GALLSTONES

What are gallstones?

Gallstones are lumps of solid material that form in the gall bladder - the reservoir for bile. Most are the size of peas, but they can be as large as pebbles. Gallstones can be found in the gall bladder itself, or in the bile duct that connects the gall bladder to the small intestine.

Gallstones are made of cholesterol, bile pigments or calcium, or a combination of these.

Gallstones symptoms

Often gallstones don't cause symptoms, but if one partially or completely blocks the normal flow of bile it may cause an attack of biliary colic, with upper abdominal pain, nausea and vomiting.

These episodes are normally brief and typically follow a fatty meal, which causes the gall bladder to contract.

Stones that continue to block the drainage of bile can cause inflammation or infection of the gall bladder and bile ducts, jaundice and acute pancreatitis.

Causes of gallstones

Many people will develop gallstones. Overweight people over 40, pregnant women and women in general are all more likely to develop them. They're also more common in people of Asian and European origin.

Eating a high-fat diet makes gallstones more likely to form.

Gallstones treatments

Eating a low-fat diet and maintaining an ideal weight may help to prevent the formation of gallstones.

Occasionally they pass out into the intestines on their own, especially if they're small. Treatment is only needed if gallstones are causing problems.

Complementary therapies may be tried to help remove gallstones, but there's little evidence they do any good.

Medical (non-surgical) treatments include a drug to dissolve the gallstones (ursodeoxycholic acid) and ultrasonic shockwaves, called lithotripsy, to break down the stones within the body so they can pass out on their own. These are suitable for about one in five patients, but there may be side-effects and the stones may simply form again.

There are various different surgical options:

• Operating through an endoscope, a telescope into the gut. The stones may be broken down within the gall bladder and removed
• Removal of stones and gall bladder (cholecystectomy) - this is the most reliable treatment. As with all operations, there are risks and complications, but these are steadily reducing as techniques improve

Cholecystectomy may be done as an open operation through a cut in the abdomen, or a closed or minimally invasive operation via an endoscope put through a tiny cut in the abdominal wall. There used to be concern about the safety of this type of surgery, but in skilled hands it's now as safe as open surgery and is how most cholecystectomies are done in the UK.

After gall bladder surgery

It used to be thought people adapted quickly to the loss of a gall bladder, but there may be problems. Some patients still have symptoms, albeit much milder. Others have problems with bile refluxing into the stomach and gullet, causing severe indigestion.

There may also be reduced absorption of fat resulting in diarrhoea. This usually - but not always