All about gallstones

Gallstones, or cholelithiasis, happen when the bile or cholesterol in the gallbladder hardens into small stones. They don’t always cause pain, but when they do it can be terribly uncomfortable.

What is the purpose of the gallbladder?

The gallbladder is a small pear-shaped organ that sits just below the liver on the upper-right section of your abdomen. Its main purpose is to store a small amount of bile secreted from the liver until it is ready to be delivered into the small intestine. The bile, made of fluids, fat and cholesterol, aids digestion. However, most bile goes straight from the liver into the bowel, so it’s not a necessary organ.

What causes gallstones?

It is thought they form when there is a chemical imbalance in the make up of bile in the gallbladder. Age, weight, gender, and Caucasian race play the most important role. Despite what you may have heard, diet plays a relatively minor role in the development of gallstones.

Other risk factors include:

• Being female.
• Being aged over 40.
• Having Crohn’s Disease.
• Having a family history of gallstones.
• Taking medications containing estrogen, such as hormone replacement therapy or the oral contraceptive pill.

Can they be prevented?

The two main preventions of gallstones are losing weight (if you’re overweight) and avoiding foods with a high fat content.

It may also help to get regular exercise and losing weight slowly rather than rapidly.

What are the symptoms of gallstones?

If they are tiny, gallstones won’t likely cause any symptoms. It’s when they are larger, about the size of a pebble, and block the bile ducts that they start to cause problems. If this happens, symptoms may include:

• Sudden and severe pain in the upper right quadrant of your abdomen, in the centre of your tummy, between the shoulder blades or in the right shoulder.
• Nausea and vomiting.
• Diarrhoea or clay-coloured stool.
• A fever and rapid heartbeat.
• Yellowing of the skin and whites of eyes (jaundice).

If the pain continues for hours, you can’t find a position to relieve it, or you have jaundice, it’s important to seek urgent medical advice through your GP, surgeon, or local emergency department.

How are they diagnosed?

Your doctor may be able to diagnose your gallstones through a simple consultation. However, often other tests may be needed. These include:

• Blood tests, to check for signs of infection and also rule out other conditions.
• An ultrasound of the abdomen.
• An MRI or CT scan.
• An endoscopy (to exclude other causes of pain).

How are gallstones treated?

If your gallstones are not causing any problems, and were incidentally discovered during other tests, there isn’t anything you need to do. They may be managed by limiting fatty foods.

If they are causing pain, the most common treatment is keyhole surgery to remove the gallbladder (cholecystectomy). This can be done laparoscopically, through a few small incisions in the abdomen, or, rarely, via open surgery.

Medication to dissolve the stones, or shock wave therapy that breaks the gallstones into smaller pieces, are almost never used these days as they are ineffective.