In the wee hours of the night, you wake up with indigestion and a steady pain in your upper abdomen. It quickly gets worse. When morning arrives, it's still there, and in fact, has spread to your back, below your right shoulder. Then nausea sets in. After a few hours, to your relief, the pain and nausea subside—leaving you with a deeper sympathy for your mother and grandfather, because you recognize the symptoms they used to describe: You've inherited the family tendency toward gallstones.

Gallstones are made from bile—a liquid created in the liver and stored in the gallbladder until it's needed to digest food. Bile can crystallize into pieces of stony material, as small as a grain of sand or as big as a golf ball. Gallstones can be found in the gallbladder or in any of the ducts that carry bile between the liver, gallbladder, and pancreas. They affect twice as many women as men, and though anyone can get them, they often run in families.

And this is one family tradition you'd like to avoid!

Start by talking to your family physician about your symptoms. He or she may order an ultrasound to see if you have gallstones. Ultrasound uses harmless sound waves to make an X-ray-like image. The ultrasonographer will slide a wand-like sound-wave transmitter over your upper abdomen, and pictures of your gallbladder and surrounding organs will appear on a monitor. Most stones can be seen with a routine ultrasound.

If this is your first attack, your family physician may prescribe medications to dissolve your stones and possibly prevent them from coming back. He or she will also recommend important dietary changes:

• Rule out fatty foods, especially saturated fats (the ones that are solid at room temperature).
• Rule in high-fiber foods like whole grains, fruits, and vegetables.

If you continue to have gallstone attacks in spite of medication and changing your diet, your physician may refer you to a gastroenterologist—a specialist in digestive tract problems. This may also be necessary if your symptoms continue, but no gallstones are found on your first ultrasound

"Sometimes the gallstones can't be seen by regular ultrasound," explains Ingram Roberts, MD, chief of Gastroenterology at Bridgeport Hospital. "Then more sophisticated tests are needed. One of the newest and most effective is endoscopic ultrasound. For this test, the transmitter, in the form of a flexible tube about half an inch in diameter, is passed down the throat, while the patient is sedated for his or her comfort. This enables us to take a closer look, and to reach places not visible from outside the body."

Another new technique available at Bridgeport Hospital is endoscopic retrograde cholangiopancreatography (koh-LAN-jee-oh-PANG-kree-uh-TAH-gruh-fee), or ERCP.  ERCP can not only locate, but also treat stones that have lodged in the bile ducts.

With the patient under sedation, an endoscope—a long, flexible, lighted tube—is passed down the throat. Through it, the physician can see the inside of the esophagus, stomach, and duodenum (the beginning of the small intestine). The physician guides the endoscope to the spot where the ducts open into the duodenum, and then injects dye through it so the ducts will show up clearly on X-rays. If the exam shows gallstones in the ducts, the physician can often insert small instruments through the scope to grasp and remove them.

If frequent gallstones lead to complications, such as cholecystitis or pancreatitis (inflammation of the gallbladder or pancreas), surgery may be the best option.

"The human body can get along quite nicely without a gallbladder, and cholecystectomy (gallbladder removal) is one of the most common operations," says Bridgeport Hospital-affiliated surgeon Sean Duerr, MD, who was the first physician in Connecticut to perform this procedure by "keyhole" surgery. Keyhole, or laparoscopic, surgery means that instead of making a large incision in the abdomen to reach the gallbladder, the surgeon inserts tiny instruments through several small incisions. The result: patients go home in one day instead of five, and recovery time is much shorter than it used to be when your mother and grandmother needed this procedure.

Whether by medication, diet, surgery, endoscopy, or a combination of the four, it should be possible for you to get rid of gallstones for good!

Only a qualified physician can determine what is causing your symptoms. For a referral to an expert physician, call Bridgeport Hospital Services Referral, 24/7, English/Spanish, at 888-357-2396.