What are gallstones?
Gallstones are small, stone-like objects that form when the liquid in the gallbladder hardens. Presence of stones in the gallbladder is referred to as cholelithiasis (cho·le·li·thi·a·sis).
How do you get gallstones?
The liver normally produces bile. It drains into the first part of the small intestine to aid in digestion. It is stored in the gallbladder between meals. Bile contains water and several solids: cholesterol, fats, salts and proteins. It also contains bilirubin, a yellowish pigment. Crystals can form when the bile is stored, and as the crystals grow, they form gallstones.
The distribution of gallstone types in children differs from the adult population:- While cholesterol stones make up around 75 % of adult stones, they account for less than 25 % in children
- Black pigment stones make up close to 50 % of gallstones in children. They are formed when bile becomes supersaturated with calcium bilirubinate and are commonly formed in certain blood disorders
- Calcium carbonate stones, which are rare in adults, are more common in children, accounting for about 25 % of childhood gallstones
- Around 5 % of children have protein gallstones Gallstones can migrate into the ducts of the biliary tract and can block the flow of bile
What are the symptoms of gallstones?
Sometimes gallstones form, but cause no symptoms. However, when they do cause symptoms, the most common symptom is pain in the right upper or upper middle part of the abdomen, particularly after meals. Nausea and vomiting may occur as well. It is difficult for younger children to pinpoint their pain. But some older children may describe their pain as: centering in the right upper or middle upper abdomen with the pain spreading to the back or between the shoulder blades. The pain may feel sharp, cramping or dull with the pain coming and going (recurrent). They are likely to describe the pain as happening just after eating a meal, and/or getting worse after eating fatty or greasy foods. Sometimes gallstones can cause a blockage of one of your bile ducts. If that happens, kids tend to present with sudden onset of nausea, vomiting, fever, chills/sweats, or even jaundice, a yellowish tint to the skin and eyes.
When are gallstones a problem?
They are a problem when they block bile from flowing. When bile stops flowing this can lead to inflammation of the ducts or even infection. We have some fancy names for when this happens. Choledocholithiasis (cho·led·o·cho·li·thi·a·sis) refers to when gallstones are present in the ducts of the biliary tract. Cholecystitis (cho·le·cys·ti·tis) refers to inflammation and swelling of the gallbladder. Cholecystitis cholangitis (chol·an·gi·tis) is when there is an infection of the bile ducts. This infection can even spread up to the gallbladder itself or even get into the liver.
How do you treat gallstones?
If a child’s gallstones don’t cause symptoms, and if no complications or duct blockages are detected, treatment usually is not needed. If the gallstones cause an infection, then we treat that infection with antibiotics. If they are stuck in the duct, then they may require a procedure to remove or break up the stones. If a child has an infection or recurrent problems with gallstones, then surgery may be required to remove the gallbladder to eliminate the problem from happening again.
Your Pediatric Team at PB Digestive
Sari M. Kay, MD is a board-certified Pediatric Gastroenterologist. She has a specialties and expertise in treating patients with inflammatory bowel disease, celiac disease, eosinophilic esophagitis, constipation, infant reflux, and functional GI disorders.
Laura E. Irastorza, MD is a board-eligible Pediatric Gastroenterologist. She has expertise in treating patients with eosinophilic esophagitis, constipation, reflux, and functional GI disorders such as irritable bowel syndrome.
