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Gallstones

by Etienne Moore last modified 2013-08-14 23:08

Click here to learn more about gallstone disease and the reason why it causes upper abdominal pains

Gallstones are very common.  Some authorities say that 1 in 10 of forty to sixty year olds and 1 in 4 of the over sixties have gallstones.  Most people with gallstones do not know that they have them.  Gallstones are usually found in the gallbladder which is a plum-sized sack that sits underneath the liver in the right upper abdomen.  It acts as a reservoir for a fluid called bile which is used for the digestion of fat.  When we have a fatty meal the gallbladder squeezes its bile contents out into the gut to mix with the food.  Gallstones are essentially crystals of cholesterol, pigments or calcium that can form within the bile that is stored in the gallbladder.  If someone has gallstones then their gallbladder can contract and crunch on them after being stimulated by a fatty meal.  This can lead to upper abdominal discomfort or pain, which is termed biliary colic.  Patients with troublesome gallstones are therefore often told to keep to a very low fat diet to try to stop their gallbladder getting excited!

Gallstones can occur in a wide variety of shapes and sizes.  I have seen patients with hundreds of tiny gravel-like gallstones and also patients who have just one gallstone as large as an egg.  It is actually the smaller stones that can be the most troublesome, as they can escape out of the gallbladder to then irritate the pancreas gland, causing pancreatitis, a sometimes life-threatening condition.  Gallstones can also cause jaundice and infections in the gallbladder or the nearby bile ducts, which can also be extremely serious.

The best way to diagnose gallstones is by ultrasound scanning.  If gallstones are found and it is thought that they are giving symptoms, then a removal of the gallbladder using keyhole surgery (laparoscopic cholecystectomy) is usually recommended.  The gallbladder is not an essential organ and most patients do not notice any detrimental side-effects once their gallbladder has been removed.  The majority of gallbladder surgery patients are back to normal activities only two weeks after their operation.  Alternative gallstone treatments include special diets, drugs and shock waves but none of these are as effective as gallbladder surgery.

We are taught at medical school about the 5 F’s.  This refers to the old belief that the most common patients to get gallstone disease are Female, Fat, Fair, Forty-something and Fertile and there is definitely some truth in this.  However, I have seen symptomatic gallstone disease in all adult ages and in all sizes of patients.  Many people will not be able to prevent themselves getting gallstones and there is certainly a genetic component to the condition but keeping well hydrated and avoiding a very fatty diet may reduce your chances of future gallstone problems.  Being overweight is certainly associated with gallstone disease but beware that so too are rapid weight loss diets.

If you are getting annoying upper abdominal twinges, pains or nausea then you should discuss this with your GP because your problem may be related to gallstones.  If your GP diagnoses gallstones then you can let your GP know if you have a preferred surgeon that you would like to be referred to for consideration of gallbladder surgery treatment.

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