Gallstones

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

Doctors refer to this more severe condition as complicated gallstone disease.

Causes

Gallstones are thought to be caused by an imbalance in the chemical make-up of bile inside the gallbladder. Bile is a liquid produced by the liver to help digestion.

It's unclear what causes the chemical imbalance, but gallstones can form if there are unusually high levels of:

• cholesterol inside the gallbladder (about 4 out of 5 gallstones are made of cholesterol)
• a waste product called bilirubin inside the gallbladder (about 1 in 5 gallstones is made of bilirubin)

These chemical imbalances cause tiny crystals to develop in the bile.

These can gradually grow (often over many years) into solid stones that can be as small as a grain of sand or as large as a pebble.

Sometimes only 1 stone will form, but there are often several at the same time.

Risk Factors

Gallstones are more common if you:

• are female, particularly if you have had children, are taking the combined pill, or are having high-dose oestrogen therapy
• are overweight or obese
• are aged 40 years or older (the older you are, the more likely you are to develop gallstones)
• have a condition that affects the flow of bile (such as cirrhosis, primary sclerosing cholangitis, or obstetric cholestasis)
• have Crohn's disease or irritable bowel syndrome (IBS)
• have a close family member who's also had gallstones
• have recently lost weight (from either dieting or weight loss surgery)
• are taking an antibiotic called ceftriaxone

Diagnosis

Gallstones may be discovered during tests for a different condition, as they often don't cause any symptoms.

If you have symptoms of gallstones, make an appointment with a GP so they can try to identify the problem.

Seeing a GP

The GP will ask about your symptoms in detail and may carry out the Murphy's sign test to help determine if your gallbladder is inflamed.

During this test, the GP places their hand or fingers on the upper-right area of your tummy and asks you to breathe in.

If you find this painful, it usually means your gallbladder is inflamed and you may need urgent treatment.

Your GP may also recommend having blood tests to look for signs of infection or check if your liver is working normally. 

If gallstones have moved into your bile duct, the liver may not be able to function properly.

Further tests

If your symptoms and test results suggest you may have gallstones, you'll usually be referred for further tests.

You may be admitted to hospital for tests the same day if it's thought you may have a more severe form of gallbladder disease.

Ultrasound scan

Gallstones can usually be confirmed using an ultrasound scan, which uses high-frequency sound waves to create an image of the inside of the body.

The type of ultrasound scan used for gallstones is similar to the scan used during pregnancy, where a small handheld device called a transducer is placed onto your skin and moved over your upper abdomen.

Sound waves are sent from the transducer, through your skin and into your body. They bounce back off the body tissues, forming an image on a monitor.

This is a painless procedure that usually takes about 10 to 15 minutes to complete.

When gallstones are diagnosed, there may be some uncertainty about whether any stones have passed into the bile duct.

Gallstones in the bile duct are sometimes seen during an ultrasound scan. If they're not visible but your tests suggest the bile duct may be affected, you may need an MRI scan or a cholangiography.

MRI scan

An MRI scan may be carried out to look for gallstones in the bile ducts.

This type of scan uses strong magnetic fields and radio waves to produce detailed images of the inside of the body.

Cholangiography

A procedure called a cholangiography can give further information about the condition of your gallbladder.

A cholangiography uses a dye that shows up on X-rays. The dye may be injected into your bloodstream or directly into your bile ducts during surgery, or by using an endoscope passed through your mouth.

After the dye has been introduced, X-ray images are taken. They'll reveal any abnormality in your bile or pancreatic systems.

If your gallbladder and bile systems are working normally, the dye will be absorbed in the places it's meant to go (your liver, bile ducts, intestines and gallbladder).

If a blockage is detected during this test, your doctor may try to remove it at this point using an endoscope.

This is known as an endoscopic retrograde cholangio-pancreatography (ERCP).

CT scan

A CT scan may be carried out to look for any complications of gallstones, such as acute pancreatitis.

In this type of scan, a series of X-rays are taken from many different angles.

CT scans are often carried out in an emergency to diagnose severe abdominal pain.

Treatment Options

Treatment is usually only necessary if gallstones are causing:

• symptoms, such as tummy pain
• complications, such as jaundice or acute pancreatitis

In these cases, keyhole surgery to remove the gallbladder may be recommended. 

This procedure, known as a laparoscopic cholecystectomy, is relatively simple to perform and has a low risk of complications.

It's possible to lead a normal life without a gallbladder.

Your liver will still produce bile to digest food, but the bile will drip continuously into the small intestine, rather than build up in the gallbladder.

Prevention Tips

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.

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.

A more gradual weight loss plan is recommended.

When To See A Doctor

Make an appointment to see a GP if you think you may have biliary colic.

Contact your GP immediately for advice if you develop:

• jaundice
• abdominal pain lasting longer than 8 hours
• a high temperature and chills
• abdominal pain so intense that you can't find a position to relieve it