Do gallstones increase liver enzymes?

This is an automatically translated article.

The article was professionally consulted by Specialist Doctor I Vo Thi Thuy Trang - Gastroenterologist, Department of Medical Examination & Internal Medicine - Vinmec Danang International Hospital. The doctor has many years of experience in the field of gastrointestinal endoscopy.
Gallstones are solid stones that form in the ducts that secrete bile in the liver, including the gallbladder. If the stone size is large, causing obstruction, the patient may experience severe pain in the right abdomen, sometimes requiring emergency surgery. In contrast, gallstones can also cause elevation of liver enzymes or hepatomegaly and are detected on testing while the patient is completely asymptomatic.

1. What are gallstones?

Gallstones form on deposits in bile, which contain enzymes that help digest fats and absorb certain vitamins. Bile is made in the liver, excreted through the bile ducts and carried to a concentrated, stored in the gallbladder, a small pear-shaped organ below the liver, ready for use with meals.
When the solids in the bile are crystallized, possibly due to obstruction or the involvement of bacteria, gallstones will be present. Most gallstones are very small in diameter, possibly similar to a grain of sand, but occasionally large stones like a golf ball are found in the gallbladder.
The nature of most gallstones is composed mainly of cholesterol. The rest - called pigment stones - are made of calcium salts and bilirubin, a breakdown product of red blood cells.
In terms of prevalence, women have a higher risk of gallstones than men. It is the effect of female hormones. Estrogen increases cholesterol in bile while progesterone slows down the emptying of the gallbladder. Therefore, before the age of 40, women are diagnosed with gallstones almost three times more often than men.
However, by age 60, the risk of women is only slightly greater than that of men. In addition, estrogen therapies, such as birth control pills, increase the risk of gallstones, especially when taken as a pill rather than a patch. In addition, obesity is another risk factor that increases the incidence of gallstones because the body has more fat and produces more estrogen. Paradoxically, rapid weight loss also increases the risk, because a very low-calorie diet slows bile production and causes more cholesterol to crystallize.
On the other hand, gallstones are also common in people with diabetes or any condition that impairs bowel or gallbladder contractions, such as a spinal cord injury. Some evidence suggests an association in genetic defects for gallstone formation.

2. What are the symptoms of gallstones?

Most people with gallstones are not aware of the presence until symptoms appear. Accordingly, gallstones "remain silent" and can only be discovered incidentally, through ultrasound or CT scans performed for other conditions.
Symptoms of gallstones only occur mainly when the stone passes through the bile duct or obstructs anywhere in the bile duct. At this time, biliary colic appears. Pain tends to occur when the gallbladder contracts, usually in response to a high-fat meal to increase the expulsion of bile into the duodenum to digest food. The site of pain is usually in the upper or middle right abdomen, in the region of the liver.
The intensity of pain is greatest within an hour and can persist for several hours after a meal. Sometimes the pain can radiate to the back or right shoulder and be accompanied by nausea and vomiting. The pain then subsides as the gallbladder relaxes. However, they will tend to recur in the next meal, especially when eating a lot of fat. Over time, the patient will experience anorexia, poor appetite and wasting.
However, if the stone obstructs the bile duct, the person will have more serious problems, including acute cholecystitis, acute pancreatitis or acute cholangitis, acute hepatitis. Any of these conditions will manifest with severe pain and other symptoms, such as jaundice, yellowing of the eyes, high fever, chills, and vomiting. At this time, the patient needs to be hospitalized and treated promptly before the infection on the biliary tract spreads to the entire abdomen causing peritonitis or the systemic bloodstream infection.

3. Complications of gallstones are dangerous?

Complications of gallstones can include:
Cholecystitis. When gallstones move and get lodged in the neck of the gallbladder, cholecystitis can occur. The patient will have severe right upper quadrant pain and high fever. Common bile duct obstruction. Gallstones can cause blockages in the bile ducts. Symptoms are similar to when stones are stuck in the gallbladder neck, the patient has severe abdominal pain and jaundice, fever caused by infection of the bile duct. Obstruction of the pancreatic duct. The pancreatic duct is a tube that runs from the pancreas and connects to the common bile duct at the site just before secretion into the duodenum. A biliary stone that migrates to this segment can cause obstruction in the pancreatic duct and may lead to acute pancreatitis. Patients with severe abdominal pain continuously, accompanied by vomiting and often hospitalized immediately afterwards. Gallbladder cancer. People with a history of gallstones in the gallbladder have an increased risk of gallbladder cancer. This is the result of chronic inflammatory reactions that persist over time.

