Gallbladder problems, particularly gallstones, are among the most common digestive disorders requiring hospital treatment. Many people live with the condition without realising it, whilst for others it causes excruciating, cramping pain. What exactly is a gallstone, what are its characteristic symptoms, and what treatment options are available? In this article, we explore these questions in detail to give you a clear understanding of this common condition.
From Endomedix Gastroenterology Centre Our team of specialists is committed to providing accurate diagnoses and effective, personalised treatment, so that our patients can regain their well-being as soon as possible.
What is a gallstone?
A gallstone is a hardened deposit that forms in the gallbladder or the bile ducts. Bile is a fluid produced by the liver, which is stored in the gallbladder and plays a role in the digestion of fats. If the composition of the bile changes – for example, if it contains too much cholesterol or bilirubin (a breakdown product of red blood cells) – it can precipitate in the form of tiny crystals. Over time, these crystals can clump together and grow into stones, known as gallstones.
The main types of gallstones:
- Cholesterol stones (approx. 75%): The most common type, which is yellowish in colour and consists mainly of insoluble cholesterol.
- Black pigment stones (approx. 20%): Hard, dark stones that form when bile contains too much bilirubin. They are often associated with certain liver diseases or disorders of the blood-forming organs.
- Brown pigment stones (approx. 5%): Softer, darker stones, which typically form in the bile ducts as a result of bacterial infections.
Who is most at risk?
Although gallstones can develop in anyone, certain factors increase the risk. In Western societies, around 10% of the population is affected, and the condition is twice as common among women.
The main risk factors are as follows:
- Age: The risk increases with age. In people over the age of 70, gallstones can be detected in as many as 50% of cases.
- Female: Female hormones, particularly oestrogen, increase cholesterol levels in the bile, which promotes the formation of gallstones.
- Pregnancy and hormone replacement therapy: Gallstones are also more common due to changes in hormone levels.
- Obesity and insulin resistance: Obesity increases the liver’s production of cholesterol.
- Rapid weight loss: Sudden weight loss causes the liver to release extra cholesterol into the bile.
- Etrend: A diet high in fat and cholesterol but low in fibre promotes the formation of stones.
- Certain diseases: Coeliac disease, Crohn’s disease, liver cirrhosis and sickle cell anaemia may also increase the risk.
- Medicines: Some medicines (e.g. contraceptives, certain cholesterol-lowering drugs) may also contribute to its development.
Symptoms and warning signs of gallstones
In a significant proportion of cases (approx. 70–75%), gallstones do not cause any symptoms; in such cases, we refer to them as „silent stones”. Problems usually begin when a stone moves and blocks the opening of the gallbladder (ductus cysticus) or the bile duct.
The most common symptom is a biliary colic:
- Sudden onset of intense pain: It typically occurs in the upper right-hand part of the abdomen, beneath the right rib cage or around the pit of the stomach.
- Referred pain: The pain often radiates into the back, between the shoulder blades or into the right shoulder.
- Duration: A spasm can usually last from 30 minutes to several hours. The pain gradually gets worse and then slowly eases.
- Accompanying symptoms: As well as pain, nausea, vomiting and sweating are common.
If the blockage persists, more serious complications may develop, such as cholecystitis.
Symptoms of cholecystitis:
- Persistent, severe abdominal pain on the right-hand side that does not subside for several hours.
- Tenderness on palpation beneath the right costal margin.
- Fever, chills.
- Jaundice (a yellowish discolouration of the skin and the whites of the eyes) occurs when a stone has entered the bile duct and is blocking the flow of bile.
If you experience severe abdominal pain accompanied by a fever, chills or jaundice, seek medical attention immediately! The Endomedix Gastroenterology Centre Our specialists are on hand to help you reach an accurate diagnosis.
How are gallstones diagnosed?
The diagnosis of gallstones usually involves several steps, ranging from assessing symptoms to imaging tests.
- Physical examination: The doctor examines the abdomen and checks for tenderness beneath the right costal margin (this is known as Murphy’s sign).
- Abdominal ultrasound (UH): This is the most commonly used, most reliable and safest method for detecting gallstones. During the examination, stones in the gallbladder become visible, as do any signs of inflammation (e.g. a thickened gallbladder wall, fluid around the gallbladder). The Endomedix Gastroenterology Centre It carries out examinations using modern ultrasound equipment.
- Laboratory tests: A blood test may help to detect signs of inflammation (e.g. a high white blood cell count) or abnormalities in liver function indicating an obstruction to bile flow.
- Other imaging techniques: If the diagnosis is uncertain or if complications are suspected, the doctor may recommend further tests:
- CT (computed tomography): It is suitable for assessing complications (e.g. perforation).
- MRCP (magnetic resonance cholangiopancreatography): A non-invasive procedure for detecting stones in the bile ducts.
- ERCP (endoscopic retrograde cholangiopancreatography): This is a specialised endoscopic procedure that is primarily used when a stone is present in the bile duct. It can be used for both diagnostic and therapeutic purposes, as stones can be removed during the procedure.
Treatment options for gallstones
Treatment depends on whether the gallstones are causing symptoms and, if so, how severe they are.
Asymptomatic gallstones
If a gallstone does not cause any symptoms and is discovered by chance, treatment is not usually necessary; only regular medical monitoring is recommended. In certain cases (e.g. a very large stone, a porcelain gallbladder, or if the patient suffers from another condition that increases the risk), preventive surgery may be considered.
Treatment of gallbladder colic
Non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, are the most effective for relieving acute biliary colic. In addition, antispasmodics may also help. In cases of severe pain, a stronger painkiller containing an opioid derivative may be required.
Surgical treatment (cholecystectomy)
The definitive treatment for gallstones causing symptoms is the surgical removal of the gallbladder (cholecystectomy). Nowadays, in the majority of cases, this is carried out using a laparoscopic technique, which involves smaller incisions, a shorter hospital stay and a quicker recovery.
- Laparoscopic cholecystectomy: The camera and surgical instruments are inserted through a few small incisions made in the abdominal wall, and the gallbladder is then removed.
- Open surgery: It requires a larger abdominal incision. This is now used less frequently, mainly in cases of severe inflammation, scarring or complications.
Non-surgical treatments
These methods are used less frequently, mainly in patients for whom the risks of surgery would be too high.
- Medical lithotripsy: Medicines containing ursodeoxycholic acid may be used to try to dissolve small cholesterol stones. The treatment is a long-term process, and the stones often recur once treatment is stopped.
- ERCP: As mentioned, this is an endoscopic procedure used to remove stones from the bile duct.
Find the solution at Endomedix Centres
Symptoms caused by gallstones can significantly impair quality of life, and complications pose a serious health risk. If you experience symptoms suggestive of biliary colic or cholecystitis, do not delay seeking medical advice.
From Endomedix Gastroenterology Centre We look forward to welcoming you with our team of experienced specialists and state-of-the-art diagnostic equipment. Our aim is to provide a swift and accurate diagnosis and to draw up the treatment plan best suited to your needs. Please feel free to contact us so that, together, we can find a solution to your problem.
