Gallstones

What are gallstones?

Gallstones are hardened small stones, made up of cholesterol, that form in the gallbladder. Your gallbladder is a small pouch-like organ that’s found just below your liver on the right side of your abdomen.

The gallbladder stores and release bile – a liquid produced by the liver to help digest fats into the digestive tract. Gallstones can range in size from a few millimetres to being as large as a golf ball. The larger the gallstones are, the more likely they are to block the passage of bile and the more likely symptoms will develop. 

What are the symptoms of gallstones?

Gallstones don’t always cause symptoms, especially if they’re not big enough to block the passage of bile through the gallbladder. If a gallstone does block the exit of bile from the bile duct, something known as ‘biliary colic pain’ can happen. This is an intense and sudden pain that can last for between 1-5 hours. 

You may feel pain in the upper-right portion of your stomach, but you may also feel pain in the centre of your stomach, between your shoulder blades or your right shoulder. It’s also common for people to experience ‘attacks’ across weeks or months. 

Gallstones can also cause inflammation of the gallbladder (also known as cholecystitis) and the following symptoms can develop:

• Persistent pain

• Yellowing of the skin and eyes, called jaundice

• High temperature

What causes gallstones?

Gallstones are caused by an imbalance of the chemicals found in the gallbladder. In about 80% of cases, the concentration of cholesterol in the bile is too high and the excess cholesterol hardens to form gallstones. 

Poor flow of bile from the gallbladder is another way gallstones can develop. For example, if the gallbladder doesn’t empty the bile effectively, it can become heavily concentrated and start to crystallise into stones. 

What increases your chances of developing gallstones?

The following factors are shown to increase the risk of gallstones:

• Being overweight or obese 

• Suffering from diabetes or Crohns disease

• Prolonged periods of fasting or a diet high in fat or carbohydrates

• Being female 

• Being aged 40 or over

How are gallstones diagnosed?

An abdominal ultrasound (US) is the most common test used to identify gallstones. The sound waves sent from the ultrasound rebounds off the stones and allows them to be visualised. A US is non-invasive, painless and doesn’t involve any radiation-exposure. 

Occasionally, further scans may be required to view smaller stones, these are: 

• Magnetic resonance cholangiopancreatography (MRCP)

• Endoscopic retrograde cholangiopancreatography (ERCP)

How are gallstones treated?

The treatment of gallstones depends on the severity of symptoms and the results of the diagnostic testing. The decision will be made by you and a doctor together. If there are no, or very minor, symptoms then no treatment is required. 

Treatment is required if you have any symptoms such as stomach pain or any complications such as jaundice. In these cases, you may need to have your gallbladder removed via keyhole surgery (the procedure is called a laparoscopic cholecystectomy). 

You can lead a normal life without a gallbladder as your liver will continue to produce bile to help you digest fat.

Can you get rid of gallstones without surgery?

There are some medications that help dissolve gallstones. However, there are a number of limitations. 

• It can take months or years of treatment to dissolve gallstones 

• They will likely form again if medication is stopped 

• It will only be effective if there is no blockage in the tract

What can you do to prevent gallstones?

There are a few lifestyle changes that may help reduce your chances of having gallstones:

• Maintain a healthy weight - overweight and obese people are more at risk of gallstones and therefore having a healthy diet and remaining active can reduce this risk. 

• Avoid fasting for extended periods 

• Eat more high-fibre diets - including fruits, vegetables and whole grains

• Avoid a diet high in saturated fat

What are the complications of gallstones?

If gallstones are left untreated, the following complications may develop: 

• Cholecystitis - inflammation of the gallbladder causing jaundice, pain and a temperature 

• Pancreatitis - a gallstone can reach the pancreatic duct, causing inflammation of the pancreas (pancreatitis). This results in an intense, constant abdominal pain and usually needs emergency treatment

• Gallbladder cancer - people with gallstones are at a greater risk of developing gallbladder cancer

When should I speak to a doctor?

If you think you have gallstones, you should book an appointment to see a doctor. In particular you should look out for the following symptoms: 

• Intense pain in the abdomen or shoulders

• Yellowing of the skin or eyes 

• A fever