You may be completely unaware of the problem for years, and the volume of gallstones present does not appear to directly influence whether, or when, you may experience symptoms. A typical gallstone attack may produce a persistent and steadily increasing colic-type pain in the upper belly or upper back, which can last for several hours. There may also be referred pain (away from the actual site of the problem), usually under the right shoulder or between the shoulder blades. Such attacks can commonly occur at night, often following the consumption of a very fatty meal and after drinking.
These symptoms may also be accompanied by:
- digestive upsets: indigestion, bloating, heartburn and gas
Experts believe gallstones are caused by a chemical imbalance of the bile found inside the gallbladder. Bile is a liquid that the liver continuously produces to aid the digestive process.
Though the reason for an imbalance is not clearly understood, gallstones can develop if:
- the gallbladder has exceptionally high levels of cholesterol inside (about 80% of gallstones are yellow-green cholesterol stones)
- the gallbladder has exceptionally high levels of bilirubin, a yellow, waste product compound (about 20% of all gallstones are of this smaller, dark-coloured bilirubin type)
The result is a growth of small crystals within the bile. Over a long period (sometimes years) these increase in size to become the characteristic ‘stones’. When formed, there may be one or several stones, with some no larger than a grain of sand and others the size of a small pebble.
Other known risk factors, which may increase the likelihood of developing gallstones, include:
- your inherited genes
- your body weight
- your diet
- birth control pills
- hormone replacement therapy
When gallstones are suspected, you will be given a physical check-up. Your doctor may also require you to undergo blood tests, both to look for signs of infection or an obstruction and also to clearly rule out the possibility of any other condition.
A diagnosis of gallstones can be confirmed using ultrasound, a straightforward procedure that creates an internal image of your body. Other diagnostic procedures that may also be employed include:
- a CT scan – an investigation that uses a computer and X-rays to explore your gallbladder and associated regions.
- MRCP (Magnetic resonance cholangiopancreatography) – a non-invasive technique that employs radio-wave pulses and a magnetic field. This equipment can be used to check whether gallstones are blocking any bile ducts.
- HIDA scan (Cholescintigraphy) – by injecting a harmless material, this procedure makes it possible to test whether the squeezing action of the gallbladder is still functioning properly.
- Endoscopic ultrasound – a procedure that uses an endoscope (a thin optical instrument) and ultrasound combination to produce detailed internal images of your liver and gallbladder.
- ERCP (Endoscopic retrograde cholangiopancreatography) – a technique in which an endoscope is used to inject a dye to make the bile ducts more visible and blockages much easier to see.
Mild abdominal pain may sometimes be treated with painkillers and controlled via a healthy diet. Where further treatment is necessary, there are three common procedures that can be recommended where gallstones are causing pain:
• the ERCP technique can also be used to clear gallstones blocking a bile duct.
• keyhole surgery (laparoscopic cholecystectomy) is typically used to remove a gallbladder via small incisions.
• open cholecystectomy may be required in a few instances. This involves making larger cuts in the abdomen to safely remove the gallbladder.
Recovery from an ERCP procedure usually just requires staying in hospital overnight. The recovery time for keyhole surgery is around two weeks, whereas full recovery from open surgery can take between six and eight weeks.
The best way to prevent gallstones is to eat a healthy, high-fibre diet, while taking plenty of regular exercise to maintain an optimum body weight.