Gallstones

Gallstones are hard deposits of digestive fluid (bile) that develop in the gallbladder (a small, pear-shaped organ located on the right side of the abdomen just below the liver). Gallstones may be as small as grain of sand to as big as a golf ball.

Causes

Gallstones develop because of imbalance in the substances that make up bile. It is still unclear why these imbalances occur.  However, it is believed that gallstones may form if bile contains unusually high levels of cholesterol, bilirubin, or not enough bile salts.  

Symptoms

Many people with gallstones do not have any symptoms or are not aware that they have gallstones unless detected in tests carried out for another reason. If symptoms occur, they may include:

• Constant cramping pain that is sharp or dull which occurs in the right upper or middle upper abdomen for at least 30 minutes. Gallbladder attacks usually occur in the evening or during the night. The attack usually stops when gallstones move into the small intestine.
• A high temperature
• Jaundice

Other symptoms include nausea, vomiting and clay coloured stools.

You are at risk of developing gallstones if you:

• Are a woman
• Are more than 40 years of age
• Are taking birth control pills or pregnant
• Have a family history of gallstones
• Are of American Indian or Mexican descent
• Have diabetes
• Are overweight or obese
• Are on a high calorie and low fibre diet and have recently lost weight very quickly

Diagnosis of gallstones is done with the help of tests which include ultrasound scan of the abdomen, CT scan of the abdomen, magnetic resonance imaging (MRI) scan, endoscopic retrograde cholangiopancreatography (locate the affected bile duct and the gallstone), cholescintigraphy (diagnose abnormal contractions of the gallbladder or obstruction of the bile ducts). Your doctor may also order blood tests to look for signs of infection or inflammation of the bile ducts, gallbladder, pancreas, or liver.

Treatment

The usual treatment for gallstones is surgery to remove the gallbladder. The most commonly used technique is called laparoscopic cholecystectomy (involves small incisions, which allow for a faster recovery). Open cholecystectomy (incision of about 4 to 6 inches long is made in the abdomen and thus requires more time to heal) was the technique used in the past. However, this technique is less common now.

Nonsurgical treatments (endoscopic retrograde cholangiopancreatography) may be used to dissolve or remove stones if a person cannot undergo surgery or to remove stones from the common bile duct. Your doctor may also prescribe medications. However, the disadvantage of taking medicine is that you may need to take it for years and there are chances that the stones may come back if you stop taking the medicines.