Gallstones and You

Stones in the gall bladder, called gallstones, are very common in the general population. Approximately 25-30% of the population has stones in their gall bladder. Usually there are 2 situations when you become aware of your gallstones. One is when they are discovered by chance on ultrasound scanning of the abdomen as part of a health screening programme. The other is when you have symptoms and your doctor orders an ultrasound scan of your gallbladder.

Symptoms

Gallstones symptoms are variable. They could appear suddenly, termed acute symptoms, or they could have been troubling you for a while, termed chronic symptoms, which you have been ignoring or putting down to indigestion. The common symptoms include:

1. Pain — This can be an ache in the pit of your stomach or a band like discomfort across the upper part of your stomach after meals. Quite commonly you would think it is 'indigestion'. The pain can be severe in some and may require an injection of pain killers to settle it.
2. Nausea — A queasy feeling of wanting to vomit but not actually vomiting.
3. Fever — This usually comes together with an infection of the gall bladder.
4. Loose motion — Intermittent episodes of loose stool usually after a meal. There is no blood within the stool.

Diagnosis

Apart from taking a good clinical history of your symptoms and examining you, the quickest way to confirm the diagnosis of gallstone disease is to perform an ultrasound scan of the liver and gall bladder. The scan involves putting a probe over the right upper part of your stomach. This takes about 10 - 20 minutes and does not hurt. (You have to starve for 4 hours prior to the scan.)

Treatment

If the scan shows the presence of gallstones and you do not have a history of symptoms due to the stones then the diagnosis is asymptomatic gallstones. In general, people with asymptomatic gallstones do not require surgery.

If you clearly have symptoms due to the gallstones then you have two options. The conservative option is to try to reduce the symptoms you are experiencing without surgery. This method is not curative. The alternative is to perform an operation to remove the gall bladder and stones. This approach is to cure you of the problem.

Conservative management will require you to avoid eating fatty/oily food, eating smaller portions to avoid being over-full and giving up on some of your indulgences such as cream cakes, cheeses, curry with lots of coconut milk and hamburgers! This approach will not stop you from getting future attacks of pain or discomfort. This change in life-style merely reduces the frequency of getting symptoms.

Gall bladder surgery is now performed as key-hole surgery. Through 4 small holes on your abdomen, the gallbladder and its contents are removed (called laparoscopic cholecystectomy). This usually requires an overnight stay but for some patients it is possible to perform this as a day case.

Comments

Patients with symptomatic gallstones should strongly consider surgery. In these patients, the gallstones, if left untreated, can lead to complications such as acute inflammation of the gall bladder, empyema of the gall bladder (a pus filled gall bladder), pancreatitis and jaundice (yellowish discolouration of the skin). Although laparoscopic cholecystectomy is classified as a major operation, it is a safe operation and is associated with a relatively short period of mild wound discomfort.