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Gallstones

Introduction

Gallstones are small solid, stone-like masses formed in the gallbladder from excess bile pigment, calcium and cholesterol.

Gallstones are the result of a common digestive disorder and vary in severity from no pain or discomfort at all to an extremely painful condition.

Causes

While it's difficult to ascertain a specific cause, gallstones result from one or all of the following imbalances in the gallbladder:

Excess cholesterol in the bile

The most common cause of gallstones is an excess of cholesterol produced in the liver. If the bile is unable to dissolve cholesterol effectively, it crystallises to form gallstones.

Poorly functioning gallbladder

If the gallbladder doesn't empty bile properly, bile thickens and forms gallstones.

Excess bilirubin in the bile

Bilirubin is a pigment of bile produced as the result of haemoglobin breakdown. Medical conditions such as cirrhosis of the liver can lead to excess bilirubin production which the gallbladder can't efficiently break down. It then solidifies to form gallstones.

Symptoms

In many cases, gallstones may not cause any symptoms. Entering the bowel, they can pass through the stool painlessly.

If pain does arise, it doesn't come from the gallstones themselves but from the gallbladder.

Potential Symptoms

  • Intermittent pain in the back and abdomen, intensifying after eating.
  • Jaundice.
  • Nausea.
  • Change in stool colour.
  • Vomiting.
  • Diarrhoea.
  • Indigestion.
  • Excess gas.

If gallstones become large enough to block the bile duct, this may cause infection resulting in fever and localised pain in the gallbladder (located near the liver).

Diagnosis

If your doctor suspects gallstones, a closer look at the abdominal area and bile ducts with an ultrasound or CT scan will identify and diagnose the severity.

Treatment

Treatment for gallstones is commensurate with the severity.

In many cases, gallstones don't cause any problems and will require minimal treatment, otherwise, the following options are available:

Observation

Gallstones can dissolve or move into the stool without any medical intervention. Post-diagnosis, a doctor will observe the gallstones before carrying out treatment.

Medication

In rare cases, doctors may prescribe medication to break down gallstones. Medication only has moderate success as a treatment because it fails to prevent future recurrence, which is common.

Lithotripsy

This machine produces high-frequency sound waves to shatter the stones to help them pass through the stool. This is rarely offered as a treatment and is only effective on soft stones.

Surgery

In severe cases of recurring gallstones where health is at risk, surgery to remove the gallbladder is the most effective solution. A cholecystectomy is carried out laparoscopically and is a relatively straightforward procedure with minimal complications. The gallbladder isn't a vital organ, so there are no long-term implications of surgery

Lifestyle changes

Changes to diet such as reducing fatty foods may prevent recurrence of gallstones.

If the stones block bile ducts, this can lead to complications including infection and inflammation of the pancreas and may require urgent medical attention. 

Complications

If gallstones block the bile duct, it can lead to an infection of the liver called acute cholecystitis. If you develop sudden fever and pain in the area and you have or suspect you have gallstones, seek urgent medical attention.