Gallstones (cholelithiasis) are small hard pellets that form when bile (a digestive fluid made by the liver) begins to harden as it is stored in the gallbladder. Gallstones may also form from cholesterol and broken down blood cells. Biliary dyskinesia happens when the gallbladder does not squeeze hard enough to push all of the bile contents into the small intestine. When bile remains in the gallbladder, it can crystalize and form gallstones. Biliary dyskinesia can also exist without gallstones.
About 2 percent of children have gallstones. Gallstones in babies and young infants are often related to prematurity and other existing conditions, such as jaundice, cystic fibrosis or prolonged use of intravenous feeding. Gallstones go away without treatment in about 20 percent of infants with the condition.
The frequency of gallstones in older children has increased due to a rise in obesity and better ultrasound detection technology. Obesity can lead to gallstones, because when bile cannot dissolve all of the cholesterol in the body, the cholesterol and bile can form a stone.
Gallstones are more common in children with sickle cell disease or other conditions that cause a break down of blood cells. Children with sickle cell disease are more likely to develop gallstones as they get older.
Symptoms of gallstones and biliary dyskinesia often begin with pain in the right upper abdomen. Other symptoms may include:
- Fever
- Jaundice (if a gallstone blocks a bile duct)
- Nausea
- Pain with eating
- Pain after meals
- Vomiting
Gallstones may dissolve or travel out of the gallbladder, into a bile duct and pass out of the body. When gallstones require treatment, pediatric surgeons can remove the gallbladder. Gallstones usually do not come back after treatment. Sometimes pain remains after treatment for biliary dyskinesia. When this happens, doctors will look for other causes, such as conditions of the liver or pancreas.
Diagnosis of Gallstones & Biliary Dyskinesia
Pediatric surgeons and gastroenterologists at Riley at IU Health perform the following exams and tests to diagnose gallstones and biliary dyskinesia:
- Clinical exam. A doctor will examine your child’s abdominal area. He or she will talk with your child to locate the pain and determine when it occurs.
- Ultrasound. This test uses sound waves to create images of the gallbladder and bile ducts. This painless exam can show where gallstones are located in the biliary tree.
- Hepatobiliary iminodiacetic acid (HIDA) scan. A HIDA scan uses a radioactive chemical to trace the path bile takes from the liver to the gallbladder and into the small intestines. A nuclear medicine camera follows the flow of the chemical agent through your child's body. This helps the doctor see how well the gallbladder contracts and whether any gallstones or blockages exist.
Treatments
Treatments
The treatment goal for gallstones and biliary dyskinesia is to relieve pain. Options include:
- Monitoring. If gallstones are small and symptoms are mild and do not cause pain, no immediate treatment is needed. Your child’s doctor will watch the gallstones over time.
- Cholecystectomy (gallbladder removal). Laparoscopic (minimally invasive) surgery can be performed to remove the gallbladder. This treatment is used for gallstones and biliary dyskinesia. Gallbladder removal is the most common treatment used to remove gallstones and prevent new ones from forming.
- Endoscopic retrograde cholangiopancreatography (ERCP). If a gallstone is stuck in a bile duct, this endoscopic procedure can be performed to remove the stone.
- Biliary interventions. Various interventional radiology (minimally invasive) procedures are available to treat gallstones and blockages in the bile duct.
- Medicine. Gallbladder removal does not relieve pain for all patients with biliary dyskinesia. If pain remains after surgery, pain relievers are used to ease symptoms.
Key Points to Remember
Key Points to Remember
- Gallstones are small hard pellets that develop in the gallbladder from bile, cholesterol or broken down blood cells.
- Biliary dyskinesia happens when the gallbladder does not squeeze hard enough to push all of the bile contents into the small intestine. This may cause gallstones.
- Pain in the right upper abdomen is the most common symptom for both conditions.
- Gallbladder removal is the most common treatment used to remove gallstones and prevent new ones from forming.
- Biliary dyskinesia is also treated with gallbladder removal and pain medicine.
Support Services & Resources
Support Services & Resources
Visit the links below to find support groups and services and learn more about gallstones and biliary dyskinesia.
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
This website from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition offers family-friendly information about gallstones.
Gallstones & Biliary Dyskinesia Research
Gallstones & Biliary Dyskinesia Research
Pediatric surgeons and pediatric gastroenterologists at Riley at IU Health completed and presented a study about the use of HIDA scans and gallbladder removal to treat biliary dyskinesia. Not all children are cured with surgery, and researchers are looking for ways to relieve the pain that remains after gallbladder removal.
Locations
Locations
Locations
In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.
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