Gallstones

Gallstones occur when the substances that make up bile in the gallbladder are out of balance. Crystals can form and over time, the crystals can stick together to form gallstones. There are 2 types of gallstones: cholesterol (most common) and pigment. At the UVM Medical Center, gallstones are diagnosed and treated with advanced technologies, such as ERCP (endoscopic retrograde cholangiopancreatography).

Gallstone Care at UVM Medical Center

Most gallstones do not cause problems, but if they are large enough to block a duct they will usually need treatment. At the UVM Medical Center, our team focuses on prevention, teamwork, technology & trusted expertise to diagnose and treat gallstones.

You can have gallstones and no gallbladder symptoms, but if they are blocking a duct then you may feel one or more of the following:

• Intense abdominal pain; see a doctor immediately if you can't sit still or find a comfortable position
• Your skin and the whites of your eyes turn yellow (jaundice); see a doctor immediately
• High fever with chills; see a doctor immediately
• Sudden pain in the upper right or center (just below your breastbone) of your abdomen
• Back pain between your shoulder blades
• Right shoulder pain

Gallstone Diagnosis

Gallstones often cause no signs or gallbladder symptoms. However, if you're having intense pain in the pit of your stomach or upper right abdomen, your doctor may recommend diagnostic testing. The University of Vermont Medical Center's physicians are specially trained in advanced technologies to diagnose stomach and intestinal problems. The following are diagnosis tools that we use here at the UVM Medical Center:

ERCP (endoscopic retrograde cholangiopancreatography) is a procedure used to take a close look at your bile ducts for blockages. ERCP can even be used to remove gallstones on the spot.

Other than ERCP, there are other tests to check your bile ducts for gallstones such as:

• Hepatobiliary iminodiacetic acid (HIDA) scan
• Magnetic resonance cholangiogram (MRC)

Ultrasound: An ultrasound is an imaging test that uses reflecting sound waves to take pictures of the inside of your body. We use these types in gallstone diagnosis:

• Abdominal ultrasound is the best test to find gallstones. This test does not hurt.
• An endoscopic ultrasound (EUS) can be used to see gallstones in the common bile duct. A doctor gently moves a thin, flexible, lighted viewing instrument (endoscope) with an ultrasound probe down the throat and through your stomach to examine the tubes that drain the gallbladder, liver and pancreas.

Computed tomography (CT or CAT) scan may be used if your ultrasound does not show gallstones but if your doctor still thinks you have a problem with your gallbladder. In this test, a doctor injects dye into a vein in your arm. Then a machine takes X-rays as the dye moves through your liver, gallbladder, bile duct and intestine.

Blood tests can also reveal problems caused by gallstones such as an infection, jaundice or pancreatitis.

Treatments for Gallstones

Cholecystectomy (gallbladder removal surgery) is the primary treatment for gallstones that are causing pain, inflammation or infection. This surgery is the only way to prevent gallstones in the future. The UVM Medical Center uses the following treatments for gallstones:

Cholecystectomy

Cholecystectomy is a common surgery and the risk of complications is small. This gallbladder removal surgery can be performed one of two ways:

Laparoscopic Cholecystectomy

This is typically the preferred method since it is minimally invasive and healing time is shorter. The surgeon inserts a tiny video camera and special surgical tools through four small incisions to see inside your abdomen and remove the gallbladder.

Open Surgery

If your gallbladder cannot be removed laparoscopically, then surgeons may use one large incision.

Medications for Gallstones

Patients with gallstones who cannot have surgery may be treated with medications. However, these medications aren't commonly used since it may take months or years to dissolve your gallstones in this way.