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Everything You Need to Know About the Gallbladder and Gallstones 2025

Written By TheCRCS
January 13, 2025

Written by Dr. Ronnie Mathew, Senior Consultant Surgeon, CRCS

What is the Gallbladder, and what does it do?

The gallbladder is a small, pear-shaped organ in the upper right side of the abdomen. Think of your gallbladder as a little storage pouch for bile, a digestive fluid made by your liver. When food is eaten, the stomach releases a hormone that causes the gallbladder to contract and release bile into the small intestine. The bile fluid helps break down fats in the food you eat. 

What are Gallstones, and why do they occur?

Gallstones are small, hard deposits that form in your gallbladder. They can range in size from a grain of sand to a golf ball. These stones form when there's too much cholesterol, bile salts, or bilirubin in the bile. When this happens, the excess material hardens into stones. Gallstones are usually harmless, but they can sometimes block the flow of bile and cause pain, nausea, inflammation/infection, and other complications. 

Gallstones are hardened deposits of digestive fluid that form in the gallbladder, and can sometimes cause pain or no symptoms at all.


Who is at risk of gallstones?

Generally, several groups are more likely to develop gallstones:

  • Age: As you age, your risk of developing gallstones increases. Men are more likely to get them after age 60, while women are more prone between the ages of 20 and 50.
  • Gender: Women have a higher risk of gallstones than men because of their naturally higher oestrogen hormone levels. Oestrogen increases cholesterol in bile, and another hormone, progesterone, can slow the gallbladder's emptying process.
  • Weight: Carrying extra weight is a major risk factor. Body fat releases oestrogen, which increases cholesterol levels in bile. Rapid weight loss can also trigger gallstones because it simultaneously dumps a lot of cholesterol into the bile.
  • Genetics: If gallstones run in your family, you’re also more likely to get them.
  • Hormones: Hormonal changes, such as those from pregnancy, hormone replacement therapy, or birth control pills, can raise the risk of gallstones by increasing oestrogen levels.
  • Cholesterol-lowering drugs: While these drugs lower cholesterol in your blood, they can increase the cholesterol in your bile, leading to a higher risk of gallstones.
  • Diabetes: People with diabetes often have high levels of fatty acids called triglycerides, which can contribute to the formation of gallstones.
  • Diet and lifestyle: Eating a diet high in fat and cholesterol and low in fibre, and a sedentary lifestyle can increase your risk of gallstones.

Can gallstones be prevented from forming in the first place?

  • There is some evidence that a healthy lifestyle, regular physical activity, and ideal body weight might prevent cholesterol stones and symptomatic gallstones. However, the evidence for this recommendation is not strong.
  • Medications with Ursodeoxycholic acid may be useful in preventing high-risk patients (e.g., morbidly obese patients undergoing rapid weight loss following bariatric (weight loss) surgery) from developing gallstones. However, studies suggest that ursodeoxycholic acid does not reduce biliary symptoms once the stones have formed.

What are the symptoms of gallstones?

Most people with gallstones don’t even know they have them because they don’t always cause symptoms. But if a gallstone gets stuck in the bile duct, it can cause sudden, severe pain in the upper right part of your abdomen. This pain is known as biliary colic.  If the blockage isn't treated, it can lead to serious problems like infections or inflammation of the gallbladder. 

If the bile does not drain well, it can cause:

  • jaundice
  • dark urine
  • light-coloured stools

What treatment options are there for gallstones?

  • Gallstones causing no symptoms or issues

Gallstones do not cause any symptoms in a majority of people. In such cases, there is no specific treatment apart from general diet control and treating any underlying causes that predispose gallstone formation. 

  • Gallstones causing symptoms and complications

Gallstones may lead to:

  • biliary colic
  • gallbladder infection/inflammation
  • obstructive jaundice
  • pancreatitis
  • fistula formation
  • blockages in the bowel

These conditions require specific treatment for each condition. For example, painkillers for pain symptoms, antibiotics for infection/inflammation, clearing the bile duct when there is obstructive jaundice, drainage of gallbladder in certain conditions, specific treatment for pancreatitis, operation when bowel blockage due to gallstones, etc. These are only general suggestions, and usually, they require a combination of treatment strategies.

In addition, it would also usually require the removal of the gallbladder (called Cholecystectomy). Cholecystectomy is the most common treatment for gallstones. This is typically performed with a minimally invasive surgical operation. The gallbladder is not an essential organ, so people can live normal lives without it. 

Medical or shockwave treatments (called lithotripsy) can be considered to dissolve the gallstones, but they may not be as effective.

