Gallstones
Where is my gallbladder and what
does it do?
The gallbladder is a small pear shaped sac with a capacity of around
50 mls which is situated just below the liver. Its main job is to
collect bile which is then released into the gut after eating to aid
digestion particularly of fatty foods.
How common are gallstones and how
do they form?
Gallstones are very common, their incidence increases with age and
they are far more common in females. They are seen in around 10% of
women in their forties and 30% over the age of 60. the incidence of
gallstones in men is roughly half that for women. Bile contains a
variety of substances such as cholesterol, phospholipids, bile salts
(the by-products of red blood cell breakdown) and water. These
substances remain in solution but when one of them becomes too
concentrated it begins to precipitate and form a stone. These stones
may continue to grow in size as more of the bile constituents “stick”
to them or a great many may form in a similar way. A number of factors
may contribute to the formation of stones including obesity, small
intestinal disease (such as Crohn’s disease), oestrogen (such as the
oral contraceptive pill), diabetes and liver disease, although the
majority of patients with gallstones do not have any serious
underlying disease to account for their formation.
What symptoms do gallstones cause?
Gallstones may give rise to a variety of symptoms, the following is a
synopsis of the most common;
Silent gallstones
The vast majority of gallstones cause no symptoms at all and are often
detected incidentally by a scan performed for other reasons. These
stones are unlikely to cause the patient any problems and are usually
don’t require any treatment.
Chronic cholecystitis or Biliary
colic
Gallstones may cause pain which presents as recurrent, intermittent
bouts of pain in the upper abdomen which is often related to eating
fatty foods. This may also give rise to a mild fever and vomiting.
Pain is often cramping in nature and usually settles without seeking
medical treatment, only to return at a later stage and is caused by
the gallbladder contracting onto the stones which may temporarily
block the gallbladder.
Acute cholecystitis (inflammation
of the gallbladder)
This occurs when the gallstone blocks the gallbladder causing
inflammation that doesn’t resolve spontaneously. Patients often have
severe, sharp pain below the ribs on the right side which requires
admission to hospital. These symptoms usually settle with time,
antibiotics and bowel rest but often require an operation to prevent
the pain from returning.
Jaundice
Stones may pass from the gallbladder and lodge in the common bile duct
without passing into the gut. In this case the bile can not pass from
the liver into the gut, the by-products of red blood cell breakdown
can not be excreted from the body and the patient develops jaundice
with classical pale stools and dark, tea coloured urine.
Pancreatitis
Pancreatitis is the most dangerous complication of gallstones and can
be life threatening. A stone may lodge in the bile duct which causes
inflammation of the pancreas gland as digestive juices become
activated in side the gland causing the tissue to digest itself.
Pancreatitis leads to sudden onset, severe upper abdominal pain
requiring admission to hospital.
How can my gallstones be diagnosed?
Gallstones are usually seen clearly by a simple ultrasound test. In
some cases an MRI scan may be used to visualise the stones
particularly if they are present in the bile ducts.
Treatment for gallstones
The majority of gallstones do not require any medical treatment with
only 2% of those found to have silent gallstones developing symptoms
each year. Patients with chronic cholecystitis can often manage by
following a low fat diet but many patients prefer to undergo an
operation to remove the stones. Gallstones can be dissolved with drugs
however this is a very slow process and they usually reform. Currently
the best treatment for gallstones is to remove the gallbladder by
keyhole surgery (laparoscopic cholecystectomy). People have no
difficulties living a normal life and eating a normal diet without
their gallbladder and around 40,000 cholecystectomy operations are
performed in the UK each year. The majority of patients are able to go
home the same day as the surgery.
Only around 5% of patients have to
undergo a more “traditional”, open operation, which is usually
performed in particularly complex cases. This results in a much larger
scar and a slower recovery but may be necessary when the gallbladder
is particularly inflamed or there are stones present in the bile ducts
which require removal. Although laparoscopic cholecystectomy is
generally very safe, 0.3% of people sustain injuries to their bile
ducts which may require further surgery to correct. If a patient has
been jaundiced or has abnormal liver tests it is important to ensure
there are no stones in the bile ducts, this is generally done before
the operation by means of an endoscopy known as an ERCP. This is
performed under sedation and may require an overnight stay. Stones may
also be removed from the bile ducts at the time of surgery either
laparoscopically or by an open operation.
What happens after surgery?
Patients can usually go home the same day and return to normal
activities as soon as they feel ready.
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