Gallstones

Gallstones are stones that form in the gallbladder. The gallbladder is a small sac attached to the liver that stores bile between meals. The gallbladder draws water from the bile making it more concentrated. During a meal (especially fatty food) the gallbladder squeezes the stored bile into the intestine to help with digestion.

 

Why do gallstones develop?

It is not very clear, but some main reasons are:

• The bile in the gallbladder is too concentrated leading to precipitation of salts.
• The gallbladder does not empty completely and properly.

 

What are the risk factors?

1. Gender (more women than men develop gallstones)
2. Advancing age
3. Family history of gallstones
4. Obesity
5. Pregnancy and birth control pills
6. Rapid weight loss
7. Diabetes

What are the types of gallstones?

1. Cholesterol stones
2. Pigment stones
3. Mixed stones

Regardless of the type, stones cause problems in the same way. 

What are the symptoms of gallstones?  

1. No symptoms. 7 out of 10 people with gallstones will not experience any symptoms.
2. Biliary Colic. Pain is the most common symptom. The pain is usually in the right upper belly and often goes to the right shoulder blade or back. Often you will feel nausea and you may vomit. The pain tends to be brought on by fatty foods.
3. Complications  

What are the complications of gallstones? 

1. Acute Cholecystitis; the inflammation and infection of the gallbladder caused by blockage of the gallbladder by stones and repeated attacks of biliary colic. This requires hospital admission for intravenous antibiotics. Surgery is usually performed during the hospitalisation or shortly after. If untreated acute cholecystitis can lead to the rupture of the gallbladder.
2. Bile Duct Obstruction; this occurs when a stone slips from the gallbladder into the main bile duct. This can lead to:

• Jaundice: yellowish discolouration of the skin and eyes.
• Acute cholangitis: this is a life threatening infection in the bile ducts. It requires immediate treatment.
• Acute pancreatitis: inflammation of the pancreas due to the irritation caused by the stone in the bile duct. It can be life threatening.

How are gallstones diagnosed? 

In addition to blood tests, an ultrasound is the most common test performed. It is a safe and highly accurate test. Other tests such as MRI, CT scan and endoscopy are sometimes performed if there is suspicion of other conditions or if there is a chance of stones slipping into the bile ducts. 

If the stones are picked up by chance and are not causing any symptoms then watchful waiting is all that is needed. However, once gallstones start to cause symptoms then surgery is recommended.

What is a Cholecystectomy?

 This is the surgical removal of the gallbladder and the stones in it. It is almost always performed laparoscopically (key hole surgery) and patients get to go home 1 day after surgery. However, if key hole is considered unsafe or impossible then the surgery may need to be completed with a longer incision beneath the right ribs and the patient will need a longer hospital stay of about 6 days. Gallstones that have slipped into the bile duct may need to be removed endoscopically (ERCP) either before or shortly after surgery.

But, Don't I need my gallbladder?

People that have had their gallbladder surgically removed live perfectly well without it. Bile will continue to be produced by the liver and help digestion. Your quality of life will not be affected.