Gallstones

Gallstones (biliary calculi) are small stones made from cholesterol, bile pigment and calcium salts, usually as a mixture that forms in the gall bladder.

The gall bladder is a small sac that holds bile, a digestive juice produced by the liver that is used in the breakdown of dietary fats. The gall bladder extracts water from its store of bile until the liquid becomes highly concentrated. The presence of fatty foods triggers the gall bladder to squeeze its bile concentrate into the small intestine.

Gallstones are a common disorder of the digestive system, and affect around 15 per cent of people aged 50 years and over. Some things which may lead to the formation of gallstones include the crystallisation of excess cholesterol in bile and the failure of the gall bladder to fully empty.

In most cases, gallstones don’t cause any problems. However prompt treatment may be necessary if stones block ducts and cause complications such as infections or inflammation of the pancreas (pancreatitis).

Symptoms
In approximately 70 per cent of cases, gallstones cause no symptoms. The symptoms of gallstones may include:

• Pain in the abdomen and back. Pain is generally infrequent but severe.
• Increase in abdominal pain after eating a fatty meal.
• Jaundice.
• Fever and pain, if the gall bladder or bile duct becomes infected.

• Mixed stones – the most common type. They are comprised of cholesterol and salts. Mixed stones tend to develop in batches.
• Cholesterol stones – comprised mainly of cholesterol, a fat-like substance that is crucial to many metabolic processes. Cholesterol stones can grow to significant sizes, large enough to block bile ducts.
• Pigment stones – bile is greenish–brown in colour, due to particular pigments. Gallstones made from bile pigment are typically small but numerous.

• Biliary colic – a gallstone can migrate from the body of the gall bladder into its neck (cystic duct), leading to obstruction. Symptoms include severe pain and fever.
• Inflammation of the gall bladder (cholecystitis) – the gall bladder duct becomes blocked by a gallstone, leading to infection and inflammation of the gall bladder. Symptoms include severe abdominal pain, nausea and vomiting.
• Jaundice – if a bile duct leading to the bowel is blocked by a stone, trapped bile enters the bloodstream instead of the digestive system. The bile pigments cause a yellowing of the skin and eyes. The urine may also turn orange or brown.
• Pancreatitis – inflammation of the pancreas, caused by a blocked bile duct low down near the pancreas. Pancreatic enzymes irritate and burn the pancreas and leech out into the abdominal cavity.
• Cholangitis – inflammation of the bile ducts, which occurs when a bile duct becomes blocked by a stone and the bile gets secondarily infected. This causes pain, fever, jaundice and rigors (shaking).

• General tests – such as physical examination and x-rays.
• Ultrasound – sound waves form a picture that detects the presence of gallstones.
• Endoscope test – called endoscopic retrograde cholangiopancreatography (ERCP). A thin tube is passed through the oesophagus and injects dye into the bowel to improve the quality of x-ray pictures.
• HIDA scan – a special type of nuclear scan that assesses how well the gall bladder functions.
• Magnetic Resonance Cholangiopancreatography (MRCP) - a form of the body imaging technique Magnetic Resonance Imaging or MRI. A patient's liver, biliary and pancreatic system is imaged using a MRI unit. An image similar to an ERCP test can be obtained.

• Dietary modifications – such as limiting or eliminating fatty foods and dairy products.
• Surgery – to remove the entire gall bladder, or stones from bile ducts. Around eight in 10 gallstone cases showing symptoms will require surgery. Procedures include ‘keyhole’ (laparoscopic) surgery and abdominal surgery (laparotomy), where the gall bladder is removed through an incision in the abdomen.
• Lithotripsy – a special machine generates soundwaves to shatter stones. This treatment is used for those people with small and soft stones, which accounts for around two out of 10 cases of gallstones with symptoms.
• Medications –some drugs can dissolve gallstones but this treatment is only rarely given, due to side effects and a variable success rate.

• Your doctor
• Nurse on Call Tel. 1300 606 024 – for expert health information and advice (24 hours, 7 days)
• Gastroenterologist.

• Gallstones are small stones – made from cholesterol, bile pigment and calcium salts – that form in the gall bladder.
• Medical treatment isn’t necessary unless the gallstones present symptoms.
• Treatment options include surgery and shattering the stones with sound waves.

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