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AUSTRALIAN GASTROENTEROLOGY INSTITUTE
(educational arm of the Gastroenterological Society of Australia)
Website: www.gesa.org.au

GALLSTONES

What are gallstones?
Gallstones are stones which form in the gallbladder, a small sac which lies under the liver. The function of the gallbladder is to store bile, a greenish-brown liquid produced by the liver. During the digestion of food, the gallbladder contracts and bile passes down the bile duct into the upper part of the bowel. Gallstones may also pass from the gallbladder into the bile duct. This involves passage through the cystic duct, a narrow tube which joins the gallbladder to the bile duct.

Why do gallstones form?
There is no simple answer to this question. In some people, the liver produces too much cholesterol and this can result in the formation of cholesterol crystals in bile which grow into stones. In others, gallstones form because of changes in other components of bile or because the gallbladder fails to empty normally. Gallstones become more common with advancing age and can be found in up to 15% of senior citizens. They are more common in women than in men, in people who are overweight and in those with a family history of gallstones.

What symptoms do gallstones cause?
About 7 out of 10 people with gallstones have no symptoms. When symptoms occur, the most common is episodes of moderate or severe pain in the upper abdomen or in the back. This is usually due to small gallstones which move into and block the cystic duct. This may result in an infection in the gallbladder, a condition called cholecystitis. In general, symptoms such as indigestion, fullness and nausea are not due to gallstones. When gallbladder stones move into the bile duct, they may cause episodes of pain or they may partly block the bile duct causing jaundice (yellow eyes and skin) or bile duct infections. Occasionally stones at the lower end of the bile duct can cause inflammation of the pancreas gland, a condition called pancreatitis.

Are gallstones serious?
Most people with gallstones never have a serious complication. However, if stones are untreated for many years, about 1 in 10 will develop jaundice, pancreatitis or infections in the gallbladder or bile duct. These complications often require urgent treatment in hospital.

How are gallstones diagnosed?
The first investigation is usually an ultrasound study. This test is relatively simple, free of side-effects and is highly accurate for demonstrating stones in the gallbladder. Additional investigations may be required for people with serious complications or those who are thought to have stones in the bile duct. For example, a flexible tube (endoscope) test called endoscopic retrograde cholangiopancreatography (ERCP) may be required to demonstrate and remove bile duct stones. In this test, an endoscope is passed through the oesophagus and stomach into the bowel and x-rays are taken after dye is injected into the bile duct.

Can gallstones be disolved?
Drugs are available to dissolve gallstones. However, they are not very effective and some have side-effects. Furthermore, even if stones dissolve, they often return after stopping the treatment. Because of these problems, drug treatment for gallstones is undertaken only in unusual circumstances.

Can gallstones be crushed?
Gallstones and kidney stones can be shattered using a machine (lithotripter) which generates shock waves outside the body. This form of treatment is more effective for kidney stones than for gallstones. In addition, patients need to take gallstone-dissolving tablets for at least six months after treatment. Again, this form of therapy is undertaken only in unusual circumstances.

Do I need an operation?
If you have stones in the gallbladder but no symptoms, there is no need to have an operation. If you have episodes of pain, it is probably wise to have an operation although this does not need to be performed urgently. If you have complications such as jaundice or infections in the gallbladder or bile duct, you need urgent treatment, usually surgery or endoscopic removal of a stone in the bile duct.

What sort of operation will I need?
Stones which are located in the gallbladder are treated by removal of the gallbladder (cholecystectomy). Stones which are located in the bile duct can be treated either endoscopically or by surgery. today, most gallbladders can be removed by "key-hole" surgery using laparoscopes. The operation is performed through three small incisions in your abdomen and you will probably leave hospital after 1 or 2 days. Occasionally "key-hole" surgery is impossible or risky and the operation is performed through a longer incision below your right ribs. This requires a longer stay in hospital, perhaps from 5 to 8 days. Operations of this type are very safe but there are always small risks of complications during surgery such as bleeding or damage to the bile duct, or of complications after surgery such as chest infections. Occasionally it may be necessary to perform an endoscopic procedure after the operation if x-rays taken during the operation show a stone in the bile duct.

Will the operation cure my symptoms?
Surgery relieves symptoms in most people. However, about 1 in 20 will continue to have episodes of "gallstone-like" pain, usually due to strong contractions of muscle in the wall of the bowel. These symptoms often improve with medical treatment.


DIGESTIVE HEALTH FOUNDATION

The Digestive Health Foundation (DHF) is an educational body committed to promoting better health for all Australians by promoting education and community health programs related to the digestive system.

The DHF is the educational arm of the Gastroenterological Society of Australia, the professional body representing the Specialty of gastrointestinal and liver disease in Australia. Members of the Society are drawn from physicians, surgeons, scientists and other medical specialties with an interest in GI disorders.

Since its establishment in 1990 the DHF has been involved in the development of programs to improve community awareness and the understanding of digestive diseases.

Research and education into gastrointestinal disease are essential to contain the effects of these disorders on all Australians.

Guidelines for General Practitioners and patient leaflets are available on a range of topics related to GI disorders. Copies are available by contacting the Secretariat at the address below.

Digestive Health Foundation 145 Macquarie Street SYDNEY NSW 2000

Phone: (02) 9256 5454 Facsimile: (02) 9241 4586 E-mail: gesa@racp.edu.au Website: http://www.gesa.org.au