Gallstones

Gallstones are tiny stones typically composed of cholesterol. They tend to develop in the gallbladder and stay there, though it is possible for the stones to move out of the gallbladder and this can contribute to severe symptoms. In the majority of cases, gallstones do not result in any symptoms but if they become entrapped in the ducts or escape from the gallbladder this can be a cause for concern.

How do gallstones develop?

The gallbladder is a small sack-like organ located underneath the liver. It is responsible for storing bile (gall is an old-fashioned term for bile). Bile contains a number of different chemicals and gallstones develop as a result of the bile being unable to keep these chemicals in liquid form (this may be caused by a chemical imbalance). These stones often start as small crystals and increase in size. Sometimes there is just one stone but it is possible for somebody to have several stones.

How common are gallstones?

It is estimated that around 10-15% of the adult population in England and Wales have gallstones, although most people do not suffer any symptoms and are unaware of the stones. Gallstones are the most common reason for emergency admissions of people with abdominal pain, and around 50,000 operations are carried out each year to remove the gallbladder. Women are much more likely than men to develop gallstones and they tend to be more common in older people.

What causes gallstones?

Experts believe gallstones form as a result of an imbalance in the chemicals in bile, a liquid that is produced by the liver to digest fats. There are a number of risk factors for gallstones, including:

Gender: women are up to 3 times more likely to develop gallstones than men.
Age: the risk of gallstones increases with age, although they can still affect younger people.
Obesity.
Liver cirrhosis.
Family history: around 30% of people with gallstones have a close family member who has had gallstones.
Crohn’s disease and irritable bowel syndrome.
Taking certain forms of medication, including an antibiotic called ceftriaxone, which is used to treat pneumonia and meningitis.

Symptoms of gallstones

Many people with gallstones do not experience any symptoms and they are usually found during investigations for other conditions. Gallstones only cause problems if they move from the gallbladder, where they can become trapped in the bile ducts, or escape into other areas of the body. This movement can result in the following symptoms:

Severe abdominal pain: known as biliary colic, which is an intense pain that comes on very quickly and can last up to 5 hours. It usually develops at the top of the abdomen or on the right hand side).
Jaundice (this causes yellowy skin and eyes).
Nausea.
Vomiting.
Sweating.

Complications of gallstone disease

If the gallstones escape from the gallbladder and cause symptoms, this is known as gallbladder disease. The three most common symptoms of gallbladder disease are:

Acute cholecystitis (inflammation of the gallbladder): symptoms include fever, a racing heartbeat and pain in the abdomen, which spreads to the shoulder blades.
Acute pancreatitis (inflammation of the pancreas): symptoms include sudden pain at the top of the abdomen, nausea, vomiting, diarrhoea, fever and a loss of appetite.
Acute cholangitis (inflammation of the bile ducts): symptoms include fever, nausea, confusion, itchy skin and pain at the top of the abdomen.

When should I see a doctor?

You should seek urgent medical help if you experience a high temperature and abdominal pain that do not go away after 8 hours. If you are experiencing abdominal pain on a regular basis and it comes and goes, it is also advisable to see your GP.

Diagnosing gallstones

Gallstones can be discovered during tests for other conditions, including blood, ultrasound and cholesterol tests. If you have symptoms of gallstones your GP will ask you about relevant symptoms and will check your heart rate and temperature. This will help them to determine if you have a case of complicated gallstone disease. Your GP may also perform an examination to check for tenderness and inflammation. If they suspect you have gallstones they will refer you for an ultrasound scan. If the scan shows that stones are present a test called a cholangiography may be carried out. This involves injecting a coloured dye into the bloodstream to enable doctors to see X-ray images of the gallbladder and find out more about the stones and state of the gallbladder. Once the doctors have more information about the gallbladder they can draw up a treatment plan.

Treating gallstones

If you do not have any symptoms your doctor may not recommend treatment and will adopt a policy of ‘watchful waiting’. This means that your condition will be monitored carefully. If you do develop symptoms the most common treatment is to remove the gallbladder (this is known as cholecystectomy), which can now be done via keyhole surgery and it is a relatively straightforward procedure.

Will I be able to live normally without a gallbladder?

The gallbladder is an important organ but you can survive without it and live a normal life. Many people have their gallbladders removed and doctors recommend it as the best treatment for people who have problems with their gallstones. It may be necessary to adapt your diet slightly if you have had your gallbladder removed and avoid eating fatty foods.

Alternatives to surgery

Some people may prefer not to have surgery and, if this is the case, there are other treatments available but they are not always effective. If you only have very mild symptoms taking painkillers to ease episodes of biliary colic may be sufficient, but if you have more severe symptoms you may be advised to have a procedure known as ERCP (endoscopic retrograde cholangiopancreatography), which involves using an endoscope (a thin, flexible tube) to remove the stones.