We name gallstones, or cholélithiase, the formation of stones inside the gallbladder, the organ that stores bile secreted by the liver. Calculations, which are sometimes called “stones” do indeed look like small pebbles. In the majority of cases, they are composed of cholesterol crystallized. Stones made from bile pigments can also form, especially with severe liver disease or sickle cell anemia, but these will not be discussed here.

The shape, size and number of calculations (there may be several hundred) differ from one individual to another. They can be as small as a grain of sand or as big as a golf ball.

Most of the time, the stones do not cause any symptoms. However, they can block the ducts that lead bile to the liver and intestines. This is called a biliary colic (see diagram) if the crisis is temporary. No longer able to empty, the gallbladder then begins to swell, which can cause violent pain. When stones do not cause colic, they are sometimes discovered randomly on an ultrasound or CT scan (scan) of the abdomen.

It should be noted that the intensity of the symptoms does not depend on the decals calculations. Indeed, small stones can result in intense pain, while large stones will go unnoticed. They are sometimes too big to come out of the gallbladder and block the ducts.

Causes

La bile consists mainly of water, bile salts (which, by emulsifying fats, play a large role in their digestion by the intestine), cholesterol, phospholipids, pigments and electrolytes.

The gallstones of cholesterol are formed when:

• the bile contains too much cholesterol;
• the bile does not contain enough bile salts;
• the gallbladder does not contract regularly (the gallbladder is then said to be “lazy”).

It is not known exactly what triggers stone formation, but various risk factors have been identified. Obesity is one of them. Note that there is no link between hypercholesterolemia and the concentration of cholesterol in the bile.¹.

Who is affected?

La gallstones, or gallbladder calculus is quite common and affects 2 to 3 times more than women than men. From the age of 70, 10% to 15% of men have it, as well as 25% to 30% of women. The risk of having gallstones increases withage, to reach almost 60% after 80 years, probably due to the decrease in the effectiveness of the contractions of the gallbladder. Calculations cause complications in only 20% of them and it can be hepatic colic, cholecystitis, cholangitis, or acute biliary pancreatitis.

Biliary colic

A crisis de hepatic colic or biliary colic, is due to a gallbladder stone that passes into the bile ducts and becomes blocked there transiently, temporarily preventing the bile from flowing out. It lasts an average of 30 minutes to 4 hours. A duration of more than 6 hours should give rise to fear of a complication. The pain subsides when the stone spontaneously dislodges, allowing the bile to flow normally again. A person who has suffered from an attack of biliary colic is likely, in 70% of cases, to suffer others. If the first attacks are bearable, they tend to worsen when the stones are not treated.

Most seizures occur outside of meals. They can occur at any time of the day, and most often there is no triggering event. The seizure occurs after the gallbladder contracts and ejects a stone that can block a bile duct. Ingestion of a meal naturally causes the gallbladder to contract, stimulated by the presence of food in the digestive tract. The gallbladder also contracts randomly and spontaneously at all times of the day and night.

Possible complications

In the majority of cases, gallstones do not cause complications. However, persistent untreated pain may one day or another intensify to the point of leading to life-threatening situations: acute cholecystitis (inflammation of the gallbladder), acute cholangitis (inflammation of the bile ducts ) or acute pancreatitis (inflammation of the pancreas).

In the presence of the symptoms below, see a doctor urgently :

• fever;
• abnormally yellow color of the skin;
• very intense and sudden pain on the right side of the abdomen which persists for more than 6 hours;
• persistent vomiting.

In addition, people suffering from gallstones are, in the long term, a little more at risk of developing a gallbladder cancer, which is however very rare.