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Gallstones

Published by Bupa's health information team, April 2009.

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 are formed when some of the chemicals stored in the gallbladder harden into a mass. One large stone may develop, or a lot of tiny ones.

• About gallstones
• Symptoms of gallstones
• Complications of gallstones
• Causes of gallstones
• Diagnosis of gallstones
• Treatment of gallstones
• Prevention of gallstones
• Further information
• Questions and answers
• Related topics
• Sources

About gallstones

The gallbladder

The gallbladder is a small, bag-shaped organ on the right-hand side of your body, just below your liver. It stores a green liquid called bile, which is produced by your liver to help your body digest fats and other substances. When you eat, bile is released from your gallbladder into your intestines through a narrow tube called the bile duct.

The gallbladder and surrounding structures

What are gallstones?

Bile contains cholesterol, bile salts and waste products like bilirubin (a pigment formed from the breakdown of old red blood cells). Gallstones form when these substances are out of balance.

There are two basic types of gallstone.

• Cholesterol gallstones are the main type in the UK and form if you have too much cholesterol in your bile.
• Pigment gallstones form when there is too much bilirubin in your bile. These gallstones tend to develop if you have liver disease, infections in your bile tubes or inherited blood disorders such as sickle-cell anaemia (your red blood cells are a different shape and this affects the amount of oxygen they can carry around your body).

Symptoms of gallstones

Gallstones are very common. Most cause no symptoms at all and you may not even be aware you have them. Gallstones that don't cause any symptoms usually don't need any treatment.

Gallstones can irritate the lining of your gallbladder and they can get stuck in your bile duct causing an attack of abdominal (tummy) pain that:

• develops quickly
• is severe
• lasts about one to three hours before fading gradually
• isn't helped by over-the-counter painkillers

Other symptoms of gallstones may include:

• feeling sick or vomiting
• sweating
• restlessness
• jaundice (yellowing of your skin or the whites of your eyes)

If you have any of these symptoms, see your GP.

Complications of gallstones

If gallstones aren't removed, they can cause problems in your gallbladder, bile duct and gut. These can include infections and blockages of your digestive tract. Your GP will discuss these complications with you.

Causes of gallstones

You can get gallstones at any age, but your chances of getting them increase as you get older. Women are more at risk of developing gallstones than men.

You're more likely to get gallstones if you:

• have a family history of gallstones
• are overweight
• lose weight rapidly
• have too much oestrogen - pregnancy and hormone replacement therapy (HRT) can increase your chance of developing gallstones
• have diabetes
• have liver disease
• have Crohn's disease

If you have had surgery to remove part of your stomach, this may also increase your chance of developing gallstones.

Diagnosis of gallstones

Sometimes gallstones are found by chance during medical tests for other conditions. Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history, as this is important in the diagnosis of gallstones. If gallstones are suspected, your GP may ask you to have an ultrasound scan. This uses sound waves to produce images of the inside of your body and pinpoint the location of any gallstones.

Blood and/or urine tests may be done to check for signs of infection, inflammation, jaundice or problems with your pancreas.

Treatment of gallstones

If your gallstones aren't causing you any symptoms, they can usually be left alone, as most won't go on to cause problems.

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 reduce your symptoms.

Surgery

People can usually live without a gallbladder, and the most common treatment for gallstones that are causing problems is surgical removal of the gallbladder. This is known as cholecystectomy (pronounced "co-lee-sist-ect-omy").

For most people the benefits (improved symptoms) are greater than any potential problems. However, all surgery carries some risk. Your surgeon will discuss the benefits and risks with you.

Laparoscopic cholecystectomy

This keyhole surgery is most commonly used in gallbladder removal and is done under general anaesthesia, usually as a day case. A laparoscope (a long, thin telescope with a light and camera lens at the tip) is inserted through a small cut near your navel. Specially adapted surgical instruments are then inserted through some more small cuts to remove the gallbladder. The operation lasts between 60 and 90 minutes. 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 keyhole surgery isn't possible and involves the removal of the gallbladder through a larger cut in your abdomen (tummy). This type of surgery is done under general anaesthesia. This means you will be asleep during the operation. Open cholecystectomy surgery has a longer recovery time than keyhole surgery, and you may need to spend a day or two in hospital to recover.

Endoscopic retrograde cholangio-pancreatography (ERCP)

ERCP removes gallstones and is often performed in addition to having your gallbladder removed. The procedure is usually done under sedation - so you're awake but relaxed and comfortable during the procedure. A narrow, flexible, telescopic camera called an endoscope is put into your mouth and down through your gut to your bile duct. Special instruments can be passed inside the endoscope to allow the surgeon to remove gallstones from the bile duct.

Non-surgical treatments

In special situations (for example, if you can't have general anaesthesia, or don't want to have surgery), you may need to have non-surgical treatment.

• Dissolution uses medicines to dissolve the gallstones but isn't suitable for everyone and may take a very long time.
• Shock-wave lithotripsy uses high-energy sound waves to break gallstones into tiny fragments, which can then be dissolved by medicines.

Prevention of gallstones

Many of the risk factors for gallstones - your gender, your age and your race for example - can't be altered. Vegetarians develop fewer gallstones, so it might help to increase your fresh fruit and vegetable intake and reduce the amount of animal products in your diet.

Further information

• Core (Digestive Disorders Foundation)
  www.corecharity.org.uk

Related topics

• Gallbladder removal
• Healthy eating
• Healthy weight for adults

Sources

• Sanders G, Kingsnorth AN. Gallstones. BMJ 2007; 335:295-299. www.bmj.com
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:446-447
• Shaffer EA. The biliary system. www.gastroresource.com, accessed 1 July 2008
• Martin DJ, Vernon DR, Toouli J. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No: CD003327.pub2. DOI: 10.1002/14651858.CD003327.pub2. www.cochrane.org

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: April 2009