Gallstones and Gallbladder Disease

The gallbladder is a small pear-shaped sac, attached to the underside of the liver. The bile duct is a tube that carries bile from the liver to the duodenum. When the patient is fasting, the lower end of the bile duct closes and bile back-flows into the gall bladder. There it is concentrated by the gall bladder, absorbing the water in the bile. When a patient eats a fatty meal, the gall bladder squeezes out the bile to help absorb the fats. So the gallbladder stores, concentrates and releases bile, which is made in the liver and plays a major part in the digestion (breaking down) of fat. Bile will still be present, after your gallbladder is removed.

Sometimes the substances contained in bile crystallize in the gall bladder, forming gallstones. These small, hard concretions are more common in those over 40, especially in women and the obese. They can cause inflammation of the gall bladder, a disorder that produces symptoms similar to those of indigestion, especially after eating a fatty meal. If a stone becomes lodged in the bile duct, it produces severe pain (biliary Colic). Gallstones may pass out of the body spontaneously; however, blockage can occur in the main bile duct preventing the normal flow of bile to the duodenum leading to Jaundice (yellowish discoloration of skin).

• Cholesterol stones
• Pigment stones
• Mixed stones – the most common type. They are composed of cholesterol and salts

A number of causes have been suggested. It is thought that some people secrete more cholesterol than others. As the gallbladder concentrates the bile stored in it, the cholesterol precipitates forming crystals and that these adhere together forming the stones. The stones then tend to enlarge or multiply especially if there is any infection involved. Pregnancy, obesity, rapid weight loss and a family history of gallstones are factors that increase the chances of developing gallstones. Other causes include liver cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anaemia in which too much bilirubin is formed. It is also more common in diabetics and people taking Cholesterol-lowering drugs.

If you have been found to have gallstones or you are having symptoms of nausea, vomiting and abdominal pain then an operation is warranted. The pain is mainly in the upper and right upper quadrant of the abdomen, under the ribs. It might radiate to the back or to the area between the shoulder blades. The pain can be very severe leading the patient to pace around and preventing to find a comfortable position. Attacks are generally but not always provoked by fatty foods such as chips, cream or cheese. During a severe attack, the patient may develop Jaundice (yellow skin).The diagnosis is usually made from the typical symptoms and an ultrasound scan. Many other types of scans are available which will lead to the same conclusion.

Gallstones may be diagnosed incidentally during the course of tests for other conditions. It is a point of debate as to whether these stones warrant an operation; you should discuss this with your specialist. Other presentations include vague indigestion, bloating sensation, and belching.

No, but surgery is recommended as the only reliable way for cure. It is possible to dissolve the stones, however, this can take a considerable period of time (over 1 year) or break them into small pieces, but unfortunately these techniques have high failure rate and the drugs used have unpleasant side effects. There is also the high possibility of the gallstones recurring after such a treatment. The problem is that it is the gall-bladder and not the gallstones that is diseased.

The doctor will only advise and not force anything on you. Your gallstones may not cause any trouble. However, if you have already had symptoms and several previous attacks of colicky pain, then it is unlikely for these to resolve spontaneously. Pain is usually due to the blockage of the duct by a stone and preventing the gallbladder from emptying (biliary colic) or to inflammation of the gallbladder (cholecystitis).

Severe pain can be related to the inflammation of the pancreas (pancreatitis) which can be life threatening and develops as the stones move out of the gallbladder down the common bile duct. You can develop jaundice (yellow discoloration of the skin) with its consequences, if these stones block the main bile duct preventing the normal flow of the bile into the duodenum.

Very few. The function of the gallbladder is to store bile produced by the liver between meals and release it during mealtime. The absence of a gallbladder allows a constant drip of bile into the intestine. In most patients, the diseased gallbladder has long-since ceased to function and its removal does not alter the digestive balance in any way. A few patients will notice a very slight increase in the frequency at which they open their bowels.