Gallstones are small pebbles that form in the gall bladder as result of concentrated bile. The gall bladder is the organ that is attached to the liver and stores bile. Gallstones are common in developed countries, affecting about 10% of adults and 20% of those over the age of 65. Many people may have gallstones and be unaware that they do. Only 20% of people diagnosed with gallstones will need treatment.
The majority of gallstones are due to excess cholesterol in the blood. High levels of cholesterol due to obesity and conditions such as diabetes are a predisposing factor. Other factors that can lead to gallstones include an excess of a substance called bilirubin, which is a by-product produce by the liver after breakdown of red cells. Conditions that result in poor flow of bile can result in statis of bile and subsequent gallstone formation.
Gallstone are more common after the age of forty, though they can occur at any age. They are also more common in females. This is due to hormones such as oestrogen which increases cholesterol levels and progesterone which may affect contraction of the gall bladder. Whites have been shown to have a genetic predisposition to develop gallstones more than other races.
Usually gallstones have no symptoms unless there is complications. They can be detected incidentally when an ultrasound scan is done for other reasons. When they have symptoms often the most common symptom is abdominal pains. This is due to gallstones getting stuck in the biliary tree. The pain is usually dull and severe. It is mostly localised on the right side of the abdomen below the liver and they may be severe pain when you touch in that area. This is often associated by nausea , and vomiting. Persistent blockage can lead to infection which may manifest with fever, chills, yellow eyes and dark urine.
Other potential complications from gallstones include infection and inflammation of the gallbladder with subsequent scarring. Blockage of the biliary tree can lead to back flow of bile into the liver. This can result in inflammation of the liver and eventually shrinkage of the liver. Sometimes gallstones can block the pancreatic duct resulting in pancreatitis. This can cause long term damage and eventually result in the pancreas not functioning. If bile cannot reach the small intestine this can lead to malabsorption as bile is needed for the breakdown of fats and absorption of fat soluble vitamins.
Most people with gallstones do not need any treatment and often the gallstones are left alone. When they are complications due to the gallstones, the ideal thing is to treat the complications medically if possible and then remove the gallbladder. Gall bladder removal surgery can be open surgery or can be “key hole” surgery which results in better cosmetic results.