Gall Stone Formation

The liver has many purposes.  One of the purposes is to produce bile, a fluid that consists of a very concentrated solution of bile salts that works similar to a detergent to help break fat in the diet into tiny globules.  If you put a teaspoon of vegetable oil into a cup of water the oil and water do not mix well.  The oil forms into large droplets and floats to the top of the glass.  If you add some detergent to the water and shake it slightly the oil disperses into many very tiny globules of oil.  The detergent is said to be a dispersing agent.  Bile works like this in the gut, dispersing dietary oils and fats into tiny globules as a part of the digestive process.

The biliary system uses the gall bladder to store and concentrate bile.  The liver produces bile at a fairly constant rate, but it is only needed after meals.  Rather than flow down the biliary ducts and into the duodenum all the time, there is a muscular sphincter, the sphincter of Oddi at the distal end of the common bile duct, that opens when stimulated by cholecystakinin which is released by the stomach when food is ingested.  At other times the bile backs up into the gall bladder.

In the gall bladder water is reabsorbed and the bile is concentrated.  In some individuals the bile salts crystallize in the gall bladder and form stones.  These gall stones can flow with the bile into the common bile duct, and if they do not pass through the Sphincter of Oddi they can cause obstruction of the outflow of bile.  This type of obstructive jaundice is usually painful, and the attacks are called biliary colic.  If the episode leads to more inflammation of the gall bladder and biliary ducts, it’s called acute cholecystitis.  This type of painful jaundice is usually from acute obstruction, and is often due to gall stone disease.  Painless jaundice is usually due to a tumor or slower developing cause of obstruction, and tends to be a more ominous symptom.

There is no known positive aspect of gall stones.  They seem to happen when the bile becomes overly concentrated.  It is felt that if a person develops gall stones that even if the stones are removed, or drugs used to make the stones disappear, that they will recur if the medication is stopped.  The standard treatment of symptomatic gall stones is cholecystectomy.  This is now usually done by a laparoscopic procedure that can often be done without an overnight hospital stay, and with a very quick recovery process.  Most patients who have cholecystectomy recover nicely and have normal or nearly normal digestive function without the gall bladder.  Some patients have difficulty with fatty food digestion, and have diarrhea or a syndrome called dumping where they have a bowel movement shortly after eating fatty foods.