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Gallstones

What are Gallstones?

The gallbladder is a small pear-shaped organ that acts as a storage tank for bile. The bile is made in the liver by liver cells and is sent through tiny ducts or canals to the duodenum (small intestine) and to the gallbladder. The gallbladder stores the bile to have it available in larger quantities for secretion when a meal is eaten. The ingestion of food and especially fats cause the release of a hormone, which in turn signals the relaxation of the valve at the end of the common bile duct which lets the bile enter the small intestine. It also signals the contraction of the gallbladder which squirts the concentrated liquid bile into the small intestine where it helps with the emulsification or breakdown of fats in the meal.

Gallstones are collections of crystals of various substances in the bile. They look like small stones or gravel and they grow in the gall bladder. Around 5.5 million adults in the United Kingdom have gallstones. They are more common in women than men, but overweight people and those over 60 seem to be more at risk. Gallstones may stay in the gall bladder or move into the bile duct (the tube between your liver and intestine).

gallstones diagram

What causes Gallstones?

There are many risk factors that have been linked to gallstone disease such as increased age, being female and family history. The majority of people who have gallstones are unaware that they have them.

What are the symptoms of Gallstones?

Not all gallstones cause symptoms – often, people do not know that they have them. However, common symptoms of gallstones include:

  1. Upper abdominal pain, which can be central or towards the right side of your body. This pain can be severe and last for hours. It may be difficult to find a comfortable position to sit or lie down in.
  2. Longer lasting pain under the rib cage on the right-hand side, with tenderness or pain when you move.
  3. Nausea/bloating.

All the above symptoms may be triggered by a fatty meal. If the gallstones move from your gall bladder into your bile duct, you may also experience:

  • Jaundice – yellowing of your skin or eyes, sometimes with dark urine or pale motions (stool). This may happen if the bile duct becomes blocked with gallstones.
  • Upper abdominal pain from inflammation (swelling) of your pancreas, known as pancreatitis.
  • Fever/high temperature caused by an infection from inflammation of the bile ducts (cholangitis) or the gall bladder (cholecystitis).

How are Gallstones diagnosed?

Your doctor will ask you about your symptoms, and examine you. He or she may also ask you about your medical history. They will examine you and they may press gently with their fingers over the right-hand side of your abdomen. This area may feel tender if your gallbladder is inflamed.

You may have further tests including:

  • Blood and urine tests to check how well your liver is working
  • An ultrasound scan – this uses sound waves to produce an image of the inside of the body
  • Magnetic resonance cholangiopancreatigram (MRCP) – an MRI scan of the gallbladder, bilary tree and pancreas
  • Endoscopic retrograde cholangio-pancreatography (ERCP) – a detailed x-ray of your pancreas and bile ducts using a narrow, flexible, tube-like telescopic camera called an endoscope
  • Hepatobiliary iminodiacetic acid scan – x-ray images of your gallbladder are taken following injection with iodine dye

How are Gallstones treated?

If the Gallstones are causing you pain, you have jaundice, an inflamed pancreas or you have cancer of your gallbladder you may need your gallbladder removing.

There are two surgical techniques used to remove the gallbladder.

  • Laparoscopic cholecystectomy – your gallbladder is removed through small cuts in your abdomen (tummy), using a surgical technique called keyhole surgery.
  • Open cholecystectomy – your gallbladder is removed through one large cut in your abdomen, using a surgical technique called open surgery.

If you have gallstones but they aren’t causing any symptoms, or surgery to remove them isn’t suitable for you, there may be alternative treatments.