Gallstones

What is the gallbladder? How do gallstones form?

The gallbladder is a pear-shaped organ present below the liver. It collects bile from the liver, and concentrates and transports it to the small intestine for the digestion of fats.

An imbalance in the contents of bile can lead to the formation of a gallstone or many gallstones. There can be two types of gallstones:

Cholesterol stones: Most common type, caused by excess cholesterol in bile

Pigment stones: Smaller stones composed of excess bilirubin, a pigment found in bile

What are the causes of gallstones?

The risks of developing gallstones may include:

Being female
Being obese or overweight
Aged 40 years or more
Suffering from certain liver diseases that affect the flow of bile
Suffering from certain disorders that affect the intestine such as irritable bowel syndrome (IBS) or Crohn's disease
Having a family history of gallstones
Having recently lost weight through diet or weight-loss surgery

What are the signs and symptoms of gallstones?

Upper abdominal band like pain. Pain may be felt in back also, and if the gallbladder is inflamed, under the ribs on the right side of the abdomen.

There may be an association with food, though not always.

Attacks of pain may be unpredictable and associated with nausea and vomiting. This pain is often referred to as biliary colic.

How are gallstones diagnosed?

Gallstones are commonly diagnosed through imaging studies. Upper abdominal ultrasound is the best test to diagnose gallstones, however you may also need an MRI scan, CT scan or cholangiography (a dye injected into the bile ducts is tracked using X-ray imaging).

Liver Function Tests (blood test) are also performed.

What are the consequences of not treating gallstones?

Certain gallstones that do not cause symptoms do not require treatment. However, left untreated, gallstones may become symptomatic. They can cause inflammation in the bile ducts, gallbladder, liver or pancreas. This can in turn lead to infection, obstructive jaundice and even cancer.

What treatment choices are available for gallstones?

Laparoscopic Cholecystectomy is the gold treatment option for gallstones

This is minimally invasive or key hole surgery whereby four small incisions are made on your body and the gallbladder is removed along with the stones.

Can I have the stones removed and not my gallbladder?

The only effective treatment for gallstones is removal of the gallbladder because by removing the stones only, the problem will re-present in a relatively short time frame.

Can I have gallbladder pain without gallstones?

Some people experience typical gallbladder type pain in the absence of gallstones. This requires further investigation and exclusion of other diseases. Occasionally, a specific test of gallbladder function is done to assess its filling and emptying. In selected cases, gallbladder removal may be advised if symptoms continue.

Complex Gallstones

Some people will endure repeated attacks of gallbladder pain over many years without any complications occurring. However, complications can and do occur, and the following should be considered very carefully if you decide not to have surgery for your symptomatic gallstones.

The major complications of gallstones are:

Acute cholecystitis (inflammation of the gallbladder): The stone gets stuck in the outlet of the gallbladder and does not release. First, there is a chemical reaction of the bile literally starting to digest the gallbladder causing inflammation and unremitting pain. Then, the bacteria, naturally occurring in the gallbladder, get into the act, and the resulting infection makes the situation worse and can lead to gangrene of the gallbladder. Emergency surgery is usually recommended and keyhole surgery may not be possible.
Jaundice (yellow discolouration of the skin and eyes): This occurs when a stone gets stuck in the main bile duct and blocks bile going from the liver to the bowel. There is a backup of bile into the liver, which then cannot function properly. Bile is absorbed into the bloodstream and this stains the skin and other organs a yellow colour. Secondary infection of the bile ducts can occur (cholangitis) which can be life-threatening. The stone(s) must be removed from the bile duct urgently by ERCP or surgery.
Pancreatitis A stone in the main bile duct can interfere with the pancreas and cause pancreatitis. This is potentially a life-threatening illness and requires hospital treatment by an experienced surgical team.
Cancer Although rare, cancer of the gallbladder can occur and may be fatal. Cancers usually occur when gallstones have been present for 20 years or more.