What are gallstones?
Gallstones are stones that build up in the gallbladder and can cause a variety of symptoms. The gallbladder is a pear-shaped organ that sits under the liver in the upper right side of the tummy. The liver produces bile that helps the body digest and absorb fat. Between meals, bile is stored and concentrated in the gallbladder. When fat from food enters the small bowel, this makes the gallbladder squeeze to deliver bile into the bowel to mix with fat from the diet.
Gallstones are more common in women, particulary those who have had multiple prgenancies, in people who are overweight or obese, as well as with certain conditions such as sickle cell anaemia. Gallstones are very common, affecting 10-15% of adults in the UK.
What problems can gallstones cause
Gallstones can cause a variety of problems. Many people have gallstones and do not get any problems or symptoms from them. However, in other people, gallstones can cause different conditions that cause pain and other symptoms which are explained below.
Pain. Gallstones commonly cause intermittent pain in the upper part of the tummy. This is often in the upper middle, to the upper right side, and through to the back. This pain often lasts a few hours at a time, following eating fatty foods or at night. When the pain is severe, many people feel sick, they may vomit and they may also feel hot and sweaty. This is the most common problem from gallstones and is called biliary colic. It usually slowly gets better after a few hours.
If the pain continues for more than a few hours, it may be a sign of a different problem from gallstones. This includes the gallbladder becoming inflamed (called cholecystitis). With cholecystitis, in addition to the pain lasting for many hours or even days, and a person may have a fever and feel generally unwell. It is important to see a doctor who will examine you, take your temperature, may take blood tests and will usually prescribe a course of antibiotics. Some people with cholecystitis require emergency admission to hospital for pain relief, intravenous antibiotics and monitoring.
Similar pains may be caused by other gallstone problems. The exit from the gallbladder may be blocked permanently by a gallstone, or a gallstone can move from the gallbladder into the bile ducts. These are tubes taking bile from the liver to the bowel. Stones in the bile duct can cause jaundice (yellowing of the skin and eyes), pancreatitis (inflammation of the pancreas gland) and cholangitis (infection in the bile ducts). These conditions can be serious and require medical attention.
Nausea and vomiting. Many patients feel sick and may vomit when they have pain from their gallstones. Much less commonly, gallstones can move into the bowel and cause a blockage which results vomiting and the bowels stop working.
Fever. Inflammation of the gallbladder (cholecystitis) and other problems from gallstones such as cholangitis may cause a fever. These problems often make a person feel generally unwell as well as having pain. Doctors often prescribe antibiotics for these conditions, and may refer patients to hospital for further tests or treatment if needed.
Jaundice. A gallstone may leave the gallbladder and enter the bile ducts which go from the liver into the bowel. If a stone gets stuck in this tube it may stop bile flowing into the bowel. This blockage causes a build up of bile which can accumulate in the skin and whites of the eyes, which develop a yellow colour, and the urine turns very dark. This requires urgent medical attention to investigate the cause and determine if gallstones stuck in the bile tube are the cause and need removing. Removal of a stone that has become stuck in the bile duct is often done with a telescope inserted through the mouth (called an ERCP).
What can be done for my gallstones?
Depending upon whether your gallstones are causing you problems, your general health, and your preferences, there are a variety of options to manage gallstones. All the different options for management have pros and cons which will be discussed with you by your doctor. These include:
- Symptom management including pain relief
- Tablets to try and dissolve gallstones
- Surgery to remove the gallbladder containing the gallstones
Surgery. If a person starts to have problems from their gallstones, and they are otherwise fit and well, surgery is usually recomended. For most people, surgery to remove the gallbladder can be performed using keyhole techniques through four small incisions. Most people can go home the same day as surgery, or the following morning. The particular benefits and risks of surgery will be discussed with you by your surgeon to help you make an informed decision about whether or not to have your gallbladder removed.
