Gallstones

Gallstones | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Gallstones Gallstones About gallstones Symptoms of gallstones Causes of gallstones Diagnosing gallstones Treating gallstones Complications of gallstones Preventing gallstones About gallstones Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. In most cases they dont cause any symptoms and dont need to be treated. However, if a gallstone becomes trapped in a duct (opening) inside the gallbladder it can trigger a sudden intense abdominal pain that usually lasts between 1and 5hours. This type of abdominal pain is known as biliary colic. Some people with gallstonescan alsodevelop complications, such as inflammation of the gallbladder ( cholecystitis ), which can cause: persistent pain jaundice a fever When gallstones cause symptoms or complications, its known as gallstone disease or cholelithiasis. Read more about: symptoms of gallstones complications of gallstones The gallbladder The gallbladder is a small, pouch-like organ found underneath the liver. Its main purpose is to store and concentrate bile. Bile is a liquid produced by the liver to help digest fats. Its passed from the liver through a series of channels, known as bile ducts, into the gallbladder. The bile is stored in the gallbladder and over time it becomes more concentrated, which makes it better at digesting fats. The gallbladder releases bile into the digestive system when its needed. What causesgallstones? Gallstones are thought to develop because of an imbalance in the chemical make-up of bile inside the gallbladder. In most cases the levels of cholesterol in bile become too high and the excess cholesterol forms into stones. Gallstones are very common. Its estimated that more than 1in every 10 adults in the UKhas gallstones, although onlya minorityofpeople develop symptoms. Youre more at risk of developing gallstones if youre: overweightor obese female, particularly if youve had children 40 or over (the risk increases as you get older) Read more about: causes of gallstones preventing gallstones Treating gallstones Treatment is usually only necessary if gallstones are causing: symptoms such as abdominal pain complications  such as jaundice or acute pancreatitis In these cases, keyhole surgery to remove the gallbladder may be recommended.This procedure,known as a laparoscopic cholecystectomy , is relatively simpleto perform and has a low risk of complications. You can lead a perfectly normal life without a gallbladder. Your liver will still produce bile to digest food, butthe bile will just drip continuously into the small intestine, rather thanbuild up in the gallbladder. Read more about: treating gallstones diagnosing gallstones Outlook Most cases of gallstone disease are easily treated with surgery.Very severe cases can be life-threatening, especially in people who are already in poor health. However, deaths from gallstone diseaseare rare in the UK. Symptoms of gallstones Most cases of gallstones dont cause any symptoms. But if a gallstone blocks one of the bile ducts, it can cause sudden, severe abdominal pain, known as biliary colic. Other symptoms may developif the blockage is more severe ordevelops in another part of the digestive system. Abdominal pain (biliary colic) Gallstonescan causesudden, severe abdominal pain that usually lasts 1to 5hours(although it can sometimes last just a few minutes). The pain can be felt: in the centre of your abdomen (tummy) just under the ribs on your right-hand side it may spread from hereto your side or shoulder blade The pain is constant and isnt relieved when you go to the toilet, pass wind or are sick.Its sometimes triggered by eating fatty foods, butmay occur at any time of dayand it may wake you up during the night. Biliary colic doesnt happen often. After an episode of pain, it may be several weeks or months before you experience another episode. Some people also have periods where they sweat excessively and feel sick or vomit. Whengallstones cause episodes of biliary colic, it is known as uncomplicated gallstone disease. Other symptoms In a small number of people, gallstones can cause more serious problems if they obstruct the flow of bile for longer periods or move into other organs (such as the pancreas or small bowel). If this happens,youmay develop: a high temperature of 38C (100.4F) or above more persistent pain a rapid heartbeat yellowing of the skin and whites of the eyes (jaundice) itchy skin diarrhoea chills or shivering attacks confusion a loss of appetite Doctors refer to this more severe condition as complicated gallstone disease. Read more about the complications of gallstones . When to seek medical advice If you think you may be experiencing biliary colic, you should make an appointment with your GP. Contact your GP immediately for advice if you develop: jaundice abdominal pain lasting longer than eight hours a high temperature