Gallstones

What are gallstones?

Gallstones are small, hard stones that form in the gallbladder, a small pouch-like organ found under the liver. The gallbladder stores bile, a fluid produced by the liver that helps digest fats. Gallstones form when substances in bile, usually cholesterol, harden into stone-like lumps, which can range in size from tiny grains to several centimetres. A person may have one large stone, many small ones, or a mixture.

Gallstones are common, and many people who have them never know, because gallstones often cause no symptoms at all — these are sometimes called silent gallstones and usually need no treatment. Problems arise when a gallstone blocks one of the tubes (ducts) that carry bile, which can cause sudden pain and, in some cases, more serious complications. Understanding when gallstones are harmless and when they need attention is the key to managing them.

Symptoms

Many people with gallstones have no symptoms. When gallstones do cause symptoms, usually because a stone blocks a bile duct, the main one is pain. Symptoms can include:

• •Sudden, severe pain in the upper right or centre of the tummy (a gallbladder attack, or biliary colic)
• •Pain that can last from a few minutes to several hours
• •Pain that may spread to the shoulder or back
• •Feeling sick or being sick
• •Pain that can be triggered by eating, particularly fatty foods
• •In complications: fever, jaundice (yellowing of the skin or eyes), or persistent pain

Causes and risk factors

Gallstones form when there is an imbalance in the substances that make up bile, most commonly too much cholesterol, which can harden into stones. The exact cause is not always clear, but several factors increase the risk of developing them:

• •Being overweight or obese
• •Being female, particularly with pregnancies
• •Being over 40
• •A family history of gallstones
• •Losing weight very rapidly
• •Certain conditions and diets

Treatment

Gallstones that are not causing symptoms usually do not need any treatment and can simply be left alone, as the risk of them causing problems is low. When gallstones do cause symptoms or complications, however, treatment is generally recommended, because once someone has had symptoms they are likely to have them again, sometimes more seriously.

The most common treatment for symptomatic gallstones is removal of the gallbladder (a cholecystectomy), usually done with keyhole surgery. The gallbladder is not essential — the body can cope well without it, with bile flowing directly from the liver to the gut — so its removal is a well-established and generally very effective treatment that resolves the problem permanently. A doctor will discuss whether surgery is appropriate and what it involves. In some situations, other approaches may be considered, but gallbladder removal is the mainstay for troublesome gallstones.

Complications and when to seek help

While many gallstones are harmless, they can sometimes cause complications that need prompt medical attention, which is one reason symptomatic gallstones are usually treated. Complications occur when a gallstone causes a persistent blockage or leads to inflammation or infection. These include inflammation of the gallbladder (cholecystitis), which causes persistent severe pain and fever, and blockage of the bile duct, which can cause jaundice and, if infection develops, a serious illness.

Gallstones can also, less commonly, cause inflammation of the pancreas (pancreatitis), a serious condition. Because of these risks, certain warning signs need urgent medical attention: severe tummy pain that does not settle, pain with a high fever and chills, or yellowing of the skin or the whites of the eyes (jaundice). These suggest a complication rather than a simple gallbladder attack and should not be ignored.

For most people, though, gallstones are either silent or cause manageable symptoms that are effectively resolved by treatment. Knowing the difference between the typical pain of a gallbladder attack — which settles — and the warning signs of a complication allows you to seek the right level of care. If you have gallstone symptoms, a doctor can confirm the diagnosis, usually with an ultrasound scan, and advise on the best approach.