There are several risk factors of gallstones:
- Rapid weight loss
- Chronic hemolytic disorders
- Obesity and diabetes mellitus
- Certain medications
The risk for gallstone development increases significantly after the age of 40. Individuals between 40 and 69 are 4 times more likely to develop gallstones than younger people.
Women of reproductive age are also at greater risk of developing gallstones. They are 4 times more likely to develop gallstones than men. However, the sex specific difference in risk decreases after menopause. The risk is thought to be higher in women of reproductive age because of hormone composition, pregnancy and the use of oral contraceptives. Estrogen reduces the production of bile salts and increase secretion of cholesterol in the gallbladder resulting in cholesterol supersaturation. Progesterone synergistically promotes stone formation by causing hypomobility in the gallbladder.
Mexican Americans and Native Americans are at a higher risk for gallstones than other ethnic groups.
Rapid weight loss
Rapid weight loss promotes gallbladder formation when weight loss is due to a decrease in caloric intake. This promotes bile stasis. In addition, lipolysis, the breakdown of fats and other lipids, enhances cholesterol motility and secretion in the gallbladder. Together, these conditions creates an environment that promotes bile supersaturation with cholesterol and subsequently gallstone development.
Chronic hemolytic disorders
Hemolytic disorders are conditions in which red blood cells are attacked by the immune system. When the red blood cells rupture, bilirubin is released which in turn promotes the development of calcium bilirubinate stones.
Obesity and diabetes mellitus
These conditions are associated with increased bile stasis and cholesterol saturation, two circumstances that promote gallstone formation.
As mentioned above, obesity is associated with gallstone formation. This is because overweight individuals have a high level of cholesterol in bile. Individuals that are overweight also have larger gallbladders and gallbladders that do not function well. The location of the fat also impacts gallstone formation. People with large amounts of fat around their waist are more likely to form gallstones than those with fat around their hips and thighs.
For individuals that don’t eat for a while or that lose weight rapidly, such as those that practice crash dieting or undergo weight-loss surgery, the liver will release of large amounts of cholesterol in the bile. Just like being overweight affects gallbladder function, losing weight quickly can affect its ability to completely empty.
While one may have gallstones, they may not experience issues. One is more likely to experience gallstone related issues if they had gallstones before extreme weight loss or if the amount of weight lost is significant.
Certain medications can also promote gallstone formation. Estrogen-containing medications like birth control pills and hormone replacement therapies can increase cholesterol in bile and reduce gallbladder physical functioning. There are some exceptions as hormone replacement done with patches is not associated with increased gallstone formation. Cholesterol-lowering medications, while lowering cholesterol in the blood, can increase the amount in bile promoting gallstone formation. Octreotide, a drug used to treat a hormone disorder called acromegaly has also been associated with decreased gallbladder motility. Total parenteral nutrition also impacts gallbladder function, resulting in increased incidences of gallstones.
Complications that can arise as a result of gallstones
There are several complications that could arise from gallstones including:
- Acute Cholecystitis
Acute cholecystitis is inflammation of the gallbladder caused by a blockage of the gallbladder by the gallstones. This results in a continuous pain and sometimes a fever. This condition needs immediate medical attention. It is treated with administration of fluids, pain medications and antibiotics. The gallbladder is commonly removed soon after.
Choledocholithiasis occurs when one or more gallstones leave the gallbladder through the bile duct preventing bile from emptying from the gallbladder into the intestines. Blockage can lead to even more severe conditions such as the following:
- Jaundice: Yellow discoloration of the eyes and skin
- Acute cholangitis: An infection of the bile ducts resulting in pain, chills and fever. Much like acute cholecystitis this condition also requires immediate attention and removal of the gallbladder)
- Acute pancreatitis: Rapid inflammation of the pancreas resulting in severe abdominal pain.