and chills abdominal pain so intense that you cant find a position to relieve it Ifits not possible to contact your GP immediately, phone your local out-of-hours or NHS 24s 111 service. Causes of gallstones Gallstones are thought to be caused by an imbalance in the chemical make-up of bile inside the gallbladder. Bile is a liquid produced by the liver to aid digestion. Its still unclear exactly what leads to this imbalance, but gallstones can form if: there are unusually high levels of cholesterol inside the gallbladder (about 4in every 5gallstones are made up of cholesterol) there are unusually high levels of a waste product called bilirubin inside the gallbladder (about 1in every 5gallstones is made up of bilirubin) These chemical imbalances cause tiny crystals to develop in the bile. These can gradually grow (often over many years) into solid stones that can be as small as a grain of sand or as large as a pebble. Sometimes only 1stone will form, but there are often several at the same time. Whos at risk? Gallstones are more common if you: are female, particularly if youve had children,are taking the combined Pill, or are undergoing high-doseoestrogen therapy are overweight or obese are aged 40 years or older (the older you are, the more likely you are to develop gallstones) have a condition that affects the flow of bile  such as cirrhosis (scarring of the liver), primary sclerosing cholangitis, or obstetric cholestasis have Crohns disease or irritable bowel syndrome (IBS) have a close family member whos also had gallstones have recently lost weight (from eitherdieting or weight-loss surgery) are taking an antibiotic called ceftriaxone Diagnosing gallstones Gallstones may be discovered during tests for a different condition, as they often dont cause any symptoms. If you do have symptoms of gallstones ,make an appointment with your GP so they can try to identify the problem. Seeing your GP Your GP will ask about your symptoms in detail and maycarry out the Murphys sign test to help determine if your gallbladder is inflamed. During this test, yourGP places their hand or fingers on the upper-right area of your tummy and asks you to breathe in. If you find this painful, it usuallymeans your gallbladder is inflamed and you may need urgent treatment. Your GP may also recommend having blood tests to look for signs of infection, or to check if your liver is working normally.If gallstones have moved into your bile duct, the liver may not be able tofunction properly. Further tests If your symptoms and test results suggest you may have gallstones, youll usually be referred for further tests. You may be admitted to hospital for tests the same day if your symptoms suggest you have a more severe form of gallbladder disease. Ultrasound scan Gallstones can usually be confirmed using an ultrasound scan, which uses high frequency sound waves to create an image of the inside of the body. The type of ultrasound scan used for gallstonesis similar to the scan used during pregnancy, where a small handheld device called a transducer is placed onto your skin and moved over your upper abdomen. Sound waves are sent from thetransducer, through your skin and into your body. They bounce back off the body tissues, forming an imageon a monitor. This is a painless procedure that usually takes about 10 to 15 minutes to complete. When gallstones are diagnosed, there may be some uncertainty about whether any stones have passed into the bile duct. Gallstones in the bile duct are sometimes seen during an ultrasound scan.If theyre not visible but yourtestssuggest the bile duct may be affected, you may need an MRI scan or a cholangiography. MRI scan A magnetic resonance imaging (MRI) scan may be carried out to look for gallstones in the bile ducts. This type of scan uses strong magnetic fields and radio waves to produce detailed images of the inside of the body. Cholangiography A procedure called a cholangiography can give further information about the condition of your gallbladder. A cholangiography uses a dye that shows up on X-rays . The dyemay be injected into your bloodstream or injected directly into your bile ducts during surgery or using anendoscopepassed through your mouth. After the dye has been introduced, X-ray images are taken. Theyll reveal any abnormality in your bile or pancreatic systems. If your gallbladder and bile systems are working normally, the dye will be absorbed in the places its meant to go (your liver, bile ducts, intestines and gallbladder). If a blockage is detected during this test, your doctor may try to removeit at this point using an endoscope. This is known asan endoscopic retrograde cholangio-pancreatography (ERCP). See treating gallstones for more information about ERCP. CT scan A computerised tomography (CT) scan may be carried out to look for any complications of gallstones, such as acute pancreatitis . This type of scan involves