Overview
The gall bladder is a small pear-shaped bag under the liver. It stores bile, the fluid the liver makes to digest fat, and squeezes it into the small intestine after a meal.
Gallstones form when the balance of bile changes, or when the gall bladder does not empty properly. They may be as small as grains of sand or as large as a pebble.
Symptoms
Most gallstones sit quietly. Trouble starts when a stone blocks a duct, bringing on what is often called a gall bladder attack.
- Severe, steady pain in the centre of the tummy or under the right ribs
- Pain lasting from about half an hour to several hours
- Pain that often begins in the evening or at night, or after a heavy or fatty meal
- Pain that may spread through to the back
- Feeling sick, vomiting, and being unable to find a comfortable position
When to see a doctor
See a doctor in the next few days if pain in the upper tummy lasted more than 30 minutes even though it settled, if attacks keep returning after rich meals, or if gallstones have been found on a scan done for another reason.
Causes
Gallstones form when something changes the make-up of bile. The most common kind forms when bile holds more than it can keep dissolved. Another kind forms when there is too much bilirubin, the pigment made when red blood cells are broken down.
A gall bladder that empties slowly or incompletely also lets bile sit and thicken, which helps stones to form.
Risk factors
- Being over 40
- Being female
- Being overweight or obese
- A diet high in fat and low in fibre
- Losing a lot of weight very quickly, or crash dieting
- Diabetes
- Crohn's disease
Complications
A stone stuck in the neck of the gall bladder can make it inflamed and infected, causing constant pain and fever. A stone that slips into the main bile duct blocks the flow of bile, turning the skin and eyes yellow, darkening the urine and making stools pale. A stone blocking the opening the pancreas shares can set off pancreatitis, a severe inflammation that needs hospital care.
Prevention
- Keeping to a healthy weight
- Losing weight steadily rather than crash dieting
- Eating more fibre, including whole grains, vegetables, fruit and dal
- Cutting down on fried and very fatty food
- Being physically active most days, and keeping diabetes controlled
Diagnosis
An scan of the upper tummy is the usual test and shows stones in the gall bladder well. Blood tests check for infection and show whether the liver and pancreas are affected.
If a stone is suspected in the bile duct, an MRI of the bile ducts may be arranged, or a camera test that looks at the duct directly.
Treatment
Stones that cause no symptoms are usually left alone. Once attacks begin, the usual treatment is an operation to remove the gall bladder, most often by keyhole surgery through a few small cuts, which allows a quicker recovery than open surgery.
A stone blocking the main bile duct can be removed during a camera test, with a tube passed through the mouth into the duct. Inflammation or infection is treated in hospital with fluids, pain relief and , and surgery follows once the person is stable.
While waiting for treatment, a lower fat diet and simple pain relief are often suggested. Life without a gall bladder is normal, because bile still flows from the liver into the intestine.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Every gallstone found on a scan has to be removed.”What is true?
Fact
Stones that cause no symptoms are often left alone, because they do not stop the gall bladder, liver or pancreas from working. Treatment is usually advised once they start causing attacks of pain or complications, and that decision is made with a surgeon.
Myth“Gallstones can be flushed out at home with oil, lemon juice or special drinks.”What is true?
Fact
The treatments known to work are removing the gall bladder by surgery, or clearing a blocked bile duct with a camera passed through the mouth. Nothing taken at home has been shown to get rid of stones, and waiting while attacks continue allows the gall bladder or the pancreas to become inflamed.
Myth“You cannot digest food properly once the gall bladder is taken out.”What is true?
Fact
The gall bladder stores bile but does not make it. After it is removed, bile still reaches the small intestine from the liver, so people live normally without one. Some find very fatty meals harder to manage for a while after the operation.
Myth“Only overweight people get gallstones.”What is true?
Fact
Being overweight does raise the risk, but so do being over 40, being female, losing weight very quickly, diabetes and Crohn's disease. Slim people get gallstones too, and a very fast weight loss diet can bring them on.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
I have gallstones but no pain. Do I need an operation?
Usually not. Silent stones do not interfere with the working of the gall bladder, liver or pancreas, and many people never have any trouble from them. A surgeon may still advise removal in particular situations, and will explain the reason if so.
Can medicines dissolve gallstones instead of surgery?
Medicines to dissolve stones exist but suit only a small number of people, work slowly and often do not clear the stones completely, and stones can return afterwards. For most people who have attacks, removing the gall bladder is the treatment that gives a lasting result.
What can I eat to stop the attacks?
Cutting down on fried and very fatty food often makes attacks less frequent while you wait for treatment, and eating more fibre helps generally. Diet alone does not remove stones that are already there, so it is not a substitute for seeing a surgeon.
How long does it take to recover from gall bladder surgery?
That depends on whether the operation is done by keyhole or open surgery and on the person's general health. Keyhole surgery usually means a short hospital stay and a return to everyday activity within a couple of weeks. Your surgeon will give you the timing that fits your case.
