Introduction to Gallstones
Gallstones are small stones that form in the gallbladder, a small sac-like organ which sits behind the liver on the right hand side of the abdomen.
What are Gallstones?
Gallstones are small stones that form in the gallbladder, a small sac-like organ which sits behind the liver on the right hand side of the abdomen. It is responsible for the storage of bile. Bile contains cholesterol and bilirubin and with changes in concentrations, stones may form. Most stones do not cause any problems and can be left alone. Occasionally, a stones can obstruct the exit of the gallbladder and cause a severe episode of pain that can last several hours. This can sometimes lead to a condition called acute cholecystitis, which is when the gallbladder becomes inflamed due to an infection. This can develop into a chronic condition if it is not managed.
What causes Gallstones?
Stones can form for many reasons. There could have been a change in the concentration in the gallbladder due to dehydration, causing a stone to form. Elevated levels of cholesterol and/or bilirubin can increase the chance of stone formation (80% of stones are made of cholesterol). Such chemical imbalances allow for the formation of small crystals which slowly grow into stones that can be relatively large. These stones don’t always cause problems.
What are the symptoms of Gallstones?
If a stone impacts and obstructs the exit of the gallbladder (cystic duct) or common bile duct, there is intense abdominal pain on the right upper side of the abdomen underneath the ribs and/or in the centre of the abdomen. This can last for a few minutes up to five hours and can radiate to the back. This episode of pain may be a one off or may occur again in a few weeks or months. The obstruction can cause a change in the colour of your skin (jaundice). Jaundice is when the blockage of bile flow causes an increased amount of bilirubin pigment (bile component) to be reabsorbed back into the blood, causing a yellowing of the skin and eyes. This is known as uncomplicated ‘biliary colic’. It can become ‘complicated’ if the gallbladder becomes infected causing inflammation; additional signs and symptoms such as vomiting, sweating, fever and a tender abdomen may be present. Blood tests will reveal if the gallbladder has become inflamed and infected and will guide treatment.
How are Gallstones treated?
The treatment plan for gallstones depends on how much it affects your life. If you get one episode and haven’t experienced another since, you may wish to leave any interventions and monitor if the symptoms return, at which point you can discuss an intervention.
If the case is complicated or occurs frequently, you will need to receive an intervention to treat the infection (in complicated cases) and possibly remove the gallstone and/or gallbladder (in complicated and frequent uncomplicated cases).
Immediate management is with strong pain relief and medication to treat any nausea and sickness you may experience. There are medications that you may receive, that can dissolve the gallstones. However, these are rarely effective.
The surgery for removing the gallbladder is keyhole, which is where the surgeon accesses the gallbladder using only four small holes in your abdomen. It can also be done via open surgery where the abdomen is opened, although keyhole is preferred. Gallstones can also be removed with an endoscope, which is a large tube that is placed into the body via the mouth.
Education and lifestyle advice (e.g. diet) will be given to reduce the risk of another event and the doctor may review your medications to check if there are any drugs that could have caused or increased the risk of gallstone formation.