What is the best way to explain gallstones to patients?

How to Explain Gallstones to Patients

When explaining gallstones to patients, focus on their formation, symptoms, potential complications, and treatment options using simple language and visual aids to ensure comprehensive understanding.

What Are Gallstones?

• Definition: Gallstones are solid deposits that form inside the gallbladder or biliary tract
• Prevalence: Affect up to 20% of adults, with more than 20% of those developing symptoms or complications 1
• Types:
  • Cholesterol stones (most common) - formed primarily from hardened cholesterol
  • Pigment stones - formed from bilirubin (black or brown varieties)

Risk Factors to Explain

• Female sex
• Increasing age
• Pregnancy
• Physical inactivity
• Obesity and overnutrition
• Genetic factors (account for approximately 25% of total risk) 1
• Rapid weight loss (increases risk significantly)

Explaining Symptoms

The most important symptoms to explain include:

• Biliary colic: Episodic upper abdominal pain that is:

  • Severe and located in the epigastrium and/or right upper quadrant
  • Often has relatively abrupt onset (may awaken patient from sleep)
  • Steady in intensity
  • May radiate to the upper back
  • Often associated with nausea
  • Typically lasts for hours up to a day 2

• Important distinction: Explain that dyspeptic symptoms (indigestion, belching, bloating) are common in people with gallstones but may be unrelated to the stones themselves 2

Potential Complications

Explain that complications can be serious and potentially life-threatening:

• Acute cholecystitis (gallbladder inflammation)
• Acute cholangitis (bile duct infection)
• Biliary pancreatitis (inflammation of the pancreas)
• Less common: Mirizzi syndrome, cholecystocholedochal fistula, gallstone ileus 3

Diagnosis Process

Explain the diagnostic approach:

• Abdominal ultrasound (primary diagnostic tool)
• Blood tests to check liver function
• Additional imaging may be needed in some cases 4, 5

Treatment Options

1. For asymptomatic gallstones:

   • Often no treatment is needed (observation)
   • Annual risk of developing symptoms is 2-5% in the initial years 2

2. For symptomatic gallstones:

   • Laparoscopic cholecystectomy (surgical removal of gallbladder) is recommended as the risk of recurrence or complications increases over time 6
   • For acute pain: NSAIDs, spasmolytics, and sometimes opioids for severe pain 6

3. For bile duct stones:

   • Primarily treated endoscopically (ERCP with stone extraction) 6
   • Should be performed within 72 hours for patients with acute cholangitis 5

4. Prevention:

   • Lifestyle modifications for those at risk
   • Ursodeoxycholic acid can reduce risk during significant weight reduction from diet or bariatric surgery 7, 6

Natural History Without Treatment

• Many people with gallstones never develop symptoms
• For those with asymptomatic stones, annual risk of complications is less than 1% 2
• For those with symptomatic stones at discovery, approximately 6-10% suffer recurrent symptoms each year 2

Visual Aids and Communication Tips

• Use simple anatomical diagrams showing the gallbladder, bile ducts, and liver
• Show images of actual gallstones to help patients visualize
• Compare sizes to familiar objects (peas, marbles, etc.)
• Ensure patients understand when to seek medical attention (persistent pain, fever, jaundice)
• Provide written materials for patients to review at home

By explaining gallstones in clear, accessible language and addressing both the condition and its management, patients can better understand their diagnosis and participate in treatment decisions.