Gallstones are stone-like lumps
that can be tiny or the size of a
table tennis ball that form
within the gallbladder
A gallstone attack can feel like a heart attack, stomach ulcers, irritable bowel syndrome, reflux, or pancreatitis. Accurate diagnosis is important.
What are gallstones?
Gallstone surgery is recommended if the stones are problematic, causing pain and/or discomfort.
“While gallstones do not always cause symptoms, when they lodge at the entrance to or within the bile ducts they are generally painful. If you experience pain, we recommend gallstone treatment. The recomended treatment is gall bladder removal buy keyhole surgery (laparoscopic cholecystectomy). Gallstone symptoms can vary, but often follow fatty meals or come on late in the evenings or during sleep.”
A gallstone attack can include:
- steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours
- pain in the back between the shoulder blades
- pain under the right shoulder
- severe pain in the locations mentioned above similar in intensity to contractions during childbirth. Often impossible to find a comfortable position
- nausea or vomiting
- indigestion & belching
- abdominal bloating
- recurring intolerance of fatty foods
“Many patients with gallstones have no symptoms and often do not know they have them. These are called ‘silent stones’. Usually we do not recomend surgery for asymptomatic stones as the chance of symproms developing are only 1in 50 per year and complications then in only 1in 1000 per year. Exceptions may include women thinking of starting a family, immunocompromised individuals or those pre specific events like working in remote locations abroad”.
What are the types of gallstones?
There are 3 main types of gallstones:
- Mixed stones: These are the most common type and account for 80 percent of gallstones. They are usually yellow-green and are made mostly of hardened cholesterol along with a small quantity of calcium and bile pigment. It’s believed these stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts.
- Pigment stones: These are made up of a yellow-orange pigment called bilirubin, which is formed by the breakdown of red blood cells. It’s not known why pigment stones form. However, they tend to develop in people with cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anaemia.
- Cholesterol stones: These are made up almost entirely of cholesterol. They are usually tiny and sand-like. Most small polyps are made up of these cholesterol stones stuck to the gallbladder wall.
Who is likely to get gallstones?
“Obesity is another major risk factor for gallstones, especially in women. Other gallstone risk factors can be excess oestrogen from pregnancy, hormone replacement therapy, or birth control pills. If you have lost a lot of weight in a very short time, you can also be at risk of gallstones. As the body metabolises fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile. This process can cause gallstones.”
Ultrasound is the most sensitive and specific test for gallstones. Other diagnostic tests include:
- Blood tests. These may be used to look for signs of infection, obstruction, pancreatitis, or jaundice.
- Computed tomography (CT) scan. This may show gallstones or complications. Only 10-20% of gallstones show up on x-ray or CT scan
- Endoscopic retrograde cholangiopancreatography (ERCP). While you are sedated a telescope is passed via the stomach into the duodenum. The bile duct is accessed and a special x-ray dye is used to look for stones in the bile duct. These stones can then be extracted.
- HIDA scan. This is a special scan using a tiny dose of radiation that assesses the function of the gallbladder. A gallbladder damaged by stones tends to lose the ability to contact and empty properly.
Risks and complications with gallstones
When the gallbladder entrance is obstructed by a stone you will experience pain. It usually lasts several hours and relieves when the stone moves. It may be made worse by fatty foods, which make the gallbladder contract.
Repeated inflammation leads to thickening and scarring of the gallbladder.
If the stone blocking the gallbladder does not move then a severe attack occurs. This can be very painful and cause you to feel very unwell. If untreated, an infection can develop leading to an empyema or abscess of the gallbladder.
This can occur if the bile duct becomes blocked by a passing stone. The bile backs up in the liver and eventually, your skin and eyes turn yellow. Other signs are if your urine becomes dark and stools are pale.
This is an infection of the bile duct, which carries bile from the liver to the gallbladder and then to the intestines. It can be life-threatening and requires urgent treatment.
Passage of stones through the bile duct can cause some bile to flow into the pancreas instead of out into the gut. The bile activates the digestive enzymes in the pancreas too soon causing inflammation of the pancreas. This causes severe pain that radiates through to the back. A severe attack of pancreatitis can cause many complications and may be life-threatening.
Prolonged inflammation of the gallbladder from stones can lead to gallbladder cancer. It is often untreatable once diagnosed but is very rare.
What should you do if you have repeated gallstone pain?
An additional procedure is an ERCP. This may be performed before or very soon after removal of the gallbladder.
When the gallstones are formed or are trapped in your bile duct, you may need an ERCP (or endoscopic retrograde cholangiopancreatography).
To remove them, your surgeon will use a thin, flexible tube with a microscopic camera in it. This will pass through your mouth down the oesophagus, through the stomach and into the first part of the intestine called the duodenum to the opening of the bile duct.
Is gallbladder removal the only option?
In most instances, the answer is yes and it is the most effective option. It rectifies the problem before it escalates requiring emergency surgery.
Rarely if an individual is very frail and the stones are tiny they can be dissolved with medications. However, the medications are difficult to tolerate and they can cause stones to block the bile ducts causing complications. The treatment is long (weeks and months). The stones frequently reform within the year as well.
If you have gallstones and are asymptomatic, you may not require any form of surgery. If you do have pain, surgery is recommended. The most common gallstone removal treatment involves removal of the gallbladder itself, also known as a cholecystectomy. In most cases, our experienced Perth surgeons operate via keyhole surgery (over 99.5%).
"Some patients are unable to have gallstones surgery. If that’s the case, your doctor may prescribe drugs. These drugs are made from bile acid and are used to dissolve the gallstones. However, this treatment may take months or even years and is used for small cholesterol gallstones only."
"Some patients are unable to have gallstones surgery. If that’s the case, your doctor may prescribe drugs. These drugs are made from bile acid and are used to dissolve the gallstones. However, this treatment may take months or even years and is used for cholesterol gallstones only."
The importance of working with experienced surgeons
Our surgeons at Upper GI West are experienced in minimally invasive surgery. In fact, they underwent formal additional training involving advanced laparoscopic surgery of the entire Upper GI tract. This includes the gallbladder and bile ducts - having the ability to remove the gallbladder laparoscopically - which means reduced recovery time and no large surgical incisions for the patient.
Gallstones develop more often in ther obese and are common after weight loss surgery due to the rapid weight loss (more likely if bypass surgery due to changes in the circulation of bile). As our surgeons at Upper GI west offer a comprehensive Upper GI and Bariatric service, we are able to monitor and treat issues that may present following obesity or weight loss surgery and manage appropiately.