow tint and tone. When gallstones move into the common bile duct that leads to the small intestine, digestive enzymes from the pancreas and bilirubin from the liver cannot reach the small intestine.
These substances build up in the gallbladder and bile ducts before they end up spilling over and accumulating in the liver. Bilirubin accumulates in the liver tissues and the blood because it has nowhere else to go. Bilirubin is produced as the liver breaks down old and dead red blood cells.
This substance is synthesized in the liver and made into bile for use during digestion. When bilirubin accumulates in the body, the skin takes on a yellow color because bilirubin has a potent yellow pigmentation to it.
Bilirubin leeches from the vessels that feed the individual’s eyes, which give the white of their eyes the characteristic yellow tint seen with jaundice.
5. Dark Urine or Clay-Colored Stool
A healthy individual’s stool gets its dark color from the bile used in the process of digestion. A small amount of bile in the intestine is absorbed to be re-used, while the remainder is secreted in the stool.
Bile is used in the digestive system to enable the breakdown of fats into molecules the intestine can absorb. Fats are the component of food that is the most difficult for the body to digest and takes the longest to digest.
An individual with gallstones may experience symptoms related to the absence of bile when the gallstones obstruct the ducts that deliver the bile to the intestine.
With a bile duct blockage, no bile can come through to aid in digestion and fats in the food an affected individual consumes are not broken down. These undigested fats remain in the stool until it is excreted.
The stool is pale because there is no bile in it, and often has a foul odor as a result of undigested lipids. Darker urine may manifest if bile builds up behind the gallstone blocking it from reaching the intestine.