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Gallstones, causes, symptoms and treatment

Gallstones are stones which are found within the gallbladder.  

Incidence/Age/Sex

Gallstones are present in 10 – 20% of the population in the western world. Women are affected more than men with a 3 : 1 ratio in the under 40s, 80 – 90% of all gallstones do not cause symptoms. Gallstones are commoner in developed countries.

Causes/Prevention

70 – 80% of all gallstones in the west are predominantly made of cholesterol with some bile pigment and Calcium mixed in. The remainder are pigment stones.

Important risk factors are racial origin (gallstones are uncommon in Africa), increased age, female sex, obesity and an increased number of previous pregnancies. They are commoner in diabetics. The western diet probably plays a part in their formation. Pigment stones are commoner in people with certain blood disorders such as sickle cell disease and also in cirrhosis.

Signs and Symptoms

Most gallstones are asymptomatic. Some times a gallstone can be stuck in the neck of the gallbladder where it causes pain (acute cholecystitis). The pain is usually in the right upper quarter of the abdomen and it can be some times felt in the back and shoulder. It is often accompanied by nausea and vomiting. If a stone moves from the gallbladder duct into the common bile duct it can cause a blockage to the bile and then lead to jaundice.

Complications of the Disorder

Infection of the gallbladder secondary to gallstones can occur occasionally causing peritonitis and gallbladder perforation. Infection of the bile duct can occur (cholangitis) which can lead to fever, pain and jaundice leading to shock and septicaemia.

Tests

Gallstones are usually detected by an ultrasound examination which will usually show gallstones in the gallbladder, gallbladder distension and gallbladder wall thickening. Where jaundice is present a stone may be shown in the common bile duct and the duct itself may be enlarged because of back pressure from bile coming from the liver.

Treatment

Gallstones found on a routine scan are not treated since most do not cause symptoms. In an attack of acute cholecystitis the patient is usually admitted to hospital, rested in bed, given intravenous fluids and starved for a day or two and an antibiotic is often given. Pain relief is usually required.

Surgery

Surgery is performed urgently in a small number of cases where the gallbladder is gangrenous or perforated, otherwise the patient is allowed to recover from the attack and a gallbladder removal done 2 – 3 months later. Surgery is either open (cholecystectomy) or keyhole (laparoscopic cholecystectomy). The gallbladder and its duct are removed through a small incision in the right upper part of the abdomen. Most cases are done laparoscopically and patients are able to leave hospital in 24 – 48 hours.

Stones in the common bile duct are treated with a procedure called ERCP and sphincterotomy where an endoscope is passed through the mouth down to the level of the common bile duct outlet. Stones stuck in the bile duct are removed and a small cut in the bile duct sphincter is made in order to allow any other stones to pass naturally. Shockwave treatment of gallstones can be carried out in a lithotripter and this causes the stones to dissolve into smaller fragments which may be passed subsequently.


Last Editorial Review: 4/2/2010