Gallstones

What is it?

The gallbladder is a small pear-shaped organ located on the underside of the liver. The liver constantly produces bile, a substance necessary for breaking down fats that enter the intestine through food. This bile is made up of bile salts and cholesterol: two components produced by the liver. When the balance between these two components is disturbed, a sediment can form in the bile. This can develop into grit and eventually even stones in the gallbladder.

The exact origin of gallstones is not yet entirely clear, but a number of influencing factors are known (gender, age, body weight, hormone fluctuations...). For example, obesity, rapid weight loss and pregnancy are known risk factors. Women are also more likely to develop gallstones than men.

Symptoms

The vast majority of patients with gallstones have no symptoms at all. However, gallstones can also give rise to a whole range of types of discomfort or symptoms.

Difficulty digesting

Nausea, convulsions or a feeling of heaviness in the stomach area can occur on a regular basis, especially after consuming heavier or fatty meals.

Biliary colics

Biliary colics are pain symptoms that are usually felt under the right rib arch or in the abdominal area, but the pain can also radiate to the back, shoulder or sternum. These pains occur when gallstones are pressed into the bile duct during the contraction of the gallbladder. The symptoms therefore occur very suddenly, usually after eating a heavy meal.

In the majority of cases, the colic disappears spontaneously after some time, the intake of medication can speed this up a bit. The pain usually disappears because the gallbladder stops pressing and the stone no longer pushes against the bile duct. However, a small bile stone can also descend through the bilary tract to the duodenum, after which the pain symptoms fade away.

Gall bladder infection

When a gallstone gets stuck in the neck of the gallbladder, the latter can no longer empty itself. Because the gallbladder can no longer function normally, an inflammation often occurs. It can sometimes evolve very quickly. In such a situation, the colic pain lasts much longer. Most patients also develop a fever.

Jaundice

Jaundice is manifested by an increasing yellowing of the skin and the white parts of the eyes, but often also by generalised itching. This phenomenon occurs when a gallstone gets stuck in the large main bile duct that connects the liver to the small intestine. Bile can now no longer drain into the intestine and ends up in the blood. As a result, patients may sometimes notice that their bowel movements are very pale (no more bile dye in the intestine) and the urine becomes very dark (the kidneys filter bile out of the blood). If this situation persists, the stagnant bile in the main bile duct will become infected, which can lead to a serious infection of the main bile duct (cholangitis).

Pancreatitis

The pancreas empties into the duodenum at exactly the same place as the main gall bladder. This outlet is closed off by a small sphincter. When a gallstone gets stuck just at the level of the common opening, the pancreas can no longer drain digestive juices. This can lead to serious inflammation and even infection of the pancreas (pancreatitis).

How is the diagnosis made?

• The location of the gallbladder under the liver makes it easy to see in most people using an ultrasound. Usually, characteristics of gallstones and/or inflammation can be quickly established this way.
• In some cases, an ultrasound is inadequate, this is sometimes the case with very obese people. In such patients, a CT scan of the abdomen is sometimes performed. Although inflammatory signs can be detected with this examination, not all gallstones can be seen on these scanner images.
• A magnetic scan (MRI or NMR) is sometimes more appropriate for mapping the entire biliary system.
• In addition to imaging, an extensive blood test can also help in making the diagnosis. For example, in addition to increased inflammatory values, sometimes disturbed liver and pancreatic tests are also present.

Treatment

In the absence of symptoms, a watchful waiting approach may be adopted. As soon as the gallstones cause pain or a gall bladder infection, it is best to intervene:

Removal of the gallbladder

In the vast majority of patients a surgical removal of the gallbladder (a cholecystectomy) is indicated in these cases.

Nowadays, the surgical removal of the gallbladder is almost always performed by means of keyhole surgery (laparoscopy). However, in some cases it is still necessary to make a classic incision under the rib arch in order to remove the gallbladder (conventional gallbladder surgery).

Endoscopic retrograde cholangio pancreaticography (ERCP)

In some cases, endoscopic treatment of gallstones is necessary when gallstones are trapped in the main biliary tract or at the level of the pancreas outlet. This study is called a endoscopic retrograde cholangio pancreaticography (ERCP). With this technique, the stone in the main galleries is searched for and removed by means of some type of stomach examination with a long, fine camera. Here, the sphincter muscle at the outlet of the main bypass can be cut. Afterwards, the gallbladder usually needs to be removed to prevent a recurrence of the problem.

Medication

In case of an inflammation of the gallbladder, antibiotics are usually administered.

There are also medicines that can dissolve gallstones. However, these only work on some patients and the effect often takes months. When the medication is effective, the gallstones will gradually diminish and possibly dissolve completely. After stopping the medication, however, they can come back. A blood test should also be carried out regularly during treatment, as abnormal values of the liver tests is regularly observed.

Latest publication date: 12/12/2023
Supervising author: Dr Monsaert Els