Gall Stones

Gallstones are very common, however only some people develop symptoms

If you start to experience symptoms, specialist healthcare is available to remove the gallstones and help you to feel better again. On occasions, when gallstones are not treated sufficiently, more serious problems can arise so early diagnosis and specialist treatment is vital.

What causes gallstones?

Bile is produced by the liver to help digest fats. It is stored in the gallbladder which releases bile into the digestive system when required. It is believed that gallstones are caused by an imbalance in the components of bile, leading to the formation of stones which may be cholesterol stones, pigment stones or mixed stones.

It is estimated that 5-10% or more of adults in the UK have gallstones, however the majority will show no symptoms. It is three times more common in women than in men.

The risk of developing gallstones increases for:

  • Being overweight or obese
  • Women who have had children
  • People who are over the age of 40

Gallstones can be harmless but if symptoms arise then it is vital to see a doctor, as treatment to remove the gallstones may be necessary. This will avoid the serious complications of gallstone disease.

Consultation with a specialist, who can conduct the necessary diagnosis tests, is the first step to better understanding your symptoms.

Symptoms of gallstones

Symptoms can arise when one/more gallstones enters one of the tubes that connect the liver to the gallbladder (cystic duct or the bile duct). Gallstones can escape into and block another part of the digestive system.

The main symptom of gallstone disease is known as bilary colic. This typically presents with:

  • A sudden and severe pain in your abdomen, which isn’t relieved by going to the toilet, passing wind or being sick, and often after a fatty meal.
  • Pain is usually gripey in nature and is typically located in the upper part of your tummy, or on the right-hand side of your body, just under the ribs.
  • Occasionally the pain will move to your shoulder blade.
  • The pain may last for several hours.
  • You may experience an episode of bilary colic and then feel fine for several weeks, or even months before another episode occurs.

Whilst these symptoms can be painful, they are generally considered to represent “uncomplicated” gallstone disease.

Consultation with a specialist, who can conduct the necessary diagnostic tests, is the first step to better understanding your symptoms.

Diagnosis of gallstones

Diagnosis begins with a consultation with a doctor to determine the exact nature of your symptoms. They may use one or more of the following tests:

  • Ultrasound scan – high frequency sound waves which can usually confirm gallstones
  • MRI scan – magnetic resonance imaging (MRI) uses magnetic fields to assess for gallstones in the bile ducts
  • Cholangiography – uses a dye that shows on special imaging. The dye may be administered into your bloodstream, direct into the bile duct during surgery, or via an endoscope. The dye can detect any blockages in liver, bile ducts, gallbladder or intestine.
  • CT scan – is sometimes used to look for complications of gallstones, including acute pancreatitis.

Complications of gallstones may include:

On occasion a gallstone can block a bile duct resulting in a build-up of bile inside the gallbladder. The gallbladder may then become infected and symptoms can include:

  • Severe and constant abdominal pain that can travel to the shoulder blade, usually lasting longer than 5 hours
  • A fever (with a temperature over 38C)
  • A raised and rapid heartbeat

Antibiotics and bed rest are usually required to treat the infection – in almost all cases the gallbladder will need to be removed.

Jaundice can occur when a gallstone escapes the gallbladder into the bile duct, blocking the flow of bile.

Symptoms include:

  • Yellow colouring of the skin and eyes
  • Dark brown urine
  • Pale stools
  • Itchy skin

If the stone does not pass through and out of the bile duct on its own, intervention may be needed in the form of an endoscopic retrograde cholangio-pancreatography (ERCP), which is a flexible camera test performed through the mouth to extract the stone(s). If this were unsuccessful surgery is required.

Bacteria can easily infect blocked bile ducts. Symptoms may include:

  • Abdominal pain that travels to your shoulder blade
  • A high temperature, fluctuating to chills
  • Jaundice
  • Confusion
  • Itching

Here, antibiotics are usually required to treat the infection but there is also usually a requirement for treatment to drain the excess bile that built-up in the liver. This procedure is known as endoscopic retrograde cholangio-pancreatography (ERCP).

If the gallstone escapes the gallbladder and blocks the tube that drains the pancreas, this can cause a severe inflammation called acute pancreatitis.

The most common symptoms include:

  • Sudden, severe dull pain in the upper abdomen
  • Pain usually gets progressively worse until it aches persistently, and is associated with a backache
  • Eating may make worsen the pain
  • Other symptoms may include:
    • Severe nausea and vomiting
    • Diarrhoea
    • Loss of appetite
    • A fever over 38C
    • Marked abdominal tenderness
    • Jaundice

Acute pancreatitis usually requires hospital admission to support the various body functions until the inflammation settles down and the stone has passed.

Cancer of the gallbladder is an extremely rare condition.

Four out of five people that develop gallbladder cancer will have had a history of gallstones. There are fewer than 1,000 cases of gallbladder cancer diagnosed each year in the UK, and even if you have a history of gallstones, there would be an estimated one in 10,000 chance of it developing into cancer of the gallbladder.

Other risk factors include:

  • Family history of gallbladder cancer
  • High calcium levels inside your gallbladder

Symptoms are similar to other complications of gallstones so it is important to seek diagnosis from a specialist to determine the exact nature of your symptoms.

Treatment of gallstones

The treatment of gallstone disease depends on the nature and severity of the condition. If gallstones are not causing significant pain they can sometimes be left alone, and monitored to ensure they don’t grow or worsen.

Or, if they are small and don’t contain calcium then it is sometimes possible to take ursodeoxycholic acid tablets to dissolve them, although this isn’t always effective.

If surgery is required to remove your gallbladder there are a number of types of procedure:

Keyhole surgery (laparoscopic cholecystectomy)

Here 3-4 small incisions are made in your abdomen. In one incision, a laparoscope is inserted that makes it possible for the surgeon to see inside your body with a light and camera. Using special surgical instruments the gallbladder can be removed through the other incisions.

This procedure is performed under a general anaesthetic and usually takes 60-90 minutes. It is usually possibly to go home the same day, although recovery may take up to 10 days.

Single incision keyhole surgery

Here only one incision is required for surgery, resulting in just one small scar following the procedure. It is a new technique and isn’t widely available as it requires specialist expertise from the surgeon.

We offer single-incision laparoscopic cholecystectomy.

Open surgery

Sometimes using keyhole surgery techniques may not be possible and open surgery is required. This can be if you have had multiple previous abdominal operations, or the gall bladder anatomy is more complicated than in a typical person.

Open surgery typically requires a longer hospital stay and recovery times.

Endoscopic retrograde cholangio-pancreatography (ERCP)

ERCP is an endoscopic procedure used to remove gallstones from the bile duct, by passing a camera through the mouth, into the stomach and through the duodenum into the bile ducts.

This procedure is usually performed with sedation but can be performed under general anaesthetic depending on the complexity of the case and the patients wishes.

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