taking a series of X-rays from many different angles. CT scans areoften donein an emergency to diagnose severe abdominal pain. Treating gallstones Your treatment plan for gallstones depends on how the symptoms are affecting your daily life. If you dont have any symptoms, a policy of active monitoring is often recommended. This means you wont receive immediate treatment, but you should let your GP know if you notice any symptoms. As a general rule, the longer you go without symptoms, the less likely it is that your condition will get worse. You may need treatment if you have a condition that increases your risk ofdeveloping complications, such as: scarring of the liver ( cirrhosis ) high blood pressure inside the liver  this is known as portal hypertension and is often a complication of alcohol-related liver disease diabetes Treatment may also be recommended if a scan shows high levels of calcium inside your gallbladder, as this can lead to gallbladder cancer in later life. If you have episodes of abdominal pain (biliary colic), treatment depends on how the pain affects your daily activities. Ifthe episodes aremild and infrequent, you may be prescribed painkillers to control further episodes and given advice abouteating a healthy diet to help control the pain. If your symptoms are more severe and occur frequently,surgery to remove the gallbladderis usually recommended. The gallbladder isnt an essential organ andyou can lead a perfectly normal life without one.Some people may experience symptoms of bloating and diarrhoea after eating fatty or spicy food. If certain foods do trigger symptoms, you may wish to avoid them in the future. Keyhole surgery to remove the gallbladder If surgery is recommended, youll usually have keyhole surgery to remove your gallbladder. This is known as a laparoscopic cholecystectomy. Duringa laparoscopic cholecystectomy, 3or 4small cuts are made in your abdomen. One larger cut (about 2cm to 3cm) will be by the belly button and the others (each 1cm or less) will be on the right side of your abdomen. Your abdomen is temporarily inflated using carbon dioxide gas. This is harmless and makes it easier for the surgeon to see your organs. Alaparoscope (long thin telescope with a tiny light and video camera at the end) is inserted through one of the cuts in your abdomen. This allows your surgeon to view the operation on a video monitor.Your surgeon will then remove your gallbladder using special surgical instruments. If its thought there may be gallstones in the bile duct, an X-ray or ultrasound scan of the bile duct is also taken during the operation. If gallstones are found, they may be removed during keyhole surgery. If the operation cant be done this way or an unexpected complication occurs, it may have to be converted to open surgery. After the gallbladder has been removed, the gas in your abdomen escapes through the laparoscope and the cuts are closed with dissolvable stitches and covered with dressings. Laparoscopic cholecystectomies areusually performed under a general anaesthetic , which means youll be asleep during the procedure and wont feel any pain while its carried out. The operation takes 60 to 90 minutes and you can usually go home the sameday.Full recovery typically takes around 10 days. Single-incision keyhole surgery Single-incision laparoscopic cholecystectomy is a newer type of keyhole surgery used to remove the gallbladder. During this type of surgery, only one small cut is made, which means youll only have onebarely visible scar. However, single-incision laparoscopic cholecystectomies havent been carried out as often as conventional laparoscopic cholecystectomies, so there are still some uncertainties about it. Access to this type of surgery is also limited because it needs an experienced surgeon with specialist training. The National Institute for Health and Care Excellence (NICE) has more information on single-incision laparoscopic cholecystectomy . Open surgery Alaparoscopic cholecystectomy may not always be recommended, for example if you: are in the third trimester (the last three months) of pregnancy are extremely overweight have an unusual gallbladder or bile duct structure that makes akeyhole procedure difficult and potentially dangerous In these circumstances, an open cholecystectomy may be recommended. During this procedure, a 10cm to 15cm (4in to 6in) incision is made in your abdomen underneath the ribs so the gallbladder can be removed.Thisis done under general anaesthetic, so youll be asleep and wont feel any pain. Open surgery is just as effective as laparoscopic surgery, but it does have a longer recovery time and causes more visible scarring. Most people have to stay in hospital for up to 5days and it typically takes 6weeks to fully recover. Endoscopic retrograde cholangio-pancreatography (ERCP) An endoscopic retrograde cholangio-pancreatography (ERCP) is a procedure that can be