Gallstones and Cholecystectomy (Gall Bladder removal)

What is a Gallbladder?

Your liver makes bile, a yellow fluid that helps to digest fatty or rich foods. It gets stored and concentrated in the gallbladder, a pouch which sits underneath the liver collecting the bile and concentrating it. When you have a meal special gut hormones are released which cause the gallbladder to contract and discharge the bile into the gut to help digestion. It works a bit like soap and emulsifies the fat. 

What are Gallstones?

These are stones that form in the gallbladder. They are generally formed from cholesterol. These stones are the commonest and can form in patients for many reasons including weight loss (dieting), fasting and high cholesterol. Patients at risk include those with a family history, women and obesity. Occasionally patients with blood disorders  can form a different type of stone called a pigment stone which can cause similar problems to cholesterol stones. 

Sometimes they sit there happily and don’t cause any symptoms. However they can also cause severe pain felt in the upper abdominal region and chest.  

How do you diagnose Gallstones? 

Generally an ultrasound scan will diagnose gallstones. Sometimes an MRI is required particularly if we are interested in looking at the main bile ducts as well. CT scanning is particularly useful at looking at acute inflammatory processes of the gallbladder such as acute cholecystitis. Occasionally we do nuclear medicine scans (HIDA) which look at the function of the gall bladder. Each test has its own strengths and weaknesses and sometimes multiple tests are required to clinch the diagnosis. 

What are Gallstone complications? 

Biliary Colic – The stone  gets stuck in the neck of the gallbladder and causes severe pain whilst they are blocking and the pain often resolves  when the gallbladder deflates and the stone  is no longer obstructing. Pain is generally less than an hour or two, intense and patients often rate it 10/10 and they are unable to get comfortable. Sometimes patients think they are having a heart attack, severe reflux or severe indigestion. 

Acute Cholecystitis – The gallbladder becomes acutely inflamed and thick walled. A gallstone generally remains stuck in the neck of the gallbladder. At its worse the gallbladder can become gangrenous which is a surgical emergency and requires immediate surgery. 

Chronic cholecystitis – This is generally regarded as Biliary Colic. Patients can have multiple attacks and feel fine in between attacks.  If there are abnormal liver function tests then one needs to have a high index of suspicion for stones that have traveled or are blocking the main bile duct.

Acute Cholangitis – The stones have moved from the gallbladder into the main bile duct and are causing blockage and infection. This can be a life threatening situation. Immediate treatment is required including antibiotics, decompression of the main common bile duct and removal of stones by endoscopy(ERCP). Removal of the gallbladder(cholecystectomy) is then required  as the gallbladder is the source of the stones. 

Acute (Gall stone)Pancreatitis – Acute pancreatitis is commonly caused by gall stones. Stones can travel from the gall bladder down into the main bile duct and down to the bottom of the duct where the main duct for the pancreas is. If the stone blocks the duct to the pancreas the patient can get pancreatitis which can range from being a relatively short attack to serious life threatening. Paradoxically it’s the small stones that can travel and cause these complications.