Gallstones are small clusters of crystals that form in the gallbladder. If they become large or numerous enough, they can block the ducts of the organ and prevent digestive bile from reaching the small intestine. Most gallstones are small and cause no ill effects, but stones large enough to warrant removal cause symptoms such as indigestion, bloating, nausea, and pain. Severe symptoms of gallstones, including chills, fever, and severe pain, indicate an emergency situation.
How are gallstones formed?
Stored in the gallbladder, bile is made up of water, cholesterol, salts, and bilirubin, a substance formed by the breakdown of red blood cells. In some cases, cholesterol or bilirubin can stick together, forming small "stones" and becoming trapped in the mucus inside the organ. Worldwide, between 10% and 20% of adults have gallstones, but less than half will experience any effects because they never grow large enough to cause damage. Stones that grow larger over time can block the organ's passageways, causing pain and other forms of discomfort. People are more likely to experience these symptoms as they age, because stones continue to form and grow throughout life.
minor symptoms
When signs of gallstones first appear, they can include indigestion, bloating, nausea, gas, and abdominal pain, known as biliary colic. Collectively, these are known as a gallbladder attack. Symptoms usually develop within an hour of eating a fatty meal, and occur when stones block the cystic duct of the gallbladder. Fatty foods trigger an attack because bile is what allows the digestion of fats to occur in the stomach. The gallbladder contracts by secreting bile, which increases the chance that stones will become trapped in the cystic duct.
The abdominal pain associated with this condition is usually felt in the right upper quadrant of the abdomen, sometimes radiating to the right shoulder. Usually the pain will go away in 60 to 90 minutes, but sometimes it can last for several hours. Mild pain can be relieved with over-the-counter medications. The pain and other effects gradually fade as the gallbladder stops contracting, allowing the stones to pass out of the duct.
People who experience mild symptoms of gallstones during an attack have a 3% to 9% chance that the disease will progress to a more serious state. Anyone who regularly experiences these symptoms should seek medical advice in order to manage the condition. Early diagnosis of the problem allows for more treatment options, including non-surgical procedures.
Main symptoms
As stones become larger or more numerous, the gallbladder often becomes inflamed and irritated, worsening the effects of an attack. The range of symptoms includes all of those in the mild category, as well as vomiting, chills, and fever. In an acute attack, the pain is more severe and can spread to cover the mid-abdominal area, right shoulder, and upper back.
This level of pain does not always respond to common pain relievers, but should respond to pain relievers prescribed by a medical professional. People with severe pain are often unable to find a comfortable position to sit or lie down, and tend to change positions repeatedly as a coping mechanism. These symptoms do not necessarily mean an emergency situation, but someone who experiences them is likely to be a candidate for gallbladder removal in the future.
Contributing Factors and Treatments
For someone who progresses beyond mild symptoms of gallbladder disease, the effects they experience will worsen with age, simply because the stones grow over time. Most people with significant symptoms will eventually require some form of medical treatment. Laparoscopic cholecystectomy, a procedure to remove the gallbladder, is quite common and usually relieves all symptoms, but it is not always necessary.
Diet
Most gallstone symptoms develop after eating fatty foods, making diet one of the most important ways to control them. The more fat in a single meal, the greater the chance of an attack and the greater the effects. Adopting a low-fat diet will not completely eliminate the disease, but it will generally reduce the frequency and severity of painful episodes.
Exercise
The effects of an attack, particularly the level of pain, can be worsened by exercise, because deep breathing and vigorous movement can put additional pressure on the contracting organ. Regular exercise improves a person's overall health, but physical exertion should be avoided during or after an episode. Any movement during an attack should be slow and careful, not only to avoid worsening the pain, but because the symptoms of a severe attack can be slightly disorienting.
Menstruation
While there is no strong evidence to prove a connection, some women find that their symptoms worsen during menstruation, to the point that mild gallbladder pain is sometimes felt in the absence of other symptoms. Women have a higher risk of developing stones than men, because estrogen promotes the secretion of cholesterol in the bile. If there is a connection between menstruation and gallbladder attacks, it could be due to the effect that estrogen levels have on stone formation. When this phenomenon occurs, there is no cause for alarm unless the symptoms are at the emergency level.
When do symptoms indicate an emergency?
In extreme cases, nausea, sharp pain in the upper abdomen, and vomiting may occur along with a high fever, violent chills, or excessive perspiration. These symptoms indicate an emergency situation where immediate medical attention is required. This is especially true when the symptoms are accompanied by jaundice, a condition in which the skin and whites of the eyes appear yellowish. These very severe symptoms develop when the gallbladder has stopped working properly, leading to the buildup of high levels of toxins in the body and bloodstream. This can occur as a result of gallbladder disease alone or in conjunction with complications, such as infection.