Gallstones: symptoms, risk factors and gallbladder surgery, a review

Gallstones can be present without causing symptoms. When they do cause trouble, the pain can be severe and sometimes a serious problem develops. This article explains what gallstones are, who is more likely to get them, how they are found and how they are treated, using information from the NHS, NIDDK and MedlinePlus.

1. Introduction

The gallbladder is a small, pear-shaped organ under the liver. It stores bile, a fluid made by the liver that helps the body digest fat ^[3]. Gallstones are hard, pebble-like pieces that form in the gallbladder, and NIDDK says they are usually made of cholesterol or bilirubin ^[2]. They can also sit in the bile ducts, the narrow tubes that link the gallbladder to the liver and pancreas ^[1].

The NHS says most people with gallstones have no symptoms ^[1]. MedlinePlus agrees that stones are often found by chance on a scan done for another reason, and people without symptoms usually do not need treatment ^[3].

2. Causes and risk factors

NIDDK explains that gallstones may form when bile contains too much cholesterol, too much bilirubin or not enough bile salts ^[2]. The NHS lists these things that raise the chance of gallstones ^[1]:

• Being over 40
• Being a woman
• Living with obesity
• A diet high in fat and low in fibre
• Losing weight very quickly, for example after weight loss surgery
• Having diabetes or Crohn's disease (a long-term bowel condition)

NIDDK also names being overweight and losing weight very fast as possible risks ^[2]. MedlinePlus adds older adults, women, people who are overweight, and Native Americans and Mexican Americans ^[3].

3. Signs and symptoms

When a stone blocks a bile duct, bile builds up and causes pain. NIDDK calls this a gallbladder attack, and it usually causes pain in the upper right belly ^[2]. The NHS calls the pain biliary colic. It can be severe and steady, may last from about 30 minutes to several hours, and is felt in the middle of the upper belly or just under the right ribs ^[1]. Feeling or being sick can come with it ^[1].

MedlinePlus says attacks often come after eating, and signs can include nausea, vomiting and pain in the belly or the back ^[3].

4. Diagnosis and tests

The NHS explains that stones may be found by chance during a scan or X-ray. If you have symptoms, you may have an ultrasound scan, which uses sound waves to make a picture, and a blood test ^[1]. NIDDK says doctors also use your medical history and a physical examination, and blood tests can show signs of infection or inflammation in the bile ducts, gallbladder, pancreas or liver ^[2]. MedlinePlus also lists a HIDA scan among its linked tests ^[3].

5. Treatment

If there are no symptoms, no treatment may be needed, although follow-up visits may be arranged ^{[1, 3]}. Treatment is needed when stones cause symptoms or complications, or when stones are in the main bile duct ^[1].

The NHS says the main treatment is an operation to remove the gallbladder, called cholecystectomy ^[1]. NIDDK says nonsurgical treatments are rarely used ^[2]. MedlinePlus notes that people can live without a gallbladder because bile finds other routes to the small intestine, and it links to an article asking whether long-lasting diarrhoea is a concern after removal ^[3].

Stones in the main bile duct may be cleared with a procedure called ERCP, in which a thin tube with a camera is passed down through the mouth ^{[1, 3]}. While waiting for surgery, the NHS says over-the-counter painkillers can help, stronger painkillers may be offered for severe pain, and avoiding foods that trigger symptoms and following a low-fat diet may be advised ^[1]. Ask a doctor or pharmacist what is suitable for you. Your surgeon decides which treatment is best.

6. Possible complications

The NHS says serious problems are rare but can happen when a blockage leads to inflammation of the gallbladder (cholecystitis), inflammation of the pancreas (pancreatitis) or jaundice ^[1]. Jaundice means yellow skin or eyes, itchy skin, darker urine and paler stools, and the yellow colour may be harder to see on brown or black skin ^[1]. The NHS says treatment for these problems usually involves pain relief and gallbladder removal ^[1].

7. Prevention and self-care

The NHS lists risk factors but gives no prevention advice ^[1]. NIDDK says that keeping a healthy weight through diet and nutrition may lower the risk, and advises talking with a health professional before changing your eating plan ^[2]. Losing weight very quickly may raise the risk ^{[1, 2]}. MedlinePlus links to an article about "gallbladder cleanse" remedies, but its page does not say that they work, so do not rely on them and tell your doctor about anything you try ^[3].

8. When to see a doctor

The NHS advises an urgent GP appointment or a call to NHS 111 (in the UK) if you have tummy pain that lasts longer than 30 minutes ^[1]. Seek emergency care for sudden severe tummy pain, pain that spreads to the back with vomiting, a very high temperature or feeling hot, cold and shivery, or yellow skin or eyes ^[1]. Do not drive yourself, and take your medicines with you ^[1].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Gallstones often cause no problems, but a blocked duct can cause sudden pain and sometimes serious complications. Knowing the risk factors, recognising the warning signs and getting prompt advice allow your doctor to choose between watching and surgery.