Silent danger

Gallstones often go unnoticed for a long time

Women suffer more frequently from gallstones than men.

(Bild: nenetus/stock.adobe.com)

Around 10-15 percent of Austrians have gallstones, mainly women. The disease often remains undetected for a long time, but can lead to serious complications. An expert explains how to detect stones at an early stage, what the risk factors are and when treatment is necessary.

The gallbladder is shaped like a small pear and is located on the right side of the abdomen below the liver. Bile produced in the liver is stored here and released into the small intestine for the digestion of fats. An imbalance in the composition of this fluid can lead to the formation of gallstones.

This is the case if the bile contains too much cholesterol or bilirubin (a breakdown product of red blood cells) or if there is a lack of bile salts, as Dr. Karin Steidl, internist at at the Barmherzige Brüder Hospital in St. Veit an der Glan (Carinthia), explains. "Cholesterol stones make up the majority of cases, while bilirubin stones, which result from the breakdown of red blood cells, occur less frequently," says the expert.

Once "clots" have formed, people often can no longer tolerate fatty foods.

(Bild: Henri/stock.adobe.com)

Don't ignore the warning signs
The symptoms of gallstones vary greatly and often only appear when the stones block the flow of bile or cause inflammation. Typical signs are intermittent, colicky pain in the right upper abdomen, which can radiate to the back and right shoulder blade, as well as nausea, vomiting, a feeling of fullness and occasionally jaundice if the outflow of bile is obstructed. Dr. Steidl emphasizes: "Many patients only become aware of the presence of gallstones through these symptoms."

Under no circumstances should the disease be underestimated. Gallstones are a widespread health problem that can lead to serious complications. "We recommend that anyone who has risk factors or notices symptoms should have an early examination," says Dr. Steidl.

How is the diagnosis made?
Sometimes the stones are discovered by chance during an ultrasound examination of the abdomen. However, they are often examined specifically because symptoms have arisen that indicate gallstones. In addition, blood tests to check for signs of inflammation and other abnormalities may help or further imaging procedures such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) may be required to confirm the diagnosis and identify possible complications.

The small stones can cause major problems such as severe pain in the upper abdomen or digestive problems.

(Bild: © Freepik / @ bycirinka)

Removal of the gallbladder
Not every gallstone needs to be treated, as the expert explains. However, if symptoms occur, a wide range of treatments may be necessary, from medication to surgical removal of the gallbladder - and therefore also the gallstones. If colic occurs and there is a high risk of stones forming again, removal of the gallbladder is usually recommended. This is carried out as part of a laparoscopy.

Dr. Walter Rumpf, senior physician at the Department of Surgery, describes the procedure: "We make a few small incisions in the abdominal wall. We then insert a video camera (laparoscope) and the necessary surgical instruments. Laparoscopic cholecystectomy, a minimally invasive method, is the gold standard."

Even after the gallbladder has been removed, bile is still produced in the liver and flows through the bile duct into the duodenum to help digest food.

If the bile duct is affected
If the stones are in the bile duct, the bile ducts become inflamed and sometimes the pancreas as well.
While a very small stone can pass into the small intestine on its own, larger stones must be removed by endoscopic retrograde cholangiography (ERC).

In this procedure, the surgeon advances an endoscope under sedation (sleeping injection) through the mouth, via the stomach and small intestine to the mouth of the bile duct and pancreas (papilla) and fills the bile duct with contrast medium. This makes the stones visible under X-ray fluoroscopy. An incision is then made at the papilla and the bile duct stones are removed using a basket. The procedure is painless for the patient.

A healthy diet, regular exercise and avoiding rapid weight loss can reduce the risk of developing gallstones.

OÄ Dr. Karin Steidl, Internistin

Bild: HF Pictures

Most important risk factors
Who has a particularly high risk of developing gallstones? According to Dr. Steidl, the most important factors are: female, fertile, over 40 years old and overweight. Female hormones appear to be important, as women who take oestrogen for contraception or during hormone therapy are more likely to suffer from gallstones. Family predisposition, diabetes mellitus and a fair skin type also play a role. "A healthy diet, regular exercise and avoiding rapid weight loss can reduce the risk of developing gallstones," advises the senior physician.

The role of diet
Diet plays a decisive role in both the development and prevention of gallstones. A high consumption of fatty and cholesterol-rich foods increases the risk of the formation of cholesterol gallstones, as these sometimes influence the composition of the bile and lead to an imbalance.

A high-fiber diet, on the other hand, can help to reduce the risk, as fiber promotes cholesterol excretion via the bile and thus reduces the formation of gallstones. It is also advisable to divide your meals into several small meals throughout the day in order to empty the gallbladder regularly and prevent stagnation of bile.