Gallstones

About one in ten people in Britain have gallstones, especially women, overweight people, and those who are middle aged or over. In 1995 alone there were 10,000 patients receiving hospital treatment for gallstones. Many more will have had tests or medicine for their stones and you will probably have heard of a friend or relative who has gallstones or has had an operation on the gallbladder.

What are gallstones?

Gallstones look like small stones or gravel, but are not as hard, and may be up to 3 centimetres across. They are usually made of cholesterol (a fat) but can include calcium salts (similar to chalk) and solids from red blood cells. They grow in the gallbladder (see diagram) and may take years to form. The gall bladder is tucked away under the liver just below the right rib cage and collects bile from the liver. Bile is important in fat digestion and mixes with the food in the intestines. After a meal the gallbladder empties the bile down a tube called the bile duct, into the intestines where it mixes with food for digestion.

What is it like to have gallstones?

People with gallstones don’t know they have them until they block the pipes draining the gallbladder, causing inflammation, or move out of the gallbladder and block the pipe leading directly to the intestine, causing jaundice, fever or severe colic. People with gallstones may have indigestion, perhaps noticed after a rich or heavy meal. The symptoms of gallbladder trouble are pains below the right ribs and sometimes an ache in the back near the shoulder blade. The symptoms that doctors take most seriously are signs of inflammation in the gallbladder causing pain and fever (acute cholecystitis) or turning yellow (jaundice), a sign of obstruction of the liver. Inflammation may feel like flu but often with pain below the ribs. The urine may turn dark and the motions go very pale, and the whites of the eyes may look yellow. Sometimes the skin turns a dusky yellow rather like a suntan.

What will the doctors do?

Your family doctor will probably ask for a urine sample to see if there are signs of jaundice. He may ask you to lie on the couch and feel below the ribs to see whether the liver is swollen or if the gallbladder is tender. If your doctor thinks you have gallstones he may refer you to the hospital for tests and if you have jaundice you may be asked to go directly to the hospital taking a letter from your doctor.

The doctors at the hospital will usually test a sample of your blood to check the liver and you may have an ultrasound scan which will show whether you have gallstones. An ultrasound scan is painless, apart from the discomfort of pressure on the skin, and produces a picture on a TV screen.

If the gallbladder is inflamed you will usually be kept in hospital for a few days and antibiotics will be given, by means of a drip, into your vein. If your gallbladder has stones the doctor may recommend that it be removed. You can live perfectly well without a gallbladder. These days the operation is usually done by laparoscopic (keyhole) surgery with very small incisions needed in the abdomen. Many patients need only stay in the hospital for one or two nights although they will return for a check up and to have stitches removed. After keyhole surgery people can get back to work in two or three weeks. If tests show that your gallstones are stuck in the tubes, the doctor may remove them endoscopically using a special tube passed through the mouth while under sedation. This procedure can remove trapped stones and is called an ERCP. It does not remove your gallbladder.

For some people the surgeon may advise a more traditional operation with a larger cut. This will require a stay of a week or so in the hospital with an antibiotic drip after the operation. Both types of operation are safe especially on younger people and non smokers. The traditional operation may be painful afterwards but this can be controlled by strong pain killers.

It is possible to dissolve gallstones with medicines but this only works on some patients and the medicines have to be taken for a long time.

What about alternative medicine?

Gallstones and diseases of the gallbladder cause serious problems and you must see your doctor. Homeopathic medicine is a possible option but the Digestive Disorders Foundation (DDF) recommends that you discuss this with your doctor and, where necessary, attend regular hospital treatments.

What should I eat?

Many people with gallstones find that some particular foods, especially those which are fatty or oily, make them feel sick and give them pain. A low fat diet can help which should be as wide ranging and balanced as possible, preferably including steamed or boiled vegetables, fruit, pasta which is oil free, steamed or poached fish or skinless chicken, grilled lean meat, skimmed milk, soya protein such as Tofu, brown bread, various types of beans and pulses such as lentils. Your doctor or the hospital dietician will give you advice. After a gallbladder operation you can introduce fats into your meals although it is healthier to avoid them if possible. Most people can eat moderate amounts of all their favourite foods without trouble.

Can I drink alcohol?

Your doctor will advise you to avoid alcohol if you have liver or gallbladder trouble. When you have recovered from a gallbladder operation, however, you should be able to drink again if you wish, within the usual limits.