used to remove gallstones from the bile duct. The gallbladder isnt removed during this procedure, so any stones in the gallbladder will remain unless removed using the surgical techniques mentioned above. ERCP is similar to a diagnostic cholangiography (see diagnosing gallstones for more information), where an endoscope (long, thin flexible tube with a camera at the end) is passed through your mouth down to where the bile duct opens into the small intestine. However, during ERCP theopening of the bile ductis widened with a small incision or an electrically heated wire. The bile duct stones are then removed or left to pass into your intestine and out of your body. Sometimes a small tube called a stent is permanently placed in the bile duct to help the bile and stones pass. An ERCP is usually carried out under sedation, which means youll be awake throughout the procedure but wont experience any pain. The ERCP procedurelasts about 30 minutes on average, but can take from 15 minutes to over an hour.You may need to stay overnight in hospital after the procedure so you can be monitored. Medication to dissolve gallstones If yourgallstones are small and dont contain calcium, it may be possible to take ursodeoxycholic acidtablets to dissolve them. However, these arentprescribed very often because: theyrerarely very effective they need to be taken for a long time (up to 2years) gallstones can recur once treatment is stopped Side effects of ursodeoxycholic acid are uncommon and are usually mild. The most commonly reported side effects are feeling sick, being sick and itchy skin. The use of ursodeoxycholic acid isnt usually recommended for pregnant or breastfeeding women. Sexually active women should use either a barrier method of contraception , such as a condom , or a low-dose oestrogen contraceptive pill while taking ursodeoxycholic acid, as it may affect other types of oral contraceptive pills. Ursodeoxycholic acid tablets are occasionally also prescribed as a precaution against gallstones if its thought youre at risk of developing them. For example, you may be prescribed ursodeoxycholic acid if youve recently had weight loss surgery, as rapid weight loss can cause gallstones to grow. Complications of gallstones A small number of people with gallstones may develop serious problems if the gallstones cause a severe blockage or move into another part of the digestive system. Inflammation of the gallbladder (acute cholecystitis) In some cases of gallstone disease a bile duct can become permanently blocked, which can lead to a build-up of bile inside the gallbladder. This can cause the gallbladder to become infected and inflamed. The medical term for inflammation of the gallbladder is acute cholecystitis. Symptoms include: pain in your upper abdomen that travels towards your shoulder blade (unlike biliary colic, the pain usually lasts longer than five hours) a high temperature (fever) of 38C (100.4F) or above a rapid heartbeat An estimated 1in 7people with acute cholecystitis also experience jaundice (see below). Acute cholecystitis is usually treated first with antibiotics to settle the infection and then keyhole surgery to remove the gallbladder . This operation can be more difficult when performed as an emergency and theres a higher risk of it being converted to an open procedure. Sometimes asevere infection can lead to a gallbladder abscess (empyema of the gallbladder). Antibiotics alone dont always treat these and they may need to be drained. Occasionally a severely inflamed gallbladdercan tear, leading toperitonitis(inflammation of the inside lining of the abdomen).If this happens, you may need to have antibiotics given directly into a vein (intravenous antibiotics) and surgery may be required to remove a section of the lining if part of it becomes severely damaged. Read more about acute cholecystitis . Jaundice If a gallstone passes out of the gallbladder into the bile duct and blocks the flow of bile, jaundice occurs. Symptoms of jaundice include: yellowing of the skin and eyes dark brown urine pale stools itching Sometimes the stone passes from the bile duct on its own. If it doesnt, the stone needs to be removed. See treating gallstones . Infection of the bile ducts (acute cholangitis) If the bile ducts become blocked, theyre vulnerable to infection by bacteria. The medical term for a bile duct infection is acute cholangitis. Symptoms of acute cholangitis include: pain in your upper abdomen that travels towards your shoulder blade a high temperature jaundice chills confusion itchy skin generally feeling unwell Antibiotics will help treat the infection, but its also important to help the bile from the liver to drain with anendoscopic retrograde cholangio-pancreatography (ERCP). Read treating gallstones for more information. Acute pancreatitis Acute pancreatitis may develop when a gallstone moves out of the gallbladder and blocks the