Pregnancy and Gallstone Conditions

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Gallstones are hard, stone-like masses that form in the gallbladder, a small organ under your liver in the right upper quadrant of your abdomen. The gallbladder stores a substance from the liver called bile. The bile has various substances dissolved in it, but these substances can precipitate out of solution, forming gallstones. There are different types of gallstones, classified based on their composition. Most are cholesterol stones, but there are also pigment stones, made of calcium and bilirubin, which comes from the breakdown of hemoglobin from red blood cells. Most gallstones are small and do not cause problems, but some grow large enough to obstruct one of the ducts that carries bile between the gallbladder, liver, and intestine. Such a stone can cause problems temporarily and then get dislodged, pass into the intestine, and you won’t notice it. But stones that cannot pass through the duct system cause problems. Such problems include inflammation of organs connected to the ducts (notably the pancreas and the gallbladder itself), inflammation of a duct, enlargement of an organ (notably the liver), and jaundice (yellowing of the skin and the white part of the eyes). Inflammation causes abdominal pain and also can lead to long term problems.

About 10-15 percent of adults in developed countries suffer from gallstone disease. However, it happens more in women than in men. Because of hormonal factors and changes in the speed bile flow, pregnancy, accelerated the formation of gallstones, as do aging and obesity. Do to various genetic factors, native peoples of the Americas are particularly susceptible to gallstone disease. Additionally, because of the effects of pregnancy on gallstones, the more times a women has been pregnant, the greater her chances of suffering gallstone disease. Smoking also increases the risk of developing gallstones. Some research studies have suggested that people whose blood concentration of HDL cholesterol (“good cholesterol”) is lower than normal are more likely to develop gallstones, but this is controversial.

When gallstones cause inflammation of the gallbladder itself, doctors call this cholecystitis. Inflammation of the bile duct is called cholangitis), while inflammation of the pancreas is called pancreatitis. These conditions all require treatment, but there is also a condition called biliary colic. In this condition, a stone obstructs a duct and causes pain that could be constant but often is intermittent. It kind of comes and goes, which may be the result of a stone moving around and sometimes letting some bile through and other times not letting it through. Biliary colic may resolve on its own, due to the stone eventually passing to the intestine. On the other hand, biliary colic may progress to one of the other conditions mentioned above, in which the gallbladder, pancreas, or a duct becomes inflamed.

Cholecystitis and cholangitis cause severe upper abdominal pain, typically with fever and chills. Pancreatitis typically causes pain following a belt pattern around the waist. Any of the conditions can be acute (intense, developing over a short time) or chronic (less intense and waxing and waning over months to years). If not recognized and treated, acute cholecystitis can rupture the gallbladder and the infection can spread to other organs, causing death. Chronic cholecystitis can lead to gall bladder cancer while both chronic and acute pancreatitis can lead to pancreatic cancer.

Digestive system doctors (gastroenterologists) and radiologists have several ways to image the bile duct system and the organs connected to it, in order to diagnose and treat gallstone conditions. Some of the methods expose the abdomen to ionizing radiation, but one such method, called a HIDA scan really involves just a tiny radiation dose well within the pregnancy safety limits. Other imaging methods, such as endoscopic ultrasound and magnetic resonance cholangiopancreatography, expose the fetus to no radiation at all.

Often gallbladder conditions can be managed conservatively, meaning that the medical staff performs tests but avoids invasive treatments, meaning treatments carried out either through endoscopy (a tube is passed through the esophagus, stomach, and intestine, with a camera and instruments) or surgically (surgeons cut through the abdomen). In some cases, endoscopic intervention, or surgery, may be required in order to protect both the mother and the fetus. In cholecystitis, for instance, complications, such as rupture of the gallbladder, which would put both the mother and the baby at extreme risk, since your life is at risk. The inflammatory conditions also come frequently with fever, which must be treated to keep the fetus safe.

When surgery is needed during pregnancy, doctors try to do this during the second trimester, or the early third trimester. Usually the procedure is performed laparoscopically, in which surgeons make three or four very small incisions (typically 1-1.5 centimeters long), each at a particular spot. Special tubes are inserted through the incisions and through one of the tubes carbon dioxide is pumped to inflate the abdomen to make room for the surgeons to operate inside. Other tubes accommodate a camera with lighting and special instruments that have very long necks so that they can be operated from outside the patient to do things inside the patient.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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