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| Gallstones: Causes, Symptoms, and Surgical Treatment Options Explained by a Doctor. Image by Health Facts by Dr Pasindu using Google Gemini AI |
Gallstones are one of the most common digestive system problems worldwide, affecting millions of people every year.
Recently, according to a study in the United States population, gallstone disease contributed to approximately 2.2 million ambulatory care visits, 1.2 million emergency department visits annually.
In the United Kingdom, the NHS reports that about 1 in 10 adults will develop gallstones at some point in their life.
While many people live with gallstones without ever knowing it, others experience painful attacks and dangerous complications that require urgent medical attention.
As a doctor, my aim here is to give you a complete, guide that answers everything you need to know about gallstones — their causes, risk factors, symptoms, diagnosis, treatment options, surgery, recovery, and lifestyle advice.
This article is based on evidence and guidelines, particularly the UK NICE guideline on Gallstone Disease, alongside references from trusted institutions like the NIH, NHS, and Mayo Clinic.
This is your one-stop resource — so you don’t need to read another article after this.
🟢 What Are Gallstones?
The gallbladder is a small, pear-shaped organ located under the liver on the right side of your abdomen.
Its job is to store and release bile — a yellow-green fluid made by the liver that helps digest fats.
Gallstones are hardened deposits that form inside the gallbladder when bile contains too much cholesterol, too much bilirubin, or not enough bile salts.
These imbalances cause crystals to form, which then stick together and grow into stones.
Gallstones can vary in size and number:
* Some are as small as grains of sand.
* Others can grow as large as a golf ball.
* A person may have just one large stone, or hundreds of smaller ones.
🟢 Types of Gallstones
There are three main types of gallstones:
1. Cholesterol Stones
* The most common type (about 75–80% of cases in the West, according to Mayo Clinic).
* Usually yellow-green.
* Form when bile contains too much cholesterol.
2. Pigment Stones
* Made of bilirubin, a substance produced when red blood cells break down.
* More common in people with liver disease, cirrhosis, or certain blood disorders (e.g., sickle cell anaemia).
* Typically dark brown or black.
3. Mixed Stones
* Contain both cholesterol and pigments.
* More common in the UK and US than pure pigment stones.
🟢 Why Do Gallstones Form? (Pathophysiology)
Bile normally contains cholesterol, bile salts, and waste products in a delicate balance. When this balance is disturbed:
* Too much cholesterol → crystals form.
* Too much bilirubin (from blood or liver disease) → pigment stones develop.
* Gallbladder doesn’t empty properly → bile becomes concentrated, promoting stone formation.
Think of it like leaving sugar in a cup of tea — if the liquid can’t dissolve it, crystals form.
🟢 Risk Factors for Gallstones
Doctors often summarize the main risks with the “4 F’s”: Female, Forty, Fertile, and Fat.
But there are more.
1. Gender: Women are twice as likely to get gallstones due to oestrogen, which increases cholesterol in bile.
2. Age: Risk rises after 40 years old.
3. Pregnancy: Hormonal changes slow gallbladder emptying.
4. Obesity: Raises cholesterol levels in bile.
5. Rapid weight loss: After bariatric surgery or crash diets.
6. Diet: High in fat and sugar, low in fibre.
7. Family history: Inherited risk.
8. Medical conditions: Diabetes, cirrhosis, Crohn’s disease, sickle cell anaemia.
9. Medications: Oral contraceptives, hormone replacement therapy, and cholesterol-lowering drugs.
🟢 Symptoms of Gallstones
Many people have silent gallstones — no symptoms, discovered by chance on a scan.
But when gallstones cause symptoms, they are often very painful.
Common Symptoms (Biliary Colic)
* Sudden severe pain in the upper right abdomen.
* Pain that radiates to the back or right shoulder.
* Pain triggered by fatty meals.
* Nausea and vomiting.
* Attacks lasting from 30 minutes to several hours.
Atypical Symptoms
* Indigestion.
* Bloating.
* Heartburn.
* Belching.
🟢 Complications of Gallstones
While many gallstones cause only occasional discomfort, some can lead to serious complications requiring hospital care.
1. Acute Cholecystitis (Inflamed Gallbladder)
* Pain, fever, tenderness.
* Requires antibiotics and usually surgery.
2. Choledocholithiasis (Bile Duct Stones)
* Stones escape into the bile duct.
* Causes jaundice (yellow skin), dark urine, pale stools.
