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Gallstones

Gallstone has logged in the duct connecting the gallbaldder to the main bile duct. This is cause severe pain known as biliary colic
Gallstones

Gallstones


Background information

  • About 15% of people in New Zealand will develop gallstones over a lifetime.

  • They are more common in;
    • Women.
    • People who are overweight.
    • Family history of gallstones.

  • There are several different types of gallstones.
    • Most stones are formed from a supersaturated solution of cholesterol in the gallbladder.
    • Only 10% of gallstones will show on a plain X-ray.
    • Most gallstones are picked up on abdominal ultrasound.

  • Most stones start as a small cholesterol crystal.
    • The crystal slowly grows depending on the saturation of bile salts and cholesterol in the bile.
    • The function of the gallbladder may be important.  Failure to empty normally could an important factor.
  • Pigment stones (10% of all gallstones).
    • These occur because of increased breakdown of blood.





Biliary colic – gallstone pain.

  • Stones in the gallbladder may cause abdominal pain - this is called biliary colic.
    • This pain is usually an “attack” with sudden onset and lasts for 4-6hours.
    • The pain is mainly in the right upper abdomen but can also be in the lower chest and back (over the right shoulder blade).
    • There is often nausea and/or vomiting.  You may appear to be pale and have excess sweating
    • The severity of the pain is often enough to want to seek out urgent medical attention.
    • Sometimes the pain is confused for a heart attack.
    • There can be repeated episodes of pain but not usually daily episodes.

  • Biliary colic is caused by a stone lodging in the outlet of the gallbladder.
    • Most of the time the stone falls back into the gallbladder and the “attack” is over.
    • Biliary colic may be brought on by a large fatty meal because this causes strong contractions of gallbladder.

  • If the pain lasts for more than 6 hours then a complication may have arisen.
    • The main potential complication is inflammation of the gallbladder.  This is called acute cholecystitis.  Hospital admission is essential.
    • Another complication is migration of a stone to the main bile duct. This leads to jaundice;  often infection (cholangitis) or pancreatitis.

  • Treatment involves
    • Intravenous fluids, pain relief, antibiotics.
    • Then proceeding to cholecystectomy (removal of the gallbladder) – usually during the same hospital admission.
    • Sometimes there is a preference for waiting for the inflammation to settle down before proceeding to surgery.




Gallstones on ultrasound but no pain.


  • This is a common situation. Ultrasound of the abdomen is a common investigation that is done for a wide variety of reasons.
  • Many gallstones that are picked up on ultrasound will be causing no symptoms.
    • 60 - 80% of all gallstones cause no problems.
    • About 20% of people with gallstones picked up by chance will develop symptoms due to the gallstones over the next 20 years.
    • Therefore most people would think that watching and waiting is the best response rather than an operation.

  • Symptoms of indigestion, fullness or bloating after meals, nausea or heartburn are not due to gallstones.




Gallstone type of pain but no gallstones

  • This is also a common situation. Pain in the right upper abdomen may be similar to gallstone pain (biliary colic) but no stones are found when the ultrasound is done.

  • The most likely explanation is that the pain does not arise from the gallbladder but from the colon or from the stomach.
    • Pain from the colon is due to irritable bowel syndrome.  Pain with IBS can occur anywhere in the abdomen.
    • Sometimes constipation leads to distension of the colon on the right side of the abdomen and right-sided abdominal pain.
    • A gastroscopy should be performed to check for peptic ulcer or acid reflux.
    • Sometimes there is no easy explanation.

  • There is a debate as to whether the gallbladder can give rise to pain in the absence of gallstones.
    • There is some suggestion that a “non-functioning gallbladder” is associated with episodes of pain.
    • This means that the gallbladder does not take up the bile coming down from the liver.
    • This “non-functioning” state can be detected by a radionuclear scan called a HIDA scan.
    • A scan showing a “non-functioning” gallbladder predicts a reasonable success rate with cholecystectomy (perhaps 2/3 will have symptom relief).


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