Gallstones

The gallbladder is sometimes easily forgotten, overshadowed (literally) by the liver and other parts of the digestive system. Many people do not know where it is or what it does. But it is worth paying attention to this critical part of your body – particularly if you are a woman or a woman during pregancy. If things go wrong with your gallbladder, it can sometimes be very painful.

What is the gallbladder?

The gallbladder is a small, pear-shaped organ that sits underneath your liver. It stores and concentrates bile, a greenish-yellow fluid made in your liver. Bile helps to digest the fats consumed in your diet. Problems can arise when the gallbladder becomes irritated by gallstones.

What are gallstones?

Bile is made up of cholesterol, bile salts, bilirubin and water. Sometimes gallstones – which can range in size from minute crystals to the size of a golf ball – develop when this liquid becomes too concentrated. When gallstones stay in the gallbladder, the condition is called cholelithiasis. When they enter the main outlet (bile duct), the condition is called choledocholithiasis.

Types of gallstones

There are two main types of gallstone: 

• cholesterol stones, and 
• pigment stones.

Cholesterol stones are the most common type, making up at least three-quarters of all gallstones. They are generally a yellowy-green colour and can occur if your liver produces too much cholesterol.

Pigment stones are less frequent. They are small and dark brown or black in colour and tend to occur in people with other types of gastrointestinal or blood disorders.

Who is at risk of gallstones?

About one in 10 New Zealanders have gallstones, although many of these people do not have symptoms. People at risk of gallstones are:

• women – twice as likely as men to have gallstones between the ages of 20 and 60 years
• pregnant women
• elderly people - about 15% of elderly people have gallstones
• overweight or obese people – due to their increased cholesterol levels
• people who lose weight rapidly – burning or metabolising your fat stores causes your liver to secrete extra cholesterol into your bile
• women using the contraceptive pill or hormone replacement therapy
• people with a family history of gallstones
• people with diabetes
• some people who take cholesterol-lowering drugs.

Symptoms of gallstones – ‘when gallstones attack’

A gallstone attack, or episode, can happen at any time but it is more likely to occur after eating a fatty meal. Symptoms can range from occasional, unpredictable ‘grumbling’ to excruciatingly painful attacks that can last for hours.

Symptoms of gallstones generally appear when the stone has become lodged in the outlet of the gallbladder (bile duct). The most common symptom is an attack of pain in the upper abdomen or the back, known as biliary colic. Attacks often happen after a fatty meal.

Gallstones animation

• Constant, severe pain in the upper right section of the abdomen that may be felt through to the back between the shoulder blades. It can also occur centrally in the upper abdomen or behind the breast bone, mimicking a heart attack. The pain increases quickly and may last from 15 minutes to several hours before subsiding.
• Nausea and vomiting. 
• Indigestion, flatulence or general discomfort in the abdomen.
• Intolerance to fatty foods.

Gallstones sometimes require immediate attention

Serious symptoms of gallstones that require immediate attention include: 

• fever, sweating and chills, and 
• jaundice – a yellowing of the skin or whites of the eyes.

Fever may be an indication of infection or inflammation of the gallbladder, or of the pancreas. The pancreas is a nearby digestive gland that produces insulin and digestive enzymes.

Jaundice, on the other hand, occurs when the main bile duct becomes blocked, leading to the build-up of a substance called bilirubin in the bloodstream.

Several other conditions can cause symptoms similar to gallstones, so it is important that you seek advice from your doctor to rule out other causes such as cardiac disease, indigestion, hepatitis, irritable bowel syndrome or gastric ulcers.

Non-symptomatic (silent) gallstones

About 70% of people who have gallstones have no noticeable symptoms and are often unaware of their presence. These gallstones are often only discovered during evaluation of other problems. For this reason, they are sometimes called ‘silent’ gallstones.

If you are found to have silent gallstones you should avoid fatty meals. It is not likely you will require surgery, unless you develop symptoms or pain. It is important to weigh up the risk, expense and discomfort of having your gallbladder removed – doctors call this cholecystectomy – against the fact the stones may never cause any clinical illness.

Also see our topic, Gallstones - diagnosis and treatment

Original material provided by everybody. Reviewed in September 2008 by Andrew Bowker, Laparoscopy Auckland.