The Management of Gallstones
Gallstones are formed when the bile that is naturally produced by the liver (and stored in the gallbladder) as an aid to digestion hardens and forms into small pebbles or stones. Too much cholesterol is thought to be one of the causes, although there are other explanations.
The gallstones themselves can vary in size – from a tiny grain of sand to the size of a golf ball; they form in the gallbladder. Patients with gallstones may have one or many that vary in size.
If they move from the gallbladder they can causes blockages in any of the bile ducts in the biliary tract. The blockages can then lead to inflammation in the gallbladder (acute cholecystitis), the bile ducts, or the liver itself. Infection follows and cancer is possible. If they move into the common bile duct then can cause painful biliary colic, obstructive jaundice or acute pancreatitis. Left untreated, gallstones can be fatal.
There may be no symptoms – the stones may be ‘silent’. This is usually the case. However, if they move into a bile duct and block it you may experience a sudden ‘attack’ (pain). This can occur after a particularly fatty meal and can strike in the middle of the night. The attack may pass as the stones move again but they may cause an infection or rupture if the blockage remains. If you experience no symptoms you will not need treatment.
‘Silient’ gallstones are often discovered by chance whilst doctors investigate other conditions. Symptomatic gallstones (ie, those that give rise to obvious medical signs) will normally be initially diagnosed by your GP who will take a medical history and give you ‘Murphy’s Sign Test’ – if by tapping your tummy near your gallbladder causes you some pain then the chances are that you will have gallstones.
The initial diagnosis will later be confirmed in hospital following both a liver function test, other blood tests (including checking bilirubin levels) and/or ultrasound imaging. Your consultant might also suggest an ERCP to check the condition of your gallbladder and the precise location of the stones. ERCP might also be used as the preferred treatment option by removing the stones but leaving the gallbladder in place.
The standard treatment for gallstones is a cholecystectomy usually performed by a laparoscopic approach using several small incisions in the tummy. Very little scarring is likely. This procedure removes the gallbladder entirely and with it the gallstones. The operation typically lasts between 1.5 and two hours and patients can normally leave hospital after three to five days – sometimes sooner.
Alternative treatments for gallstones include the use of ursodeoxycholic or chenodeoxycholic acids, which is taken by mouth as tablets. This dissolves the stones although the process can take several years. It might also be given as a precautionary measure if it is thought you might be at risk of developing them.
Lithotripsy may also be an option you doctor discusses with you. This uses ultrasonic/ electrohydraulic shock waves to break up the gallstones. Unfortunately the treatment is not always effective as gallstones can return afterwards.
People with a history of gallstones have a less than 1 in 10,000 chance of developing cancer of the gallbladder, but if you have a family history of gallbladder cancer your consultant may recommend the removal of the gallbladder – you can live quite happily without it.
Nearly everyone who has gallbladder surgery will not experience a return of the symptoms.