Take action to treat gallstones
Many of us will have gallstones – in fact, up to one-in-five adults in New Zealand have probably got them, but won’t know about it until, or if, they cause a problem.
Over a 10-year period, about a one-third of everyone with gallstones will have symptoms. The rest will likely remain undetected.
Gallstones form in the gallbladder. The gallbladder is a sac-type organ sitting just under the liver, on the upper right side of the abdomen. Its purpose is to store bile, made in the liver, and secrete it when we eat into the gut.
The bile aids digestion, particularly of fatty food. Bile is made up of various bile salts and pigments, as well as cholesterol and a substance called lecithin. Bile is normally liquid, but when parts of it start to solidify, stones are formed, known as gallstones.
Most stones are formed from fatty cholesterol when it starts to solidify and harden from sludge in the gallbladder, but less commonly they are made up of calcium or bile pigment and are known as black stones.
The number and size of stones can vary hugely. Some people have a gallbladder full of them, and others only have one or two very small ones.
Any of us could develop gallstones, but some factors make it more likely:
■ Obesity – as BMI increases, so does the likelihood of getting gallstones
■ Being female – women are twice as likely as men to get gallstones
■ Increasing age
■ Pregnancy
■ Taking certain medications, particularly the oral contraceptive pill
■ Rapid weight loss
■ Having a close relative with gallstones – this makes you about four times as likely to get them
■ Having certain medical conditions such as high cholesterol, cirrhosis, diabetes and Crohn’s disease.
If you are found incidentally to have gallstones (for example, during an ultrasound scan), but they haven’t caused you any symptoms, there is no need to be concerned – they may do nothing your entire life. However, for some they will lead to issues, requiring treatment. The most common problems resulting from gallstones include:
Biliary colic
This is a spasmodic type of pain, caused when a stone gets stuck in the cystic duct (a tube that takes bile from the gallbladder to the bile duct). The gallbladder squeezes to try to get rid of the stone, causing pain. If the stone is dislodged, going either back into the gallbladder or into the gut, the pain will ease. Typically, this pain is felt in the upperabdomen, under the ribs, on the right hand side, and can radiate around to the back.
It is often described as coming in waves and can last anything from a few seconds to several hours. It is more common to get biliary colic after a fatty meal, as the gall bladder will be more active then. Interestingly, although some people will have really severe biliary colic, for others the pain can be quite mild and can go relatively unnoticed, often put down to some sort of non-specific ‘‘indigestion’’. If the colic isn’t severe, often no urgent management will be needed other than relief of symptoms with anti-inflammatories and pain relief.
Cholecystitis
This refers to inflammation of the gallbladder and is less common than colic. As well as causing pain in the right upper-abdomen, which is usually quite severe, cholecystitis is associated with fever, malaise – feeling unwell, and ‘‘flu like’’ – shivering, vomiting and sometimes jaundice.
Cholecystitis is more serious than colic and requires urgent treatment to prevent the inflammation worsening. The risk of cholecystitis is higher in people with larger gallstones, as they are more likely to get trapped, causing a blockage in the common bile duct. Treatment requires antibiotics and often surgery to remove the gallbladder (known as cholecystectomy). Pancreatitis
If a gallstone causes obstruction to the pancreatic duct, this can lead to inflammation of the pancreas, the organ that helps us process sugar and aids digestion.
Pancreatitis can range from mild to very severe and life-threatening and, if not treated, can destroy part of the pancreas gland, resulting in diabetes. Treatment involves clearing the obstructing stone and, sometimes, removing the gallbladder.
Obstructive jaundice
If a stone obstructs the flow of bile into the duodenum (part of the gut), it can cause jaundice (yellowing of the skin and eyes), itching, dark urine and pale stools.
Treatment is similar to that for pancreatitis and is aimed at rapidly relieving the obstruction before
The pain is often described as coming in waves and can last anything from a few seconds to several hours.
more serious damage is done.
If you develop symptoms that suggest you could have symptomatic gallstones, how quickly you need to get investigations done will depend on how severe things are and whether or not there is anything to suggest inflammation or infection (which need to be dealt with very promptly). Your doctor will be able to guide you with this.
If things are manageable with pain relief – and you aren’t unwell – usually people can safely wait weeks, or even months, before getting a definitive answer.
This will involve having some blood tests to check the liver is functioning and nothing else is amiss – and probably an ultrasound scan in the first instance to look for stones. Ultrasound picks up around 95 per cent of gallstones, so this is typically the only imaging that is required.
Although mild episodes of biliary colic can be managed well with pain relief and fluids, most people with symptoms will eventually opt to have something more permanent done, especially if they have had more serious issues, such as cholecystitis or jaundice.
The permanent solution involves removal of the gallbladder, either by keyhole (laparoscopic) or open surgery.
Post-surgery, most people live quite happily without their gallbladder – bile is still produced, even though there is nowhere to store it – however some do report ongoing issues with bloating and low level abdominal pain, particularly after eating a fatty meal. Maintaining a lower-fat diet long term can be a good solution.