Gallstones (Cholelithiasis)

What it is

Gallstones form when components of bile, such as cholesterol, crystallize inside the gallbladder. They are very common, especially in women, with age, during pregnancy, with estrogen use, with obesity and after rapid weight loss. Many people feel nothing and discover the stones on a routine ultrasound. When there are symptoms, the most typical is biliary colic: intense pain in the upper right abdomen or in the pit of the stomach, which appears after fatty meals and can radiate to the back, with nausea. Gallstones can cause complications, such as cholecystitis, bile duct obstruction and pancreatitis. Symptomatic stones or those with complications are an indication for cholecystectomy, usually by laparoscopy.

Most common symptoms

• Severe pain in the upper right abdomen or upper mid-abdomen
• Pain that starts after fatty meals and radiates to the back
• Nausea and vomiting during a pain episode
• Sensation of fullness and poor digestion
• Fever and persistent pain when cholecystitis is present
• Yellowing of skin and eyes when the bile ducts are blocked
• No symptoms, found incidentally on a routine ultrasound

Causes and risk factors

• Crystallization of cholesterol and other bile components
• Female sex, pregnancy and estrogen use
• Age over 40
• Obesity and rapid weight loss
• Family history of gallstones
• Diabetes and a high-fat diet

How it is diagnosed

The evaluation begins with the history of the pain: its location, relationship to meals, duration of episodes and associated symptoms such as nausea and fever. The physical exam checks for tenderness under the ribs on the right side. Abdominal ultrasound is the test of choice, since it identifies the stones, the thickness of the gallbladder wall and any dilation of the bile ducts. Blood tests assess signs of inflammation and liver and pancreas function. In specific situations, MRI or CT scans complement the investigation.

How we treat it at Femi Saúde

Stones found incidentally, without symptoms, can simply be monitored, with dietary guidance and attention to warning signs. When there is recurrent biliary colic or complications such as cholecystitis or pancreatitis, cholecystectomy — removal of the gallbladder with the stones — is indicated. The general surgery team at Femi Saúde performs the procedure by laparoscopy, through small incisions, which usually allows for a quicker recovery, depending on the case. During an acute episode, pain relievers and, when there is infection, antibiotics control the condition until surgery. The plan is individualized, taking into account the patient's symptoms, test results and health condition.

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