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Gallstones

What are gallstones?

Gallstones are formed when chemicals in bile harden to form stones. Bile is a fluid made by the liver and stored in the gallbladder. Gallstones tend to occur in people over 40 years of age and are twice as common in women as in men.

 

Asymptomatic gallstone disease

Very often gallstones present no symptoms and are only discovered when abdominal scans are done for other conditions. Only around a third of people with gallstones go on to develop problems.

 

Uncomplicated gallstone disease

The most common symptom of gallstones is biliary colic. This is a strong pain in the upper abdomen, just below the ribs which can last anything from a few minutes to a few hours. It's usually triggered by eating, especially fatty foods.

Biliary colic is caused by gallstones moving out of the gallbladder and blocking, or partially blocking, the cystic ducts leading to the bile duct, or the bile duct itself. This puts pressure on the gallbladder and bile duct as it tries to release bile in response to food intake. Often the stone will pass out into the bile duct and on into the gut, or move back into the gallbladder, relieving the pain.

Biliary colic may be a frequent occurrence, it may only occur occasionally. It may even be a one-off event if the stone is passed out of the bile duct without further incident. Only around 5% of people with gallstone disease develop more serious symptoms.

 

Complicated gallstone disease

If the gallstone becomes lodged and blocks the tubes around the gallbladder, then it can cause more serious complications leading to infection and inflammation of the gallbladder, bile ducts or pancreas. This presents as one of the following conditions:

  • Acute cholecystitis: inflammation of the gallbladder due to infection.
  • Acute cholangitis: if the bile ducts become blocked, they can become infected.
  • Acute pancreatitis: if the gallstones block the junction of the bile duct and the pancreatic duct (which share a common entry point into the intestine) the pancreas can become inflamed.

The symptoms of complicated gallstone disease include acute upper or mid abdominal pain, which grows steadily and does not ease with visiting the toilet or passing wind. You may also experience a high temperature and shivering due to the infection, as well as nausea and vomiting. As bile builds up behind the blockage it may enter the bloodstream, causing a yellowing of the skin and the whites of the eyes called jaundice.

 

Diagnosing gallbladder problems

The Gastroenterology team at The Physicians' Clinic has a particular expertise in gallstone problems and can diagnose and treat gallstones and their complications. Endoscopic and surgical procedures are performed at state-of-the-art private hospitals in the vicinity of The Physicians' Clinic, where your consultant from The Clinic will continue to oversee your care until you are fully recovered.

Gallstone treatment at The Physicians' Clinic
The gastroenterologists within the team at The Physicians' Clinic have an international reputation for the management of gallstones and their complications. There are imaging facilities on-site and two of our gastroenterologists perform ERCP and other diagnostic procedures at state-of-the-art endoscopy units in nearby private hospitals.

 

Treatment options

Uncomplicated gallstone disease

Asymptomatic and uncomplicated gallstone disease often does not require treatment, and the stones will pass naturally in time with no further complications. If pains are a recurrent problem then it would be necessary for you to have abdominal scans and blood tests.

If the stones are confined to the gallbladder then a referral to a surgeon may be recommended for a cholecystectomy (gallbladder removal). Most cholecystectomy surgery is done using laparoscopic (keyhole) techniques so recovery is much faster. If you have a laparoscopic cholecystectomy, you may need a night in hospital, but you should be well on the road to recovery within a couple of weeks. If it is necessary to perform an open cholecystectomy, this will involve several days in hospital.

Complicated gallstone disease

Complicated gallstone disease needs additional treatment. If gallstones are lodged in the bile duct they need to be retrieved. This is done endoscopically using a procedure called endoscopic retrograde cholangiopancreatography (ERCP), which is often performed as a day case with no overnight stay required.

If you have an ERCP you are sedated and then a flexible telescope is inserted through your mouth into the duodenum, the point where the bile duct opens into the upper intestine. The stones are removed by gentle manipulation. When the bile duct has been cleared of stones a cholecystectomy is usually recommended.

If you develop acute pancreatitis as a complication of gallstones, this is very serious. Usually you would need to be closely observed and treated in hospital for some time.

 

Living without a gallbladder

You can continue as normal without your gallbladder, as the liver will continue to produce bile, although you may need to be more careful with your diet, especially fatty foods.

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