4. How to diagnose gallstones?

Blood tests. Blood tests to evaluate liver enzymes, both from liver parenchymal cells and biliary endothelial cells, may show gallstones that elevate liver enzymes. At the same time, when there is an acute complication due to stones stuck in the biliary tract, blood tests also show infection, jaundice, pancreatitis or other complications due to gallstones. Abdominal ultrasound. This is the most common and widely used imaging tool to look for the presence of gallstones in the biliary tract. The sensitivity and specificity of this tool are relatively high. Endoscopic ultrasound. This procedure can help identify smaller gallstones that may be missed on an abdominal ultrasound. The procedure involves the doctor inserting an endoscope through the mouth, which emits sound waves to create an accurate picture of the surrounding tissue. Other imaging tests. Additional tests that may help detect gallstones include computed tomography, magnetic resonance cholangiography, or endoscopic retrograde cholangiopancreatography. For endoscopic retrograde cholangiopancreatography, gallstones are not only detected and removed by intervention.

5. How to treat gallstones?

Most people with gallstones who have no symptoms will not need treatment.
The doctor only determines the need for intervention if gallstones cause clinical symptoms such as liver enlargement, jaundice, yellow eyes, fever... or on diagnostic tests such as elevated liver enzymes.
Treatments for gallstones include:
Cholecystectomy. Your doctor may recommend surgery to remove your gallbladder, because gallstones are often located in the gallbladder and often recur. This is also a non-essential organ. Cholecystectomy can be done through open surgery or laparoscopically. Once the gallbladder is removed, bile flows directly from your liver into your small intestine, instead of being stored in the gallbladder. Endoscopic retrograde cholangiopancreatography removes stones. It is both diagnostic and interventional. The doctor will cut the sphincter of the bile duct at the point where it enters the duodenum to remove the stone. Drugs that dissolve gallstones. There are several medications that can help dissolve gallstones. However, treatment can take months or years. At the same time, gallstones may form again if treatment is stopped. Therefore, medications for gallstones are not commonly used and are reserved for those who refuse surgery. However, the drug can also be preferred for cases where the stone is located in the hepatic biliary system, rather than in the gallbladder or common bile duct, where surgery is difficult to intervene. At this time, if the medical treatment does not improve or the stones cause complications, the indications for liver surgery to remove the stones may be given.

6. How to prevent gallstones?

You can reduce your own risk of forming gallstones if you:
Don't skip meals. Try to stick to your usual meal times each day. Skipping meals or fasting can increase the risk of gallstones. Lose weight the right way. If you need to lose weight, go slowly with the goal of losing about 0.5 to 1 kg per week. Losing weight too quickly can increase the risk of gallstones. Eat lots of fiber-rich foods. Building a diet with a large fiber group, such as fruits, vegetables and whole grains, helps you reduce the risk of gallstones. Maintain a healthy weight. Being overweight and obese increases the risk of gallstones. Work out to a healthy weight by reducing calorie intake and increasing physical activity. In conclusion, gallstones are not uncommon. Along with the advancement of medicine, these pathological treatments have achieved very high efficiency, solving the biliary pain that torments the patient after each meal. Patients should have regular health check-ups to detect gallstones early due to elevated liver enzymes or hepatomegaly on ultrasound. Since then, there are timely interventions to help limit the serious complications caused by gallstones.
Currently, Vinmec International General Hospital has applied endoscopic retrograde cholangiopancreatography to treat diseases of common bile duct stones, hepatic duct stones, ampulla of Vater, pancreatic head tumor, biliary stenting, Nasal biliary sond, including cholelithiasis, with a high success rate of over 98%.
To perform endoscopic retrograde cholangiopancreatography, Vinmec has equipped a modern soft endoscopic system with Endocut Electric Knife which has the advantage of not causing pancreatitis and pancreatic reactions. In order to successfully perform and minimize possible complications in this technique, in addition to investing in modern equipment, the decisive factor is a team of highly qualified and rich medical staff. experience. Endoscopic retrograde cholangiopancreatography at Vinmec is performed by famous doctors with high expertise, good skills, dedication and professionalism.

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References: health.harvard.edu, unlockfood.ca, emedicinehealth.com, health.com, niddk.nih.gov