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Gallstones

Key points

  • Gallstones develop from the chemicals and substances in bile.
  • Most people with gallstones have no symptoms, so you may not know that you have them.
  • The main treatment is surgery to remove your gallbladder and gallstones.
  • Your body can still work properly without your gallbladder.
 

Gallstones form in your gallbladder or bile duct. They are formed when the chemicals in a liquid called bile, hardens. One large stone may develop or many small ones.

About gallstones

The gallbladder

Your gallbladder is a small, pear-shaped pouch in the upper right part of your abdomen (tummy). It’s connected to your liver and bowel through your bile duct, which is also attached to your pancreas. Between meals, it stores bile that is produced by your liver. Bile is released into your bowel when you eat. This helps your body to digest fats and other substances.

Illustration showing the gallbladder and surrounding structures

What are gallstones?

Gallstones are solid lumps that develop from the chemicals and substances in bile. They vary in size and can take years to develop. Sometimes, they become large and can block your bile duct, or travel through your bile duct and block the opening to your pancreas.

There are two main types of gallstone:

  • Cholesterol gallstones are the more common type and form if you have too much cholesterol in your bile.
  • Pigment gallstones form when there is too much bilirubin in your bile. Bilirubin is a waste product from the breakdown of red blood cells. This type of gallstone can develop if you have a blood disorder, such as sickle cell anaemia.

Symptoms of gallstones

Most people with gallstones have no symptoms, so you may not know that you have them.

Symptoms usually start when one or more gallstones move out of your gallbladder and into your bile duct, where they can become stuck. This can cause pain, which is called biliary colic, and inflammation, which is called cholecystitis.

Common symptoms of gallstones may include:

  • severe upper abdominal pain on your right-side, which may spread to the centre of your back and tip of your shoulder blade – this may last for several hours
  • feeling sick or vomiting
  • a high temperature, shivering and sweating

These symptoms aren't always caused by gallstones but if you have them, see your GP.

Complications of gallstones

If your gallstones are causing you symptoms and aren't removed, they can cause complications. These include inflammation, infection and blockage of your gallbladder, bile duct or pancreas. Large gallstones can also become stuck in your bowel, which can block it. Gallstones can also lead to cancer of the gallbladder.

If a gallstone obstructs your bile duct and becomes infected, you may have a high temperature, shivering and sweating. This is known as cholangitis and it’s important that you see your GP for diagnosis and treatment as soon as possible.

Causes of gallstones

You can develop gallstones at any age, but your chances of getting them increase as you get older. Around one in 10 women in their 60s have gallstones. Women are up to three times more likely to get gallstones than men.

You're more likely to get gallstones if:

  • a member of your family has had gallstones
  • you’re overweight
  • you have lost weight quickly
  • you’re pregnant
  • you take hormone replacement therapy
  • you have Crohn’s disease
  • you have an inherited blood disorder, such as sickle cell anaemia

Diagnosis of gallstones

Many people don’t get symptoms from gallstones. Gallstones are sometimes found when people have tests for other health problems.

If you visit your GP with symptoms of gallstones, he or she will ask you about your symptoms and examine you. This may involve him or her feeling your abdomen to see if it’s tender or swollen.

You may have further tests. The main ones are listed below.

  • Blood and urine tests to check for inflammation and to see how well your liver is working.
  • An ultrasound scan – this uses sound waves to produce an image of the inside of the body. Gallstones usually show up well on an ultrasound scan.
  • Magnetic resonance imaging (MRI scan), to look at your bile duct.
  • Endoscopic retrograde cholangio-pancreatography (ERCP). This is a detailed X-ray of your pancreas and bile ducts using a special dye and a narrow, flexible, tube-like telescopic camera called an endoscope.

Treatment of gallstones

If your gallstones aren’t causing any symptoms, your doctor may suggest leaving them alone as they usually don’t cause any problems. If your gallstones are causing symptoms, you may need treatment.

Self-help

You can manage your symptoms using over-the-counter painkillers and see whether the problem gets any worse. This is called watchful waiting. Your GP will monitor your condition and he or she may suggest further treatment if your symptoms worsen.

Surgery

If your gallstones are causing pain or if you have jaundice, your doctor may recommend that you have your gallbladder and the gallstones removed. This is called a cholecystectomy.

There are two surgical techniques used to remove your gallbladder.

  • Laparoscopic cholecystectomy – your gallbladder is removed through small cuts in your abdomen (tummy), using a surgical technique called keyhole surgery.
  • Open cholecystectomy – your gallbladder is removed through one large cut in your abdomen, using a surgical technique called open surgery.

A laparoscopic cholecystectomy is usually used to remove your gallbladder. However, in some instances you may have an open cholecystectomy, for example:

  • if you can't have keyhole surgery.
  • if the operation has been started as a keyhole procedure and the surgeon considers it safer to convert to an open procedure

If gallstones are in your bile duct, they can sometimes be removed during a procedure called endoscopic retrograde cholangio-pancreatography (ERCP). ERCP is a test that can be used to diagnose gallstones in the bile duct, and if they are found during the procedure, they can sometimes be removed. It’s not possible to remove gallstones from your gallbladder with ERCP, only from your bile duct, and in most cases, this is combined with a cholecystectomy.

Gallstones can be broken up using shock waves. This is called extracorporeal shock wave lithotripsy (ESWL). A special probe uses high-energy shock waves to break up the stones. However, this treatment is now rarely used.

Prevention of gallstones

Many of the risk factors for gallstones, such as age, gender and family history can't be altered. However, you can reduce your chances of developing gallstones by maintaining a healthy weight.

Eating a vegetarian diet and drinking small amounts of alcohol may also prevent the development of gallstones.


Produced by Dylan Merkett, Bupa Health Information Team, May 2013.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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