Gallstones

Published by Bupa's Health Information Team, May 2011.

This factsheet is for people who have gallstones, or who would like information about them.

Gallstones are solid lumps or stones that form in the gallbladder or bile duct. They form when bile, which is usually liquid, hardens. One large stone may develop, or many small ones.

About gallstones

The gallbladder

The 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 the 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 to help your body to digest fats and other substances.

What are gallstones?

Gallstones are hardened lumps of bile. Bile contains cholesterol, bile salts and waste products, for example bilirubin (a pigment formed in the breakdown of old red blood cells). Gallstones develop when these substances in your bile harden, forming stones. They can vary in size, anything from as small as a grain of sand to the size of a golf ball.

There are two main types of gallstone.

• Cholesterol gallstones are the most 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. These are less common and tend to develop if you have liver disease, an infection in your bile duct or an inherited blood disorder, such as sickle cell anaemia, where your body breaks down blood cells too quickly.

Symptoms of gallstones

About eight in 10 people with gallstones get no symptoms and so you may not be aware that you have them. If you do get symptoms, it's usually because gallstones have blocked your gallbladder which then becomes inflamed or infected. This is called cholecystitis.

Common symptoms of gallstones may include:

• upper abdominal pain – this may last for several hours
• jaundice (yellowing of your skin or the whites of your eyes) – if a stone has blocked your bile duct
• feeling sick or vomiting
• a high temperature, shivering and sweating – if your gallstones have caused an infection

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 further problems such as inflammation, infections and blockages of your gallbladder, bile duct, pancreas and bowels.

Causes of gallstones

You can develop gallstones at any age, but your chances of getting them increase as you get older. Women are up to three times more likely to get gallstones than men.

You're more likely to get gallstones if you:

• have a family history of them
• are overweight
• have lost weight quickly
• are pregnant
• take hormone replacement therapy
• have high cholesterol
• have diabetes
• have Crohn’s disease
• have an inherited blood disorder, such as sickle cell anaemia

Diagnosis of gallstones

Although you may have symptoms of gallstones, many people don't and so they are sometimes found by chance during medical tests for other conditions.

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 your liver or gallbladder is tender or enlarged. Your GP may also ask you about your medical history.

You will usually have blood and urine tests to check your liver function and to look for signs of inflammation or jaundice. Your GP may also arrange for you to have an ultrasound scan. An ultrasound uses sound waves to produce an image of the inside of your body. This will help to show where any gallstones are and how large they are.

If your gallstones are in the bile duct, you may have an endoscopic retrograde cholangio-pancreatography. This is a detailed X-ray of your pancreas and bile ducts and is useful to see if gallstones have passed into them. The test is done using a narrow, flexible, tube-like telescopic camera called an endoscope, which is guided using X-rays.

Treatment of gallstones

If your gallstones aren’t causing you any symptoms, your doctor may suggest leaving them alone as they usually don’t cause any problems. If your gallstones are causing you problems, you will need treatment because they won't go away by themselves.

Self-help

It's advisable to eat a healthy, balanced diet and to control your weight. Your GP may recommend a low-fat diet to help ease your symptoms.

Surgery

If your gallstones cause you frequent and severe pain or if you are jaundiced, you may be advised to have your gallbladder removed. Gallstones will continue to form if you don't have your gallbladder removed. You can live without your gallbladder and most people don't have any problems. However, all surgery carries some risk. Your surgeon will discuss the benefits and risks with you. There are two types of gallbladder removal and both are done under general anaesthesia, which means you will be asleep during the operation.

Laparoscopic cholecystectomy

This is a method of keyhole surgery to remove your gallbladder. Your surgeon will make small cuts through your abdomen or belly button. A laparoscope (a long, thin telescope with a light and camera lens at the tip) is inserted through one of these small cuts. Specially adapted surgical instruments are then inserted to remove your gallbladder. At the end of the operation, the instruments are removed and the wounds are closed with stitches or clips.

Open cholecystectomy surgery

This is sometimes used if you can't have keyhole surgery, for example if your gallbladder is severely inflamed or if you have had previous surgery to your abdomen. Open cholecystectomy involves removing your gallbladder through a larger cut in your abdomen. It's likely to take you longer to recover from this type of surgery than keyhole surgery, and you may need to spend more time in hospital.

Non-surgical treatments

If you can't have surgery, sometimes gallstones can be dissolved using medicines. These medicines often take a long time to work and are only effective on certain types of gallstones, therefore aren't suitable for everyone. Gallstones often come back after treatment with medicine, therefore it's rarely used.

If you have gallstones in the bile duct and not in the gallbladder, you can have an endoscopic retrograde cholangio-pancreatography to find and remove them. The procedure is usually done under sedation – this relieves anxiety and helps you to relax during the procedure. Your surgeon will pass an endoscope into your mouth and down to your bile duct. Special instruments can be passed inside the endoscope to allow your surgeon to remove gallstones from the bile duct. If any gallstones are found in the gallbladder itself, you may need gallbladder surgery as well.

Prevention of gallstones

Many of the risk factors for gallstones, such as age, gender, family history can't be altered. Try eating plenty of fresh fruit and vegetables and small amounts of meat and dairy products to help prevent gallstones. If you're overweight, try to lose excess weight and take regular exercise as this can also help to prevent gallstones.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.