What are gallstones?

The gall bladder is a small, pear-shaped muscular sac under your liver. It stores the bile produced by your liver. Bile is a greenish-brown liquid and helps with the digestion of fats in the small intestine.

The gall bladder releases bile into the intestine through small tubes called bile ducts, which join together and form the main bile duct. The gallbladder contracts when we eat and empties the stored bile into the main bile duct. The bile passes along the duct into the small intestine.

Two types of gallstones can form:

• Cholesterol stones
• Pigment stones (bilirubin)

How do you know if you have gallstones?

Gallstones mostly remain in the gallbladder and cause no problems, but if they partially or completely block the flow of bile they may cause an attack of biliary colic.

Bilary colic causes severe pain in the upper abdomen, nausea and vomiting. Pain is usually most intense on the right-hand side, just below the ribs and is caused by the gallbladder squeezing hard to dislodge the stones.

The pain can last just a few minutes, but more usually lasts several hours. An episode may only happen once in your life, or it may flare up from time to time. Less severe pains occur now and then, particularly after a fatty meal.

How serious are gallstones?

Gallstones can lead to an infection. Cholecystitis is inflammation of the gallbladder and symptoms develop quickly to include abdominal pain and fever. If pain is acute you may need to go to hospital.

More serious complications caused by gallstones are obstructive jaundice and acute pancreatitis (inflammation of the pancreas).

When a gallstone totally blocks the bile duct, jaundice is usually the result. The blockage causes bile to seep into the bloodstream. Your skin and the whites of your eyes go yellow and your urine will be dark and stools pale.

The pancreatic duct and the main bile duct join together before opening into the small intestine ⁽¹⁾. The pancreatic duct carries a fluid rich in enzymes. The gallstone can block both ducts and result in inflammation of the pancreas which leads to biliary colic ⁽²⁾. You may feel this just behind your ribs, spreading through to your back and experience nausea, vomiting and fever.

What are the risks of developing gallstones?

Nobody can say precisely who will develop gallstones, but they do seem to run in families.

Women ⁽³⁾ are more likely to develop them, especially if they are overweight and/or have been pregnant. They are also common in people who have recently lost weight.

If you take an oral contraceptive or are undergoing high-dose oestrogen therapy to treat osteoporosis and the menopause, you also have a higher risk of developing gallstones.

Gallstones occur when your liver produces bile with high cholesterol content.

An excess of cholesterol in your bile may be due to the following factors:

• Getting older
• Taking oral contraceptives
• Eating a diet high in fats
• Having an excessive amount of cholesterol in the blood (hypercholesterolaemia)
• Eating too many refined carbohydrates, such as white bread, cakes, and low-fibre cereals
• Liver disease that reduces the levels of bile salts

Gallstones occur when there is too much bilirubin in your bile. Bilirubin is produced when your body breaks down old red blood cells.

People with the following conditions can develop bilirubin gallstones:

• Cirrhosis (liver disease)
• Infections in the bile duct
• Sickle cell anaemia ⁽⁴⁾

How will the doctor diagnose gallstones?

Doctors may first suspect gallstones due to the location of your pain. You will have blood tests and an ultrasound scan. Sometimes an endoscopy procedure may be carried out.

Most of the time, gallstones are found when the abdomen is scanned for other reasons. Even if your doctor does find gallstones, they may not be the cause of the problems being investigated.

How are gallstones treated?

Not all gallstones need removing, especially if they cause few symptoms. The frequency and severity of biliary colic episodes and other complications will determine whether treatment should begin ⁽⁵⁾.

Stones located in the gallbladder are normally treated by removing the gallbladder in a surgical procedure known as a cholecystectomy. This can be carried out through keyhole surgery, so you'll be in hospital for a few days and need a couple of weeks to recover ⁽⁶⁾.

In 10 per cent of patients, however, keyhole surgery is not possible, so an open cholecystectomy operation will be necessary. The gallbladder is removed through a large cut in your abdomen, so you may need a longer stay in hospital and rest for about six weeks ⁽⁷⁾.

If you have your gallbladder removed, you can still eat a normal diet. You may feel bloated or get indigestion once in a while, especially if you eat food with a high fat content. There may be an increase in the frequency of passing stools, but this can be treated by anti-diarrhoeal medication.

Cholesterol gallstones can sometimes be dissolved with medication, but this can take a long time and does not always work.

Endoscopic retrograde cholangiopancreatography (ERCP) is a surgical procedure which allows the removal of gallstones without removing your gallbladder. You will have a local anaesthetic, which means that you will be awake, but will not experience any pain.

An endoscope is passed through your mouth, down through your digestive system and into your gallbladder. An electrically heated wire is passed through the endoscope and used to widen the opening to your bile duct to allow stones to be removed or pass naturally. This procedure can be carried out when surgery is not appropriate, especially in elderly and frail patients, for example.

How can I stop getting gallstones?

Diet is important to prevent gallstones. A low fat, high fibre diet is recommended, so eat plenty of fresh fruit and vegetables and whole grains. Remember that your body does need some cholesterol, so do not cut fats out altogether.

If you are overweight, you will have more cholesterol in your bile, so the chance of developing gallstones increases. Try and maintain a healthy weight by having a balanced diet and taking plenty of regular exercise. Some experts suggest a mainly vegetarian diet ⁽⁸⁾ and cutting back on alcohol ⁽⁹⁾.

Avoid rapid weightloss diets, as it disrupts your bile chemistry, increasing the chance of gallstones. You should aim for gradual weightloss.

Infolinks:

• CORE - Digestive Disorders Foundation