Gallstones

About gallstones

The gallbladder

Your gallbladder is a small, pear-shaped pouch in the upper right part of your abdomen (tummy). It’s connected to your liver and bowel through your bile duct, which is also attached to your pancreas. Between meals, it stores bile that is produced by your liver. Bile is released into your bowel when you eat. This helps your body to digest fats and other substances.

What are gallstones?

Gallstones are solid lumps that develop from the chemicals and substances in bile. They vary in size and can take years to develop. Sometimes, they become large and can block your bile duct, or travel through your bile duct and block the opening to your pancreas.

There are two main types of gallstone:

  • Cholesterol gallstones are the more common type and form if you have too much cholesterol in your bile.
  • Pigment gallstones form when there is too much bilirubin in your bile. Bilirubin is a waste product from the breakdown of red blood cells. This type of gallstone can develop if you have a blood disorder, such as sickle cell anaemia.

Symptoms of gallstones

Most people with gallstones have no symptoms, so you may not know that you have them.
 

Symptoms usually start when one or more gallstones move out of your gallbladder and into your bile duct, where they can become stuck. This can cause pain, which is called biliary colic, and inflammation, which is called cholecystitis.

Common symptoms of gallstones may include:

  • severe upper abdominal pain on your right-side, which may spread to the centre of your back and tip of your shoulder blade – this may last for several hours
  • feeling sick or vomiting
  • a high temperature, shivering and sweating

These symptoms aren't always caused by gallstones but if you have them, see your GP.

Complications of gallstones

If your gallstones are causing you symptoms and aren't removed, they can cause complications. These include inflammation, infection and blockage of your gallbladder, bile duct or pancreas. Large gallstones can also become stuck in your bowel, which can block it. Gallstones can also lead to cancer of the gallbladder.

If a gallstone obstructs your bile duct and becomes infected, you may have a high temperature, shivering and sweating. This is known as cholangitis and it’s important that you see your GP for diagnosis and treatment as soon as possible.

Causes of gallstones

You can develop gallstones at any age, but your chances of getting them increase as you get older. Around one in 10 women in their 60s have gallstones. Women are up to three times more likely to get gallstones than men.

You're more likely to get gallstones if:

  • a member of your family has had gallstones
  • you’re overweight
  • you have lost weight quickly
  • you’re pregnant
  • you take hormone replacement therapy
  • you have Crohn’s disease
  • you have an inherited blood disorder, such as sickle cell anaemia

Diagnosis of gallstones

Many people don’t get symptoms from gallstones. Gallstones are sometimes found when people have tests for other health problems.

If you visit your GP with symptoms of gallstones, he or she will ask you about your symptoms and examine you. This may involve him or her feeling your abdomen to see if it’s tender or swollen.

You may have further tests. The main ones are listed below.

  • Blood and urine tests to check for inflammation and to see how well your liver is working.
  • An ultrasound scan – this uses sound waves to produce an image of the inside of the body. Gallstones usually show up well on an ultrasound scan.
  • Magnetic resonance imaging (MRI scan), to look at your bile duct.
  • Endoscopic retrograde cholangio-pancreatography (ERCP). This is a detailed X-ray of your pancreas and bile ducts using a special dye and a narrow, flexible, tube-like telescopic camera called an endoscope.

Treatment of gallstones

If your gallstones aren’t causing any symptoms, your doctor may suggest leaving them alone as they usually don’t cause any problems. If your gallstones are causing symptoms, you may need treatment.

Self-help

You can manage your symptoms using over-the-counter painkillers and see whether the problem gets any worse. This is called watchful waiting. Your GP will monitor your condition and he or she may suggest further treatment if your symptoms worsen.

Surgery

If your gallstones are causing pain or if you have jaundice, your doctor may recommend that you have your gallbladder and the gallstones removed. This is called a cholecystectomy.

There are two surgical techniques used to remove your 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.

A laparoscopic cholecystectomy is usually used to remove your gallbladder. However, in some instances you may have an open cholecystectomy, for example:

  • if you can't have keyhole surgery.
  • if the operation has been started as a keyhole procedure and the surgeon considers it safer to convert to an open procedure

If gallstones are in your bile duct, they can sometimes be removed during a procedure called endoscopic retrograde cholangio-pancreatography (ERCP). ERCP is a test that can be used to diagnose gallstones in the bile duct, and if they are found during the procedure, they can sometimes be removed. It’s not possible to remove gallstones from your gallbladder with ERCP, only from your bile duct, and in most cases, this is combined with a cholecystectomy.

