Gall stones

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Overview

Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder holds a digestive fluid called bile that's released into your small intestine.

Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.

People who experience symptoms from their gallstones usually require gallbladder removal surgery. Gallstones that don't cause any signs and symptoms typically don't need treatment.

Symptoms

Gallstones don't usually cause any symptoms. But if a gallstone blocks one of the bile ducts, it can cause sudden, severe abdominal pain, known as biliary colic.


Other symptoms may develop if the blockage is more severe or develops in another part of the digestive system.


Abdominal pain (biliary colic)

Gallstones can cause sudden, severe abdominal pain that usually lasts 1 to 5 hours, although it can sometimes last just a few minutes.


The pain can be felt:


in the centre of your abdomen (tummy)

just under the ribs on your right-hand side – it may spread from here to your side or shoulder blade

The pain is constant and isn't relieved by going to the toilet, passing wind or being sick. 


It's sometimes triggered by eating fatty foods, but may happen at any time of day and may wake you up during the night.


Biliary colic doesn't happen often. After an episode of pain, it may be several weeks or months before you have another episode.


Some people also have periods where they sweat excessively and feel sick or vomit.


When gallstones cause episodes of biliary colic, it's known as uncomplicated gallstone disease.


Other symptoms

Occasionally, gallstones can cause more serious problems if they obstruct the flow of bile for longer periods or move into other organs, such as the pancreas or small bowel.


If this happens, you may develop:


a high temperature

more persistent pain

a rapid heartbeat

yellowing of the skin and whites of the eyes (jaundice)

itchy skin

diarrhoea

chills or shivering attacks

confusion

a loss of appetite


Causes

It's not clear what causes gallstones to form. Doctors think gallstones may result when:


Your bile contains too much cholesterol. Normally, your bile contains enough chemicals to dissolve the cholesterol excreted by your liver. But if your liver excretes more cholesterol than your bile can dissolve, the excess cholesterol may form into crystals and eventually into stones.

Your bile contains too much bilirubin. Bilirubin is a chemical that's produced when your body breaks down red blood cells. Certain conditions cause your liver to make too much bilirubin, including liver cirrhosis, biliary tract infections and certain blood disorders. The excess bilirubin contributes to gallstone formation.

Your gallbladder doesn't empty correctly. If your gallbladder doesn't empty completely or often enough, bile may become very concentrated, contributing to the formation of gallstones.

Types of gallstones

Types of gallstones that can form in the gallbladder include:


Cholesterol gallstones. The most common type of gallstone, called a cholesterol gallstone, often appears yellow in color. These gallstones are composed mainly of undissolved cholesterol, but may contain other components.

Pigment gallstones. These dark brown or black stones form when your bile contains too much bilirubin.


Risk factors

Factors that may increase your risk of gallstones include:


Being female

Being age 40 or older

Being a Native American

Being a Hispanic of Mexican origin

Being overweight or obese

Being sedentary

Being pregnant

Eating a high-fat diet

Eating a high-cholesterol diet

Eating a low-fiber diet

Having a family history of gallstones

Having diabetes

Having certain blood disorders, such as sickle cell anemia or leukemia

Losing weight very quickly

Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugs

Having liver disease

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Complications

A small number of people with gallstones may develop serious problems if the gallstones block a bile duct or move into another part of the digestive system.

Inflammation of the gallbladder (acute cholecystitis)

If a bile duct becomes permanently blocked, it can lead to a build-up of bile inside the gallbladder. This can cause the gallbladder to become infected and inflamed.

The medical term for inflammation of the gallbladder is acute cholecystitis.

Symptoms include:

pain in your upper abdomen that travels towards your shoulder blade (unlike biliary colic, the pain usually lasts longer than 5 hours)

a high temperature

a rapid heartbeat

An estimated 1 in 10 people with acute cholecystitis also experience jaundice.

Acute cholecystitis is usually first treated with antibiotics to settle the infection and then keyhole surgery to remove the gallbladder.

The operation can be more difficult when performed as an emergency, and there's a higher risk of it being converted to open surgery.

Sometimes a severe infection can lead to a gallbladder abscess (empyema of the gallbladder). Antibiotics alone don't always treat these and they may need to be drained.

Occasionally, a severely inflamed gallbladder can tear, leading to inflammation of the inside lining of the abdomen (peritonitis). 

If this happens, you may need antibiotics given directly into a vein (intravenous antibiotics), and surgery may be required to remove a section of the lining if part of it becomes severely damaged.

Read more about acute cholecystitis.