Can there be other conditions mimicking symptoms similar to those due to gallstones?

Other conditions that mimic gallstone symptoms include:

  • vague abdominal discomfort
  • distension
  • nausea
  • flatulence

intolerance of fats may also be caused by: 

Sometimes, the conditions can overlap. Hence, seeing a specialist and making a detailed assessment is important. Investigations are usually required to diagnose gallbladder/gallstone-related problems and as well as to exclude other conditions.

What investigations can be considered to diagnose gallstone-related problems?

  • Ultrasound Is one of the best ways to demonstrate stones, being 90-95% sensitive:
  • Sometimes, stones are not mobile, so they are not easy to differentiate from unimportant polyps, and very small ones may be missed or fail to throw a helpful acoustic shadow.
  • Ultrasonography can also allow measurement of the diameter of the common bile duct (CBD) and show the liver and hepatic bile ducts. Still, it can only identify about half of any stones in the CBD with certainty.
  • If the ultrasound scan findings are negative but there is a high level of suspicion, such as in a patient with upper abdominal pain and abnormal LFTs, it is worth repeating the investigation after an interval. This may pick up stones that were previously missed.
  • An MRI scan (magnetic resonance cholangiopancreatography) may often be helpful when further clarifications are needed.
  • Endoscopic retrograde cholangiopancreatography (ERCP) may be used for the diagnosis of CBD stones and has also evolved from a diagnostic to a therapeutic procedure for the removal of CBD stones.
  • Blood tests (to assess for infection markers, bilirubin levels, liver enzymes, and amylase/lipase to assess for pancreatitis), Urinalysis, Chest X-ray (CXR), Electrocardiogram (ECG), OGD/Endoscopy, and Colonoscopy may help exclude other diseases.

At CRCS, we provide expert assessment, diagnosis, and treatment to help restore your health.

If you have any questions regarding your Gallbladder or Gallstones, then do get in touch with us today to have them answered. https://www.thecrcs.com

Important: Please note: The information provided here is not specific and is meant for general information only. It does not constitute guidance for the management or treatment of any condition and does not replace information from your healthcare professional. Please consult your healthcare professional for more information and guidance.

Acknowledgment

https://patient.info/doctor/gallstones-and-cholecystitis

Further reading and references:

  1. Gallstone disease; NICE Quality standard, December 2015
  2. Gurusamy KS, Davidson BR; Gallstones. BMJ. 2014 Apr 22;348:g2669. doi: 10.1136/bmj.g2669.
  3. David GG, Al-Sarira AA, Willmott S, et al; Management of acute gallbladder disease in England. Br J Surg. 2008 Apr;95(4):472-6.
  4. Khan HN, Harrison M, Bassett EE, et al; A 10-Year Follow-up of a Longitudinal Study of Gallstone Prevalence at Necropsy in South East England. Dig Dis Sci. 2009 Jan 22.
  5. Shojaiefard A, Esmaeilzadeh M, Ghafouri A, et al; Various techniques for the surgical treatment of common bile duct stones: a meta review. Gastroenterol Res Pract. 2009;2009:840208. Epub 2009 Aug 6.
  6. Sakorafas GH, Milingos D, Peros G; Asymptomatic cholelithiasis: is cholecystectomy really needed? A critical reappraisal 15 years after the introduction of laparoscopic cholecystectomy. Dig Dis Sci. 2007 May;52(5):1313-25. Epub 2007 Mar 28.
  7. Jones MW, Kashyap S, Ferguson T; Gallbladder Imaging
  8. Roy A, Martin D; Complicated bile duct stones. BMJ Case Rep. 2013 Aug 14;2013. pii: bcr2013200667. doi: 10.1136/bcr-2013-200667.
  9. Cholecystitis - acute; NICE CKS, January 2017 (UK access only)
  10. Laser lithotripsy for difficult-to-treat bile duct stones; NICE Interventional procedures guidance, June 2021
  11. Sanders G, Kingsnorth AN; Gallstones. BMJ. 2007 Aug 11;335(7614):295-9.
  12. Dasari BV, Tan CJ, Gurusamy KS, et al; Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev. 2013 Sep 3;9:CD003327.
  13. Machado FHF, Castro Filho HF, Babadopulos RFAL, et al; Ursodeoxycholic acid in the prevention of gallstones in patients subjected to Roux-en-Y gastric bypass1. Acta Cir Bras. 2019 Feb 14;34(1):e20190010000009. doi: 10.1590/s0102-865020190010000009.
  14. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones; European Association for the Study of the Liver (2016).

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