Gallstones (Biliary Calculus)
Gallstones are small, hard pellets that form in the gallbladder, the pouch like organ situated just under the liver, in the upper-right portion of the abdomen. Most gallstones are composed of cholesterol crystals, although some are made of bile salts, which are digestive substances manufactured in the liver and stored in the gallbladder.
The stones can be as tiny as the head of a pin or as large as a walnut. It is not clear why they form, but it may be because of an imbalance in the substances that make up bile. Excess cholesterol in the bile juices seems to be an important contributing factor.
If a gallstone blocks one of the ducts that carry bile from the gallbladder to the intestine, the result can be an attack of biliary colic, producing such symptoms as severe abdominal pain, nausea, vomiting, bloating, belching, sweating, and jaundice. The presence of gallstones can also cause gallbladder inflammation and infection, a condition known as acute cholecystitis. More often, however, the gallbladder harbors stones without causing any symptoms.
An estimated 16 to 20 million Americans over the age of 40 have gallstones, but only a million experience attacks in the course of a year. An episode may last for several hours, stopping abruptly when the gallstone passes into the intestine. Diagnostic studies include blood tests and imaging the gallbladder with X-rays, ultrasound, and CT scanning.
Medical Treatments
"Silent," or asymptomatic, gallstones do not require treatment. Those that cause recurrent painful attacks are most often treated by removing the gallbladder, an operation called a cholecystectomy. During this procedure, the bile is redirected so that it flows directly from the liver to the intestines.
A relatively new type of surgery, called laparoscopic cholecystectomy, reduces the length of a patients hospital stay and speeds convalescence, though it is not recommended for persons who have had prior abdominal surgery. This operation involves making four small punctures in the abdomen and inserting a laparoscope, a catheter with a miniature television camera. The surgical team passes the special operating instruments through the laparoscope, and performs the surgery while viewing the gallbladder and the surrounding organs on a video monitor. The team then removes the gallbladder through the laparoscope.
Instead of taking out the gallbladder, a physician may advise pulverizing the gallstones with shock-wave treatment, known as lithotripsy.
Medications, such as ursodiol (Acti-gall) or chenodiol (Chenix), can dissolve gallstones, but these drugs take months to work and must then be taken for life to prevent more of the stones from forming.
Alternative Therapies
Alternative therapies are unlikely to cure gallstones, but they may alleviate the colicky pain of an attack.
Acupuncture and Acupressure. Pain may be relieved by stimulating points on the meridians that serve the gallbladder, stomach, and liver.
Herbal Medicine. Herbalists recommend alfalfa tablets or dandelion, either in capsule form or as an extract mixed with water, to enhance gallbladder function. Turmeric capsules are also thought to have a protective effect. European herbalists advocate peppermint oil capsules.
Homeopathy. Homeopaths often prescribe celedonium, podophyllum, and berberis. Taken in highly diluted form, these are said to be similar to the substances that cause gallstones.
Nutrition. In addition to advising a low-fat, high-fiber diet, nutrition therapists may recommend vitamins E and D, lecithin, and bran supplements to reduce blood cholesterol levels.
Shiatsu. Practitioners of this Japanese form of pressure-point massage apply rhythmic pressure in circles around the abdominal area of the gallbladder to alleviate pain.
Self-Treatment
Self-care can often prevent gallstones. If you have an elevated cholesterol level, adopt a cholesterol-lowering diet, that is high in starches and fiber, and limit fat intake to 20 percent or less of your total calorie intake.
If you are overweight, try to lose excess pounds gradually through a sensible combination of diet and exercise. Avoid crash diets, however, because rapid weight loss sometimes precipitates a gallstone attack.
Refrain from cigarette smoking, which has been implicated in the formation of gallstones (as well as many other health problems). Women who have had the stones should avoid birth control pills and estrogen replacement, because high levels of this hormone have been associated with gallbladder disease.
When an attack does occur, do not eat, but do take a nonprescription pain medication and rest in bed. Call a doctor if the attack lasts more than three hours. You should also see a doctor if you have recurrent attacks.
Other Causes of Abdominal Pain
Recurring pain in the upper abdomen may also come from ulcer gastritis, or cancer of the stomach, liver, or pancreas. Pancreatitis, inflammation of the pancreas, also produces pain in this section of the abdomen.