Gallstones can be broken up using shock waves. This is called extracorporeal shock wave lithotripsy (ESWL). A special probe uses high-energy shock waves to break up the stones. However, this treatment is now rarely used.

Prevention of gallstones

Many of the risk factors for gallstones, such as age, gender and family history can't be altered. However, you can reduce your chances of developing gallstones by maintaining a healthy weight.

Eating a vegetarian diet and drinking small amounts of alcohol may also prevent the development of gallstones.

What will happen if I don't have my gallstones removed?

Answer

Gallstones that aren’t causing you any problems can be left alone. However, if you have symptoms, you may need to have the gallstones removed because they can lead to more serious problems.

Explanation

Gallstones often don’t cause symptoms and you may only find out you have them by chance, when you have tests for other conditions. If your gallstones aren't causing you any problems, it may be best to leave them alone. It's common to have gallstones for many years without knowing it.

You’re likely to get symptoms if a gallstone blocks the flow of bile out of your gallbladder or through your bile duct. Common symptoms may include abdominal pain, yellowing of your skin and the whites of your eyes, and feeling sick or vomiting.

If you have inflammation or infection of your gallbladder, you're more at risk of getting cancer of the gallbladder. It's important to remember that gallbladder cancer is very rare and most people with gallstones don't get gallbladder cancer. However, see your GP if you develop any symptoms of gallstones.

Will having my gallbladder removed affect how I can digest food?

Answer

Most people can digest food and drink normally without a gallbladder. However, around one in 10 people get diarrhoea after having their gallbladder removed. You can help yourself by making some changes to your diet.

Explanation

Bile is stored in your gallbladder to help you digest fats, but your body can still work properly without it. Once your gallbladder is removed, bile continuously drains into your intestine rather than being stored and released when you eat. This allows you to digest your food as you usually would.

You probably won't need to stop eating certain foods after having your gallbladder removed. It's common to get diarrhoea, feel more bloated than usual and get some flatulence (gas passed from your rectum) after having your gallbladder removed.

Increasing the amount of fibre you eat may help reduce diarrhoea as it bulks up your faeces and makes it firmer. This means eating plenty of fruit and vegetables, beans, pulses, lentils and wholegrain breads or cereals. Caffeine, spicy or fatty foods and dairy products may make diarrhoea worse. It's important to drink enough fluids if you get diarrhoea.

How much time will I have to spend off work after having my gallbladder removed?

Answer

If you have your gallbladder removed using keyhole surgery (laparoscopic cholecystectomy), you will usually be able to return to work within two to three weeks. If you have open surgery to remove your gallbladder, you will usually take longer to recover than with keyhole surgery. It may be four to six weeks before you can go back to work.

Explanation

Most people can go home on the same day or the day after keyhole surgery. You can usually return to your daily activities, including going back to work, after two to three weeks. However, this varies from person to person and the type of job you do, so it’s important to follow your surgeon's advice.

If you have had open surgery to remove your gallbladder, a larger cut in your abdomen is made. This means your recovery time will take longer than with keyhole surgery. You can usually get back to work within four to six weeks.

It's important to remember that everyone is different – some people may need to rest for longer while others may return to work after a few days. If you have a manual job, where you’re doing heavy lifting, you may need to recover for longer before you can get back to work.

What is Endoscopic retrograde cholangio-pancreatography (ERCP)?

Answer

ERCP is a procedure that can be used to diagnose and treat gallstones that are within your bile duct.

Explanation

ERCP is performed using a narrow, flexible, tube-like telescopic camera called an endoscope. The endoscope is passed through your mouth and down to your stomach to reach the point where your bile duct opens out into your intestine. Dye is injected into your bile duct through the endoscope and an X-ray is taken. This will show if there are any gallstones in your bile duct.



If your surgeon sees a gallstone during the procedure, he or she may be able to remove it using special instruments, or widen your bile duct to allow the stone to pass through naturally. Your surgeon can also put very small drainage tubes in, called stents, which help the bile to flow around a gallstone.

You can have ERCP as an outpatient. You will probably be awake during the procedure, although you may be given a sedative. This relieves anxiety and helps you to relax. When the procedure is finished, you may need to rest until the effects of the sedative have passed. You will be able to go home when you feel ready. You will need to arrange for someone to drive you home.