What do my gallbladder and bile duct do?
The liver produces bile, which is used in breaking down the fats in our intestines. This bile is transported from the liver to the gallbladder, where it is stored and concentrated, before being released to the small intestine through the bile duct. During meals, the gallbladder will contract and release concentrated bile through the bile duct into the head of the small intestine, where it can break down the fats in the semi-digested food. The bile juice also helps to remove bilirubin, a waste product of blood cells breaking down.
What are gallstones?
Due to chemical imbalance or infrequent emptying of the bile in the gall bladder, gallstones may develop in the gallbladder. Usually caused by over-concentration of cholesterol or other minerals in the body, gallstones are usually solid masses which sit in the gall bladder silently. However, in some cases, the gallstones may cause inflammation of the gall bladder, or they may get lodged in the bile duct, causing a block in the bile duct and hence jaundice.
There are 2 main types of gallstones:
- Cholesterol stones, the more common type that are usually yellow-green in colour
- Pigment stones, made of bilirubin (a waste product made when red blood cells are broken down), and are smaller and darker
What are the causes of gallstones?
Gallstones form when there are excessive levels of cholesterol or bilirubin inside the gallbladder or when the gallbladder fails to empty completely. These result in tiny crystals developing in the bile that can gradually grow into solid stones.
There are several risk factors that make a person more prone to developing gallstones:
- Hereditary causes. Having a close family member who has had gallstones
- Obesity
- Rapid weight loss either from ‘crash’ dieting or bariatric surgery
- Female gender, particularly if you are pregnant, have had children, are taking the combined pill, or are undergoing high-dose oestrogen therapy
- Increasing age. Those aged 40 years or older are more likely to have gallstones
- Medical conditions that affect the flow of bile (cirrhosis, primary sclerosing cholangitis or obstetric cholestasis), diabetes, Crohn’s disease, or irritable bowel syndrome
- Lifestyle factors. A diet high in fat and cholesterol but low in fibre and not getting much exercise contribute to gallstone formation
What are the symptoms of gallstones?
Gallstones usually do not cause any symptoms until there is blockage of the bile movement, either through an excessive build-up of gallstones in the gallbladder, or a block of the bile duct. When this occurs, symptoms include:
- Steady, severe pain in the upper right abdomen which can extend to the back and between the shoulder blades
- Nausea
- Vomiting
- Bloating
- Jaundice (yellowish skin and eyes)
What are the complications of gallstones?
- Gallbladder swelling (cholecystitis)
- Bile duct swelling (cholangitis)
- Pancreas swelling (pancreatitis)
How are gallstones diagnosed?
Diagnosis of gallstones may involve several tests and procedures:
- Blood tests to check for signs of inflammation, infection or blockage, and to rule out other conditions.
- Ultrasound to examine the gallbladder for stones. Abnormalities in the biliary system, including stones or signs of inflammation or infection can be seen.
- Computerised tomography (CT) scan may be used to look for complications of gallstones. It is often carried out in an emergency to diagnose severe abdominal pain.
How are gallstones treated?
Gallstones can be removed laparoscopically (minimally invasive surgery technique), where a special tool is inserted into the gall bladder through a small incision on the stomach. The stones are then removed using these special tools.
The more common approach is to remove the gallbladder entirely laparoscopically to prevent a repeated development of gallstones. It is possible for someone to live without their gall bladder. Gallbladder removal is also the common treatment for gallbladder swelling caused by gallstones. When the swelling of the gall bladder is left untreated, it is possible for the gallbladder to develop gangrene and rupture. While rare, ruptured gallbladders due to gall bladder inflammation and gallstones have a 30% chance of causing death.