Gallstones

What are gallstones ?

Gallstones are solid pieces of material that form in the gallbladder. They look like gravel or small stones and may be as small as grains of sand or as large as a golf ball. The majority of stones are less than the size of a pea and may take years to grow. There are two different types of stones.

1. Cholesterol stones – these are usually yellow in colour and are primarily made up of cholesterol. They are usually caused when bile contains too much cholesterol. The majority of stones (approximately 80%) are caused in this way.

2. Pigment stones – these are small dark stones, which consist of calcium and bile pigments (known as bilirubin).

What is the gallbladder and bile?

The gallbladder is a small pear shaped organ. The gallbladder is the collecting bag for bile, which helps us to digest food.

Bile is a yellow/brown fluid produced by the liver that helps the body break down fatty foods. Bile is stored in the gallbladder until the body needs it to digest fat. The main contents of bile are water, cholesterol, bilirubin (a pigment that gives bile and stools their colour) and bile salts. The liver may produce up to 3 cups of bile a day.

What causes gallstones?

Cholesterol stones are formed when bile contains too much cholesterol and not enough bile salts. As a result the excess substances form crystal like particles. These particles fall to the bottom of the gallbladder and the crystal particles can fuse together to form gallstones of varying sizes. However, many gallstones remain the same size for years. The cause of pigment stones is uncertain, however, they tend to develop in people who have cirrhosis of the liver. Gallstones may also develop if the gallbladder doesn’t contract as it should e.g. incomplete or infrequent emptying.

It is estimated 1 in 10 people in the U.K. will develop gallstones.

What are the symptoms of gallstones?

Most people will experience no symptoms and are unaware they have gallstones, they are sometimes called silent stones. Silent stones require no treatment.

Symptoms usually start to appear when the stones move and begin to block the pipes, which drain the gallbladder or if the gallbladder wall becomes inflamed. Symptoms when they occur may include:

• Jaundice – this is usually a sign of bile obstruction. Jaundice affects your urine, making it very dark yet making your stools very pale. The whites of your eyes and your skin may turn a dull yellow shade.
• Fever and shivers.
• Nausea and vomiting.
• Pain that can vary from a mild indigestion following a meal, to severe and intermittent pain in the right upper abdomen. This pain may also spread to the chest, shoulders or back. This pain can sometimes be mistaken for a heart attack.

Am I at risk of gallstones?

Anyone can develop gallstones, but factors that may increase your risk include:

• Age – stones are more common with increasing age.
• Being female.
• If you have severe liver disease, this is common in stones caused by calcium and bile pigments.
• Being overweight.
• Pregnant women or women who have used the contraceptive pill or H.R.T..
• People who have recently lost a lot of weight, quickly.

How are gallstones diagnosed?

If your doctor suspects gallstones are causing your symptoms he/she will feel your abdomen to see if your liver is tender or enlarged, you may also be asked to give a urine sample. The doctor will then refer you to a hospital for further tests, which will usually include blood tests and an  ultrasound.

What is the treatment for gallstones?

If gallstones have been discovered as the cause of your symptoms you will need to have the stones and your gallbladder (which causes them to form) removed. The gallbladder is not essential to daily life and most people will not even notice its removal.

There are a number of ways in which your stones and gallbladder may be removed. The most effective method is by keyhole surgery (laparoscopic cholecystectomy).

A general anaesthetic is given and several small cuts are made in the abdomen to allow the insertion of surgical instruments and a small video camera. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close up view of the organs. The surgeon then locates the gallbladder and removes it, through one of the small cuts. This method results in less pain and little scarring. You will normally only need to remain in hospital for 1 or 2 nights.