3. Cholangitis (Bile Duct Infection)
* Life-threatening infection.
* Symptoms: fever, jaundice, abdominal pain.
4. Gallstone Pancreatitis
* Stones block the pancreatic duct.
* Severe abdominal pain, nausea, vomiting.
* Can be life-threatening.
5. Gallstone Ileus (Rare)
* Large gallstone blocks the intestine.
* More common in elderly patients.
🟢 How Are Gallstones Diagnosed?
1. Ultrasound Scan
* First-line test (per NICE guidelines).
* Highly accurate.
* Non-invasive, painless.
2. Blood Tests
* Check for infection and liver function.
* High bilirubin = bile duct obstruction.
3. Advanced Imaging
* MRCP (Magnetic Resonance Cholangiopancreatography): Non-invasive MRI to see bile ducts.
* ERCP (Endoscopic Retrograde Cholangiopancreatography): Both diagnosis and treatment.
* CT scans: For complications.
🟢 Treatment Options
Silent Gallstones
* Do not require treatment.
* Only managed if symptoms or complications develop.
Symptomatic Gallstones
Non-Surgical Options
* Medications (ursodeoxycholic acid): Can dissolve cholesterol stones, but slow and stones often recur.
* Shock-wave lithotripsy: Rarely used, only in select cases.
Surgical Options (Gold Standard)
* Cholecystectomy (Gallbladder Removal):
- Laparoscopic (keyhole) preferred.
- Open surgery only if complicated.
* Day-case surgery: In the UK, many patients go home the same day.
🟢 Gallbladder Surgery: What to Expect
Before Surgery
* Blood tests, ECG, chest X-ray if needed.
* Stop certain medications temporarily.
During Surgery
* General anesthesia.
* 3–4 small cuts.
* Gallbladder removed.
After Surgery
* Go home same day or next.
* Return to work in 1–2 weeks.
* Light activity encouraged early.
Risks (Rare)
* Bile duct injury (0.3–0.5%).
* Infection.
* Retained stones in bile duct.
🟢 Life After Gallbladder Removal
* Most people live normally without a gallbladder.
* Bile flows directly from the liver to the intestine.
* Some may notice loose stools after fatty meals, but this usually improves.
* No major long-term dietary restrictions.
🟢 Diet and Lifestyle
Before Surgery
* Avoid fatty, greasy meals to reduce pain attacks.
After Surgery
* Start with light meals.
* Gradually return to normal diet.
* High-fibre foods improve digestion.
Preventive Diet (to lower gallstone risk)
* Mediterranean diet.
* Plenty of vegetables, fruits, whole grains.
* Healthy fats (olive oil, fish).
* Avoid refined carbs and high-sugar foods.
🟢 Myths About Gallstones
❌ “Gallstones always need surgery” → Not true, silent stones don’t.
❌ “Home remedies like apple cider vinegar dissolve gallstones” → No scientific evidence.
❌ “You can’t live without a gallbladder” → Most people live completely normal lives.
🟢 Public Health Perspective
* In the US, gallstones affect about 20 million adults (National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)).
* In the UK, around 60,000 gallbladder surgeries are performed every year (NHS).
* Gallstones are a major cause of hospital admissions and healthcare costs.
🟢 FAQs
Q: Can gallstones come back after surgery?
A: No, because the gallbladder is removed. Rarely, stones can form in bile ducts.
Q: Do gallstones increase cancer risk?
A: Very rarely. Long-standing untreated gallstones may slightly increase gallbladder cancer risk.
Q: Can children get gallstones?
A: Yes, but rare. More common in children with obesity or blood disorders.
Q: Do gallstones affect pregnancy?
A: Pregnancy increases risk due to hormones, but surgery is usually postponed until after delivery unless urgent.
🟢 Practical Checklist for Patients
* See a doctor if you have severe abdominal pain, jaundice, or fever.
* If diagnosed with gallstones, ask:
- Do I need surgery now or can it wait?
- What type of surgery do you recommend?
- What is the recovery timeline?
- What lifestyle changes should I make?
🟢 Conclusion
Gallstones are extremely common, and while many remain harmless, others can lead to painful attacks or serious complications.
The good news is that treatment — particularly laparoscopic gallbladder removal — is safe, effective, and offers long-term relief.
By understanding the risk factors, symptoms, and treatment options, you can take control of your health and seek medical help at the right time.
📖 References
* NICE Guideline on Gallstone Disease (CG188)
From Dr Pasindu 🥰
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