What is it?
Gallstones are hard lumps of crystals that develop within the gall bladder. The gall bladder is a small sac like organ located underneath the liver. Between meal times it collects and stores bile from the liver. Bile is a mixture of chemicals that help the digestion of food. At meal times the gall bladder squeezes the bile out and into the intestines.
Stones develop from the chemicals in bile. They are usually made of cholesterol, but can also be from pigments produced by the liver and may contain calcium salts.
Many factors increase the risk of developing gallstones:
Signs and symptoms
The majority of gallstones do not cause any symptoms. Pain at the top right side of the abdomen can occur if the gallstone blocks the cystic duct during contraction of the gall bladder. This is known as biliary colic. The pain is often linked to fatty meals (when the gall bladder contracts). Normally the pain is very intense and lasts at least 30 minutes but begins to subside within an hour. usually an attack of biliary colic lasts less than 6 hours.
In some cases of gallstone disease the stone permanently blocks the cystic duct, resulting in inflammation of the gallbladder. This condition is known as acute cholecystitis. In acute cholecystitis the pain is severe, unrelenting and prolonged (usually longer than 5 hours). The pain is typically accompanied by a fever. Bacterial infection can also occur requiring the affected patient to stay in hospital to receive antibiotics.
Occasionally the stone may move out of the gall bladder and into the tube which carries bile to the intestine (known as the common bile duct). This can cause jaundice (yellow skin and eyes). The patient may also notice dark urine and light coloured faeces.
Acute cholangitis (inflammation of the common bile duct) occurs if bacteria enter the blocked tube. This leads to a high fever often with pain, vomiting, and extreme tiredness.
Gallstones can become lodged at the junction of the pancreas and common bile duct. This leads to inflammation of the pancreas (pancreatitis).
Tests
Blood tests can show signs of inflammation and infection:
Blood tests can also demonstrate any damage to the liver or pancreas as a result of blockage or infection:
Ultrasound will show almost all gallstones over 4mm. CT and MRI scans may also be used.
Treatment
Treatment for gallstones that cause pain is an operation called cholecystectomy. This is usually done by key-hole surgery and normally involves only an overnight stay in hospital. The operation is undertaken some weeks after an attack to let the gall bladder settle down before surgery.
Alternatives to surgery can only be used in a few patients. These include shattering the stones with shockwaves, injecting a solution to dissolve the stones or medication. If the gall bladder is not removed through surgery then long-term treatment is required to prevent new stones.
If gallstones are picked up by chance, but have caused no pain, then no treatment is required.
Gallstones in the common bile duct need to be removed urgently. An ERCP (endoscopic retrograde cholangiopancreatography) is a variation of an endoscopy. A thin, long flexible tube (endoscope) is used to reach the common bile duct and dye is injected to outline the stone. The exit of the tube can be widened and the stone removed.
In most patients with gallstones in the common bile duct the gall bladder will also be removed to prevent future stones.
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