About

Gallstones are stones that form in the gallbladder and they are very common in the UK. Often, they will not cause any symptoms. However, in certain patients, they can cause a variety of symptoms or problems. These are explained below.

Figure 1. Anatomy of the gallbladder region.

Pain

Gallstones can cause pain. The most common pattern is called 'biliary colic'. This usually means that a patient will get intermittent pains, often in the upper middle or upper right side of the abdomen, and this can spread round to the back. Typically, this will last for a few hours, before slowly easing. Associated with this pain, patients may feel hot and sweaty, or sick, with some patients also vomiting. These episodes often occur at night, or they can also happen half an hour or an hour after eating, particularly after foods containing lots of fat.

Occasionally, patients may get pain similar to that described above, but it does not settle after a period of 4-6 hours. Along with the pain, some patients may experience a high temperature. This can occur when the gallbladder becomes inflamed, and this is then called 'cholecystitis'. Your doctor will look for certain signs of inflammation, when examining you and also using blood tests. Because of the inflammation, cholecystitis is usually successfully treated with a course of antibiotics. However, sometimes antibiotic treatment is not successful, and a surgical procedure is required.

Similar pains can also be caused by gallstones blocking the gallbladder permanently, or if gallstones manage to move from the gallbladder into the bile ducts, which are tubes taking bile from the gallbladder to the bowel. In these cases, gallstones can cause other problems such as jaundice, pancreatitis, or cholangitis.

Jaundice

If a stone passes from the gallbladder to the main bile duct and causes a blockage, it may cause a person to become jaundiced. This means that they have high levels of a particular chemical in their body that causes their skin and whites of their eyes to go yellow, as well as turning their urine a dark yellow or brown, and their faeces may become pale and grey. Often this is associated with general itchiness. Confirming the problem often requires blood tests and special scans. Stones in the bile duct are often then treated with a special endoscopy (camera test with a telescope inserted through the mouth into the bowel) or operation.

Pancreatitis

Pancreatitis means inflammation of the pancreas. This is a gland in the back of the upper abdomen. The pancreas normally controls a person's blood sugar, as well as producing chemicals to digest food. Gallstones passing through the bile duct are the most common cause of pancreatitis in England. People who develop pancreatitis usually have severe pain in the upper abdomen and may go through to their back, which comes on quickly and stays there for hours. It is often associated with nausea and vomiting. The diagnosis is usually confirmed with a blood test, although sometimes a scan is required. The condition of pancreatitis can be very variable, with many patients having very mild disease that settles quickly. However, it can be life-threatening, and in some patients requires treatment in intensive care and a long hospital stay.

If pancreatitis develops due to gallstones and a patient is fit for surgery, we aim to remove the gallbladder with a surgical procedure as soon as we can, usually within 2 weeks. However, in severe cases of pancreatitis, there may be a delay to wait for the inflammation to settle. In patients not fit for surgery, a special endoscopy may be performed to reduce the risk of further attacks of pancreatitis.

Cholangitis

Cholangitis is an infection in the bile ducts, and can occur in patients with a gallstone that is blocking the bile duct. This can result in a very serious, life-threatening infection requiring strong antibiotics, tests to confirm the diagnosis, and urgent treatment to relieve the blockage. This is usually done with a special endoscopy.