Gallstones are solid deposits in the gallbladder that form from components of bile. Gallstones are very common, and a significant percentage of the population has gallstones without even knowing it. Most gallstones consist of cholesterol, while others—known as pigment stones—are made of bilirubin.
Gallstones form when the composition of bile changes and crystals form. The gallbladder is located beneath the liver and stores bile, which is later released into the small intestine. If gallstones form in the gallbladder, they may remain there or migrate into the bile duct. Many people are unaware they have gallstones because they do not cause any symptoms.
Symptoms only occur when gallstones become blocked or when their location and size are problematic.
What are gallstones?
Gallstones are small, stone-like formations that have solidified from bile. About one in six Germans has gallstones, and about two-thirds of them are women.
However, only about one-quarter of those affected actually experience symptoms.
Symptoms of Gallstones
Gallstones can narrow the bile ducts, leading to various symptoms. In cases of bile stasis, for example, bile can no longer flow out. This manifests itself, for example, in
- jaundice,
- dark circles under the eyes,
- tremors,
- sweating,
- a feeling of fullness,
- bloating, or
- abdominal pain
Gallstones can also cause biliary colic. This manifests as nausea and vomiting, as well as a rise in blood pressure.
Gallstone Surgery
As long as the patient has no symptoms, gallbladder surgery is not necessary. Surgery should only be considered once the patient begins to experience symptoms. Complete removal of the gallbladder is not always necessary. In some cases, the gallstones can be removed while preserving the gallbladder.
The doctor decides which type of surgery is most appropriate. This depends on
- the location and size of the gallstones, as well as
- the overall health of the affected person
.
Endoscopic Gallstone Removal
Endoscopic gallstone removal is performed using the ERCP method (endoscopic retrograde cholangiopancreatography).
In this procedure, the physician inserts an endoscope through the esophagus, stomach, and small intestine directly into the bile duct. Smaller gallstones blocking the bile duct can then be removed through the endoscope using small forceps.
Gallstone Removal Using Shock Wave Therapy
In the past, medical treatment of the stones (litholysis) and shock wave therapy using ultrasound were also performed. This procedure is called extracorporeal shock wave lithotripsy (ESWL).
When the stones are碎, they break into very small fragments. These fragments are flushed out naturally through the bile duct. Alternatively, they can be completely dissolved with the help of oral medications. However, ESWL does not address the underlying cause of gallstone formation. Gallstones can recur even after they have been broken up. For this reason, stone fragmentation and litholysis are generally no longer used today.
Gallbladder Removal
Nowadays, cholecystectomy (the surgical removal of the gallbladder) is no longer a major procedure. It is usually performed using a minimally invasive “keyhole” technique.
During the procedure, the surgeon makes several small incisions, about 3 millimeters in size, in the abdominal wall. Through these incisions, the surgeon inserts the instruments necessary for the operation, such as
- a camera,
- a light source, and
- surgical instruments
into the abdominal cavity. This type of surgery is also known as laparoscopy. The camera’s image is transmitted in real time to a monitor, allowing the surgical team to clearly see all structures in magnified view. The surgeon removes the gallbladder along with the gallstones without having to make a large incision in the skin.
The small incisions made for the surgical instruments usually heal quite quickly and with minimal pain. If anything, they leave only very small scars.
FAQ
What symptoms do gallstones cause?
Typical symptoms of gallstones include cramping pain in the upper abdomen or pain in the right upper abdomen, often radiating to the right shoulder. Gallstone symptoms may also include nausea and vomiting. A biliary colic occurs when gallstones block the bile duct and cause cramping pain.
When do gallstones cause symptoms?
Gallstones cause symptoms when they obstruct the bile duct or bile ducts. Symptoms caused by gallstones are particularly common when large gallstones block the flow of bile. Symptoms of gallstones can also occur if the gallbladder becomes inflamed.
How is a diagnosis made when gallstones are suspected?
If gallstones are suspected, a physical examination and an ultrasound scan are performed first. This allows most gallstones in the gallbladder to be detected. If gallstones are present in the bile duct, an endoscope may also be used to examine the bile duct more closely.
How are gallstones treated?
Treatment for gallstones depends on whether symptoms are present. Gallstones that do not cause problems usually do not require treatment. If symptoms occur, surgery to remove the gallbladder is often performed to remove the gallstones. In select cases, medication may be tried to dissolve the gallstones.
What complications can gallstones cause?
If gallstones cause a blockage of the bile duct, this can lead to jaundice or inflammation of the gallbladder. Involvement of the pancreas is also possible if gallstones block the common bile duct. If left untreated, symptoms associated with gallstones can lead to serious complications.
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About the medical author
Prof. JoergG. Albert
Medical Author
Prof. Dr. med. Jörg G. Albert – medical author: expert articles, professional insights and medical knowledge in the Leading Medicine Guide.
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