Gallstone Disease
What are gallstones?
Bile is made in the liver and stored and concentrated in a small pouch attached to the bile duct and liver called the gallbladder. The gallbladder is designed to contract and empty the bile into the intestines during a meal, especially a fatty meal to help with digestion. Gallstones are usually hardened deposits of cholesterol although can also be pigment stones.
What causes gallstones?
It is not clear exactly what causes gallstones although it is likely a combination of too much cholesterol in the bile to remain dissolved and the gallbladder not emptying correctly, leading to very concentrated bile in which precipitants can begin the process of stone formation. Stones range in size from a grain of sand to a golf ball.
What are the risk factors?
Gallstones are very common, affecting around 1 in 5 adults. Women have twice the risk of men. Many factors increase your risk of gallstones. These include:
- Being female
- Overweight
- Age over 40
- Sedentary lifestyle
- High fat diet
- Pregnancy
- Rapid weight loss
- Low fibre diet
- Diabetes
- Liver disease.
What are the symptoms of gallstone disease?
Most people are not aware they have gallstones. The 3 most common problems associated with gallstones include:
- Biliary Colic, which is a severe bout of pain where a gallstone blocks the gallbladder, preventing it from emptying its contents. It can be associated with nausea and vomiting and may last a few minutes to several hours. It usually follows a fatty meal and resolves when the stone is dislodged.
- Cholecystitis refers to thickening and inflammation of the gallbladder wall when a stone gets completely stuck, prevents the gallbladder from emptying and does not resolve. It is often difficult to differentiate between biliary colic and cholecystitis as they are likely on a spectrum of the same disease process. Cholecystitis is likely if the pain has lasted longer than 4-6 hours.
- Pancreatitis is often caused by gallstones. It is due to a small gallstone passing from the gallbladder into the common bile duct (CBD) and blocking the pancreatic duct.
There are a number of other less common problems with gallbladder disease including a severe infection in the bile ducts (cholangitis), gallbladder polyps and rarely gallbladder cancer.
What is the treatment of gallstones?
Surgery is generally indicated for patients with gallstones causing symptoms. Most often this is performed laparoscopically (key-hole) and known as laparoscopic cholecystectomy. This is often done during the same hospital admission for cholecystitis and pancreatitis. Patients with symptomatic or growing gallbladder polyps or large polyps (>8mm) should also have surgery. A dye test (intra-operative cholangiogram) is often performed at the same time to make sure the bile ducts are free of stones.