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Gallbladder - gallstones
















What is the gallbladder and bile?

The gallbladder is a small muscular bag that lies just under the liver, below the ribs on the right hand side. The liver produces a liquid called bile, which is then stored in the gallbladder, with cholesterol.

When food is eaten and passes into the bowel, the gallbladder is stimulated to empty the bile into the bowel via tubes called the bile ducts. This bile helps to digest any fat in the food.


What are gallstones?Gallstones  pain

Bile is liquid, but can form crystals. These crystals can then grow into particles the size of sand, small pebbles or even stones the size of tennis balls! They are mostly composed of cholesterol and bile pigments.


Gallstones are more common in women and those with a high-fat diet. They used to be associated with people over 40 years old, but are now increasingly seen in younger people, probably in response to worsening childhood obesity.

The stones may cause no problems whatsoever, especially when very small. They can, however, cause various symptoms, including:

  • Vague abdominal pain - gallstones can cause indigestion-type pain, bloating and excess wind. These may then progress to other symptoms (below).

  • Biliary colic - if a stone lodges in the gallbladder exit, then severe pain can result. The gallbladder contracts down, trying to push the stone through the bile duct into the intestine. The pain is maximal after meals, and mostly felt in the right abdomen and ribs. Nausea and vomiting can also occur. Biliary colic will resolve if the stone falls back into the gallbladder or if it moves into the bile duct and onward. If not, then acute cholecystitis can develop.

  • Acute cholecystitis - the pain is more severe and can spread to the shoulder and shoulder-blade areas, with nausea, vomiting and fever. Most cases will settle after 4-5 days with antibiotics, but you may need to have the gallbladder removed (cholecystectomy) to prevent recurrences.

  • Chronic cholecystitis - the pain, excess wind and fatty food intolerance causes recurrent and regular problems, but without fever. Again, cholecystectomy may be required to prevent the symptoms.

  • Jaundice - if the gallstone moves into the bile duct, then it will hopefully continue into the intestine, and be passed in the faeces. If the stone gets stuck in the duct, though, then it can cause jaundice (yellowing of the skin), cholangitis (inflamed gallbladder) or pancreatitis (inflamed pancreas). These conditions can be very serious and even life-threatening.


What tests can be performed for gallstones?

If your specialist believes that you may have gallstones, then there are a number of tests that can be performed. Your specialist will tailor the tests depending on your symptoms.

  • X-rays - stones may be visible on an x-ray, but only in a few cases.

  • Ultrasound - this is the usual test for gallstones, and can give a good idea as to whether your symptoms are caused by gallstones or not.

  • ERCP - this stands for 'endoscopic retrograde cholangiopancreatography'. A tube (endoscope) is passed down the throat and into the intestine to the point where the bile duct enters the bowel. Dye can then be used to visualise the bile duct, and look for any stones. Occasionally, further small procedures can be performed at the same time to help free any stones.

  • CT or MRI - these scans may occasionally be used if the specialist needs further information on the gallbladder or surrounding areas.


How are gallstones treated?

If your stones are found by chance and have not caused any problems, then no further treatment may be needed. If the stones have caused problems, though, then treatment may be needed. Whilst there are a number of options, most treatment involves removing the gallbladder - cholecystectomy.



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