opening (duct) of the pancreas, causing it to become inflamed. The most common symptom of acute pancreatitis is a sudden severe dull pain in the centre of your upper abdomen, around the top of your stomach. The pain of acute pancreatitis often gets steadily worse until it reaches a constant ache. The ache may travel from your abdomen and along your back and may feel worse after you have eaten. Leaning forward or curling into a ball may help to relieve the pain. Other symptoms of acute pancreatitis can include: feeling sick being sick diarrhoea loss of appetite a high temperature (fever) of 38C (100.4F) or above tenderness of the abdomen less commonly, jaundice Theres currently no cure for acute pancreatitis, so treatment focuses on supporting the functions of the body until the inflammation has passed. This usually involves admission to hospital so you can be given: fluids into a vein (intravenous fluids) pain relief nutritional support oxygen through tubes into your nose With treatment,most people with acute pancreatitis improve within a week and are well enough to leave hospital after 5 to 10 days. Read more about acute pancreatitis . Cancer of the gallbladder Gallbladder cancer is a rare but serious complication of gallstones. An estimated 660 cases of gallbladder cancer are diagnosed in the UK each year. Having a history of gallstones increases your risk of developing gallbladder cancer.Approximately 4out of every 5people who have cancer of the gallbladder also have a history of gallstones. However, people with a history of gallstones have a less than one in 10,000 chance of developing gallbladder cancer. If you have additional risk factors, such as a family history of gallbladder cancer or high levels of calcium inside your gallbladder, it may be recommended that your gallbladder be removed as a precaution, even if your gallstones arent causing any symptoms. The symptoms of gallbladder cancer are similar to those of complicated gallstone disease, including: abdominal pain high temperature (fever) of 38C (100.4F) or above jaundice Gallbladder cancer can be treated with a combination of surgery, chemotherapy and radiotherapy . Gallstone ileus Another rare but serious complication of gallstones is known as gallstone ileus. This is where the bowel becomes obstructed by a gallstone. Gallstone ileus can occur when an abnormal channel, known as a fistula, opens up near the gallbladder. Gallstones are then able to travel through the fistula and can block the bowel. Symptoms of gallstone ileus include: abdominal pain being sick swelling of the abdomen constipation A bowel obstruction requires immediate medical treatment. If its not treated, theres a risk that the bowel could split open (rupture). This could cause internal bleeding and widespread infection. If you suspect you have an obstructed bowel, contact your GP as soon as possible. If this isnt possible, phone the NHS 24 111 service . Surgery is usually required to remove the gallstone and unblock the bowel. The type of surgery you receive depends on where in the bowel the obstruction has occurred. Preventing gallstones From the limited evidence available, changes to your diet and losing weight (if youre overweight) may help prevent gallstones. Diet Because of the role cholesterol appears to play in the formation of gallstones, it is advisable to avoid eating too many foods with a high saturated fatcontent. Foods high in saturated fat include: meat pies sausages and fatty cuts of meat butter, ghee and lard cream hard cheeses cakes and biscuits food containing coconut or palm oil A healthy, balanced diet is recommended. This includes plenty of fresh fruit and vegetables (at least 5portions a day) and wholegrains. Theres also evidence that regularly eating nuts, such as peanuts or cashews, can help reduceyour risk of developing gallstones. Drinking small amounts of alcohol may alsohelp reduce your risk of gallstones. However, you shouldnt regularly drink more than 14 units of alcohol a week as this can lead to liver problems and other health conditions. Regularly drinking any amount of alcohol can increase the risk to your health. Read more about: high cholesterol how to lower your cholesterol healthy eating Losing weight Being overweight, particularly being obese, increases the amount of cholesterol in your bile, which increases your risk of developing gallstones. You should control your weight by eating a healthy diet and taking plenty of regular exercise. However, avoid low-calorie, rapid-weight-loss diets. Theres evidence they can disrupt your bile chemistry and increase your risk of developing gallstones. A more gradual weight loss plan is recommended. Read more about losing weight and getting started with exercise . Source: NHS 24 - Opens in new browser window Last updated: 13 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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