Gallstones

The gallbladder is located underneath the liver and is part of the biliary tree. The liver makes bile, the function of which is to dissolve fats in your diet to allow their absorption in the intestines. Once the liver makes the bile, it goes through a network of tubes (bile ducts) known as the biliary tree and eventually into the intestines to mix with your food. The primary role of the gallbladder is to store bile, and once you eat, hormones from the stomach signal the gallbladder to contract and squeeze out the bile through a small tube called the cystic duct that joins with the central bile duct (common bile duct) to eventually go into the intestine. The pancreas is also part of the biliary tree and joins up with the main bile duct as it goes into the intestine.

Stones form in the gallbladder as a result of the bile within it crystalising and becoming solid stones. Gallstones often cause little or no symptoms at all. Occasionally they can cause pain in the top part of your abdomen that may spread into your shoulder or back, often worse on eating termed biliary colic. If a gallstone blocks the gallbladder outlet, it can cause the stagnant bile to become infected, and with inflammation of the gallbladder, this is called cholecystitis. 

If gallstones fall out of the gallbladder into the central bile duct, this can cause serious complications such as jaundice or infection in the bile ducts termed cholangitis. If a gallstone blocks off the pancreas as it passes through the central bile duct, this can cause inflammation of the pancreas gland, known as pancreatitis.

If you are suspected of having gallstones, your surgeon will perform a thorough assessment of your symptoms and perform a clinical examination. To confirm gallstones' diagnosis, an ultrasound scan can visualise the gallbladder and see if there are stones inside. Occasionally, an MRI scan (called an MRCP) or a CT scan is required to identify the exact position of the stones. 

Once a diagnosis of gallstones has been made, your surgeon can talk you through the treatment options. These can include dietary modifications and how to manage attacks of pain if you do not wish to undergo surgery. 

The definitive treatment for gallstones is surgery to remove the gallbladder called a cholecystectomy. It is not possible to shatter or dissolve the stones as this would increase the risk of the stones moving into a position to cause an obstruction. In most cases, cholecystectomy can be performed laparoscopically as a day case operation. You can live without a gallbladder, and the only reported side effect can be that your bowel motions are slightly looser after surgery due to excess bile going into the intestines. Mostly this settles without need for any treatment, but if it persists, some simple medicine can be started. 

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