Jaundice

You can get jaundice if a gallstone passes out of the gallbladder into the bile duct and blocks the flow of bile.

Symptoms of jaundice include:

yellowing of the skin and whites of the eyes

dark brown urine

pale stools

itching

Sometimes the stone passes from the bile duct on its own. If it doesn't, the stone needs to be removed.

Find out more about treating gallstones

Infection of the bile ducts (acute cholangitis)

If the bile ducts become blocked, they're vulnerable to infection by bacteria. The medical term for a bile duct infection is acute cholangitis.

Symptoms of acute cholangitis include:

pain in your upper abdomen that travels towards your shoulder blade

a high temperature

jaundice

chills

confusion

itchy skin

generally feeling unwell

Antibiotics will help treat the infection, but it's also important to help the bile from the liver to drain with an endoscopic retrograde cholangio-pancreatography (ERCP).

Find out more about treating gallstones

Acute pancreatitis

Acute pancreatitis may develop when a gallstone moves out of the gallbladder and blocks the opening (duct) of the pancreas, causing it to become inflamed.

The most common symptom of acute pancreatitis is a sudden severe dull pain in the centre of your upper abdomen, around the top of your stomach.

The pain of acute pancreatitis often gets steadily worse until it reaches a constant ache.

The ache may travel from your abdomen and along your back, and may feel worse after eating.

Leaning forward or curling into a ball may help relieve the pain.

Other symptoms of acute pancreatitis can include:

feeling sick

being sick

diarrhoea

loss of appetite

a high temperature

tenderness of the abdomen

less commonly, jaundice

There's currently no cure for acute pancreatitis, so treatment focuses on supporting the body's functions until the inflammation has passed.

This usually involves admission to hospital so you can be given:

fluids into a vein (intravenous fluids)

pain relief

nutritional support

oxygen through tubes into your nose

With treatment, most people with acute pancreatitis improve within a week and are well enough to leave hospital after 5 to 10 days.

Read more about acute pancreatitis.

Cancer of the gallbladder

Gallbladder cancer is a rare but serious complication of gallstones. Around 1,100 cases of gallbladder cancer are diagnosed in the UK each year.

Having a history of gallstones increases your risk of developing gallbladder cancer. Most people who have cancer of the gallbladder also have a history of gallstones.

But most people who have had gallstones do not develop gallbladder cancer.

If you have additional risk factors, such as a family history of gallbladder cancer or high levels of calcium inside your gallbladder, it may be recommended that your gallbladder be removed as a precaution, even if your gallstones aren't causing any symptoms.

The symptoms of gallbladder cancer are similar to those of complicated gallstone disease, including:

abdominal pain

a high temperature

jaundice

Gallbladder cancer can be treated with a combination of surgery, chemotherapy and radiotherapy.

Gallstone ileus

Gallstone ileus is another rare but serious complication of gallstones. It's where the bowel becomes obstructed by a gallstone.

Gallstone ileus is where an abnormal channel, known as a fistula, opens up near the gallbladder. Gallstones are able to travel through the fistula and can block the bowel.

Symptoms of gallstone ileus include:

abdominal pain

being sick

swelling of the abdomen

constipation


Prevention

From the limited evidence available, changes to your diet and losing weight (if you're overweight) may help prevent gallstones.

Diet

Because cholesterol appears to play a role in the formation of gallstones, it's advisable to avoid eating too many foods with a high saturated fat content.

Foods high in saturated fat include:

meat pies

sausages and fatty cuts of meat

butter, ghee and lard

cream

hard cheeses 

cakes and biscuits

food containing coconut or palm oil

A healthy, balanced diet is recommended. This includes plenty of fresh fruit and vegetables (at least 5 portions a day) and wholegrains.

There's also evidence that regularly eating nuts, such as peanuts or cashews, can help reduce your risk of developing gallstones. 

Drinking small amounts of alcohol may also help reduce your risk of gallstones.

But you shouldn't regularly drink more than 14 units of alcohol a week, as this can lead to liver problems and other health conditions.

Regularly drinking any amount of alcohol can increase the risk to your health.

Read more about: 

high cholesterol

how to lower your cholesterol

healthy eating

alcohol

Losing weight

Being overweight, particularly being obese, increases the amount of cholesterol in your bile, which increases your risk of developing gallstones.

You should control your weight by eating a healthy diet and taking plenty of regular exercise.

But you should avoid low-calorie, rapid weight loss diets. There's evidence they can disrupt your bile chemistry and increase your risk of developing gallstones.