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Gallstones

Key topics

The following information aims to answer a number of common questions that many patients have about their gallstones and the possible treatment options for them.

What are Gallstones?

They are stones that form in the gallbladder. The gallbladder is on the right side of the upper abdomen, just beneath the liver and the ribs.

It stores and concentrates the bile, which is produced by the liver. The presence of food in the stomach and the duodenum makes the gallbladder release bile into the intestine via a channel  called the bile duct to aid digestion. Gallstones may often be present and cause no symptoms.  However, very severe pain can be caused when the gallbladder is made to contract on gallstones. This is usually caused by a fatty meal. Lesser degrees of bloating, wind and indigestion may result from gall bladder disease.

If, when the gallbladder contracts, stones pass from the gallbladder into the bile ducts, they may obstruct the flow of bile. This may produce jaundice, which is characterized by a yellow tint of your eyes and skin; this occurs because the yellow pigment in the bile cannot leave the liver and overflows into the blood stream.

This pigment is also responsible for the normal brown colour of your bowel motions so when bile does not reach the intestine because of stone obstruction, the bowel motions become pale.

The urine also becomes dark, as the bile pigments produced by the liver overflow into the urine. When jaundice has been present for a long period of time, itching of the skin occurs due to build-up of bile salts in the skin.

Gallstones can also rarely cause inflammation of the pancreas gland (pancreatitis). This is a serious condition which would require hospital admission.

How do gallstones occur?

Several factors have been identified. First, bile contains a chemical known as cholesterol. If the amount of cholesterol in the bile increases, then cholesterol stones may form. Secondly, when the gallbladder does not empty properly, bile becomes stagnant, infection is more likely and, as a result, small amounts of debris may be formed. Calcium, phosphate, bile pigment and cholesterol are found within this debris and over a period of time the debris builds up to form gallstones.

Why do gallstones occur?

Gallstones may occur any age. They are present in about one in five of the population over the age of 40. In pregnancy, the hormonal changes result in incomplete emptying of the gall bladder therefore stagnation and stone formation is more likely. With certain disease or operations of the small bowel, cholesterol stones may form. In some blood disorders where red cells are destroyed, more bile pigment is produced and this may also result in gallstones. There can often be a family history of gallstones. However, the main reason for a high incidence of gallstones in the UK is the high fat content of the typical diet.

What does the treatment / management involve?

Gallstones are normally treated by an operation. Other approaches have been tried in the past but are much less effective. If gallstones do not contain calcium, bile salts may be administered to help them dissolve. However, this is a prolonged course of treatment (1-2 years), this treatment has side effects including skin rashes and diarrhoea and when the treatment is stopped, the gallstones will come back.

Patients who are elderly or unfit for surgery and who have jaundice may have the gallstones removed from the bile duct without removing the gall bladder. This is done by passing a flexible telescope (endoscopy) through the mouth into part of the intestine called the duodenum; this allows access to the lower end of the bile ducts. This procedure is called an ERCP (Endoscopic Retrograde CholangioPancreatogram).

This method is occasionally used in patients to improve their general condition and make them fitter for surgery at a later stage. It cannot be used for stones within the gallbladder however.

Surgery will involve removal of the gall bladder. This is known as a Cholecystectomy and is the treatment of choice for most patients. The gall bladder can be removed by ‘keyhole surgery’ or by open surgery, but the vast majority of gall bladders are removed by ‘keyhole surgery’. This is often referred to as a Laparoscopic Cholecystectomy.

However, if your surgeon anticipates difficulties he may advise you to have an open operation.

What would happen if your gallstones are not dealt with?

Most people with gallstones have no symptoms. We would not usually advise an operation if you have no symptoms or have had no complications as a result of gallstones.

However, it is believed that around 10–30% of gallstones become symptomatic. Untreated gallstones may continue to cause bouts of severe pain, known as biliary colic.

Gallstones increase the likelihood of inflammation and infection of the gall bladder (cholecystitis). Very rarely, an abscess can develop within the gall bladder (empyema) or the gallbladder may burst (perforate).  If gallstones get stuck in the bile duct system they may stop the flow of bile from the liver to produce obstructive jaundice.

Gallstones in the bile ducts may also rarely cause inflammation of the pancreas (pancreatitis). These are serious complications and once they have occurred we would advise cholecystectomy to prevent further attacks.

The majority of people with gallstones will experience little or no symptoms from them and the long term risk of not having an operation is low. 

Surgery

Click here for further information on what a Cholecystectomy to remove your gallbladder involves.