Should I worry about my gallstone?
Q A RECENT CT scan — for an unrelated issue — showed I have a gallstone. It isn’t causing me any issues, so what should I do?
Donovan Murugan, by email. A GAllsTOnes develop when the gallbladder, a small, pouch-like organ that stores and releases bile to aid digestion, becomes diseased or no longer works properly.
Bile contains cholesterol and waste pigment (bilirubin) from old blood cells — when the gallbladder malfunctions, it causes an imbalance in bile’s chemical make-up. The excess cholesterol and/or pigment then forms stones.
One in ten adults has gallstones, though in most cases they don’t initially cause any symptoms and don’t need to be treated.
When they are discovered by chance — as in your case — and are causing no symptoms, they are known as incidental gallstones. This type is found in about 5 per cent of men and 8 per cent of women.
However, gallstones tend to grow at a rate of around 1mm to 2mm per year, so it is likely that at some point you will get symptoms — though that may be years away.
Once gallstones have formed, there is not much you can do to reverse them, but there is some evidence to show we can prevent further stones forming with a healthy, balanced diet.
specifically, the advice is to avoid eating too many foods that are high in saturated fat, such as sausages, hard cheeses and cake, because cholesterol appears to play a role in the formation of the stones.
Being obese increases the amount of cholesterol in your bile, too, therefore increasing your risk of developing gallstones, so weight-loss is also said to help prevent them, though there’s no concrete research.
symptoms can start when larger stones get pushed out of the gallbladder and into the bile duct, which leads to the small intestine — smaller stones pass through without a problem.
A stone in the duct will cause pain known as biliary colic: this is typically felt under the rib on the right side, which may penetrate through to the back, or be felt around the right shoulder blade. You may experience nausea and vomiting, too. Once you get pain like this it’s likely to become recurrent.
Gallstones can cause other complications such as infection in the gallbladder, known as cholecystitis, too. This is an acute and severe illness of abrupt onset which causes a high temperature, severe pain in the region of the gallbladder (the upper right area of the abdomen, just under the ribs) and vomiting.
If you develop any of the symptoms I describe for biliary colic or cholecystitis, you will need to see a doctor.
Treatment involves a fairly straightforward operation to remove the gallbladder by keyhole surgery under general anaesthetic — this has no ill-effect on your subsequent health as the body adapts to the absence of the gallbladder.
However, as you are not experiencing any symptoms — for now, don’t worry. It’s best just to be aware of them and if they occur, seek prompt help.
Q I HAVE been unsteady on my feet and trembling with dizziness recently. Once I fainted and woke up to find I had no strength in my legs and couldn’t walk.
I was sent to a falls clinic, but the doctor couldn’t identify the cause. Could you shed any light on the problem? I am 84. Rosa Wheatley, Wideopen, Newcastle upon Tyne. A A cleAr diagnosis requires seeing you in person, but based on what you tell me, I’d suggest discussing the following with your doctor. One possibility is that the episodes you have experienced are transient ischaemic attacks, otherwise known as TIAs. These
are caused by a temporary interruption of blood flow to the brain, resulting in neurological symptoms — weakness, numbness, or even a brief loss of consciousness — which begin suddenly and resolve rapidly, usually within minutes or hours. The patient makes a full recovery with no lasting damage.
It is unlikely the experts at the falls clinic didn’t think of this and conduct the relevant investigations, which, as a minimum, would include an ultrasound scan of the arteries that supply the brain to check they are healthy. However, the challenge is that after a TIA, there is no residual damage in the brain — so if it wasn’t spotted immediately at the time, there is no way to be sure it is what you had.
Diagnosis would be based on taking a detailed history as well as the ultrasound scan results (for instance, if these reveal a build-up of fatty deposits that might interfere with blood flow).
If you have another fainting episode, you should be referred for an emergency scan to check for evidence of a TIA.
Another factor worth noting is your description of feeling you had no strength in your legs.
each time this happened, the symptom appeared to resolve itself, yet generally you’ve remained unsteady or dizzy. I wonder if the medicines you’ve already been prescribed may play a role, something that might not yet have been investigated?
In your longer letter, you mention being prescribed citalopram and trazodone — these are antidepressant drugs, which are also used to treat panic attacks. My question is whether the onset of your symptoms occurred after being prescribed these?
common side- effects of both medicines are tiredness and weakness, and there is a warning that using the two together can increase the risk of rare condition called serotonin syndrome.
This is an acute and potentially serious response to a drug which may include symptoms of confusion, extreme changes in blood pressure, blurred vision and incoordination.
This does not appear to be exactly what you are experiencing as your symptoms are occasional — yet it prompts me to consider whether your problems are due to these medicines.
Other potential known sideeffects of both drugs are an irregular heartbeat, weakness and feeling unsteady when walking.
Accordingly, I suggest you raise this possibility with your GP, or with the doctors at the falls clinic.
If there is agreement, a slow reduction in the citalopram dose over a number of weeks — from your current prescription of 30mg to perhaps 10mg — should result in an improvement, hopefully without prejudice to your mood state.