sappikivi

Sappikivi is the Finnish term for gallstones, solid concretions formed from components of bile that typically develop in the gallbladder. Most stones are cholesterol stones, but pigment stones made of bilirubin and calcium salts also occur. Stones can remain asymptomatic for years or cause symptoms when they obstruct bile flow.

The exact causes are multifactorial. Factors that raise the risk of cholesterol stones include supersaturation of bile with cholesterol, gallbladder stasis, obesity, rapid weight loss, female sex, older age, certain diets, and genetics. Pigment stones are more common with conditions that increase bilirubin production or disrupt bile composition, such as chronic hemolysis, liver disease, or infections of the biliary tract. Stones may remain in the gallbladder or migrate into the bile ducts.

Symptoms range from none to severe. A stone in the cystic duct may cause biliary colic—a sudden, intense pain in the upper right abdomen that often lasts several hours. If a stone blocks the common bile duct, jaundice, pale stools, dark urine, or pancreatitis can occur. Infection of the biliary system (cholangitis) is a medical emergency.

Diagnosis commonly begins with abdominal ultrasound. Blood tests may show signs of cholestasis or pancreatitis. When ductal stones are suspected, MRCP or ERCP can be used.

Treatment depends on symptoms and stone location. Asymptomatic stones often require no treatment. Symptomatic stones typically undergo cholecystectomy, usually by laparoscopy. Stones in the common bile duct are often removed via ERCP, followed by cholecystectomy. In selected patients, ursodeoxycholic acid may slowly dissolve small cholesterol stones, though this is not suitable for all stones. Prevention focuses on managing risk factors such as weight and diet, though no guaranteed method exists to prevent stones in everyone.