Bile is a yellowish-green substance secreted by the liver and stored in the gallbladder. It is used by the body in the digestion of fat. Sometimes this bile becomes concentrated and forms into gallstones. Gallstones are very common, and it is thought that around 1 in 10 adults in the UK have them in their gallbladder.
Most people who have gallstones are unaware of the fact, as they remain in the gallbladder and cause no problems. However, gallstones can move and if they become stuck along the bile duct they can cause a colicky pain. If the gallstone remains stuck, complications can occur that require treatment.
So, what are the signs and symptoms of gallstones?
Most people with gallstones in their gallbladder remain symptom free. These gallstones are ‘silent’ stones and do not need treatment. However, when gallstones make their presence known, the signs and symptoms of a gallstone attack can include:
- Generalised pain in the upper abdomen after eating a heavy meal
- A particular pain in the upper abdomen, known as biliary colic. This pain is generally felt in the right upper portion of the abdomen, comes in waves and can radiate to the right shoulder or between the shoulder blades. If examined by a doctor, pressing underneath the liver edge causes a sharp pain.
- Nausea and vomiting
- Jaundice – a yellow colouring of the whites of the eyes and the skin
- Pale stools and dark urine
How are gallstones diagnosed?
Most commonly an ultrasound scan of the gallbladder will show up gallstones. Other investigations can include MRI or CT scanning. Direct imaging can be carried out using an endoscope. Liver function tests will determine if the liver is healthy.
The risk factors of developing gallstones
Certain conditions make it more likely that you will develop gallstones in your gallbladder. People who are at risk of gallstones are older women, people who are obese, family history of gallstones and a typical western diet.
Treatment of gallstones
Often a ‘watch and wait’ or an ‘active monitoring’ approach is used. This means that if your gallstones do not cause any further problems, they may pass out naturally through your gut.
However, there are several ways of tackling gallstones directly.
Sometimes high-energy shock waves can be used to break down the gallstones in the gallbladder. This procedure is known as Extracorporeal Shock Wave Lithotripsy. Endoscopic retrograde cholangio-pancreatography (ERCP) is another technique to remove gallstones from the bile duct while leaving the gallbladder in place.
Cholecystectomy is surgery to remove the gallbladder entirely. This can be carried out as keyhole surgery under general anaesthetic or it may be done as open abdominal surgery. Because the gallbladder is not an essential organ you should not notice its absence after it is removed.
If your gallstones are small and do not contain calcium, medication may be effective in dissolving them. However, this method is generally not considered very effective and if so, the results are not long-lasting.
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