Gallstones

The gallbladder is a small organ, on the right side of your abdomen, found underneath the liver. It is a little bag the size of a pear and hangs off the bile duct, which is a narrow tube the size of a drinking straw that carries bile from the liver to the intestine (duodenum). Bile is a digestive juice that helps break down fats. The gallbladder acts as a little reservoir of bile and squeezes bile into the intestine every time food arrives there.

Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. They can range in size from very small to as large as a golf ball. You can develop one or many at the same time. In most cases, they do not cause symptoms and do not need to be treated.

Gallstones don’t always cause symptoms.

If a gallstone blocks the outflow from the gallbladder the gallbladder you may get signs and symptoms including:

• Sudden and intensifying pain in the centre or the upper right portion of your abdomen
• Back pain between your shoulder blades
• Pain in your right shoulder
• Nausea or vomiting

Gallstone pain may last several minutes to five hours.

The blockage can lead to inflammation of the gallbladder (cholecystitis).

Symptoms of cholecystitis include:

• Persistent pain
• Tenderness in the upper right side of the tummy
• A high temperature

Gallstones can also pass from the gall bladder into the bile duct where they may block the flow of bile (thereby causing jaundice i.e. yellow discoloration of the eyes and skin). They may also cause inflammation of the pancreas (pancreatitis).

It’s not always clear why gallstones form. They may develop because:

• The bile in your gall bladder contains too much cholesterol (this does not correlate with your blood cholesterol level).
• Your bile contains too much of a pigment called bilirubin
• Your gallbladder doesn’t empty properly

Gallstones are very common. It’s estimated more than 1 in every 10 adults in the UK has gallstones, although only a minority of people develop symptoms.

You’re more at risk of developing gallstones if you’re:

• Overweight or obese
• Female (particularly if you have had children)
• 40 or over (the risk increases as you get older)
• Pregnant
• Sedentary
• Have a family history of gallstones
• Have diabetes
• Have certain blood disorders, such as sickle cell anemia or leukemia
• Losing weight very quickly
• Take medications that contain oestrogen, such as oral contraceptives or hormone therapy drugs
• Have liver disease

If you feel discomfort from what you think are gallstones, see your doctor. To make a diagnosis, your doctor will ask you about your symptoms and carry out a physical examination.

Your doctor may also recommend having blood tests to look for signs of infection or check if your liver is working normally.

If your symptoms and test results suggest you have gallstones, you will be referred for more tests, such as an ultrasound scan or an MRI.

If you don’t experience any symptoms with your gallstones, generally they don’t need to be treated. There may be certain scenarios where treatment may still be advisable, especially if you:

• Have other medical conditions that mean that if you do develop complications from your gallstones you may not cope with them very well
• A higher-than-average risk of developing gall bladder cancer
• A calcified (“Porcelain”) gall bladder

A healthy diet won’t cure gallstones or completely eliminate your symptoms, but it can improve your general health and help control pain caused by gallstones, as rich, fatty meals are more likely to trigger attacks of gallstone pain.

If you have symptoms, surgery to remove the gallbladder is the recommended treatment. There are no effective medications that dissolve gallstones. The few medicines that are available are of doubtful efficacy, take months or years of treatment and the gallstones are likely to return once the medication is stopped. Breaking down the stones with ultrasound waves (shockwave lithotripsy) works well for urinary stones but not for gallstones. Removing only the stones but leaving the gall bladder mean that they will form again.

You can lead a normal life without a gallbladder. Your gallbladder is usually removed via keyhole surgery (laparoscopic cholecystectomy).

If a stone has passed into your bile duct, you may need Endoscopic retrograde cholangio-pancreatography (ERCP) – an endoscopic procedure to remove gallstones from the bile duct.

If you need more information, our team of expert specialists are here to help.