Gallstones

Gallstones are hard deposits, mostly of cholesterol, that form in the gallbladder, a small pouch under the liver that stores bile. They are present in roughly one in ten adults, and most never cause symptoms.

Silent stones are left alone. Stones that cause pain or complications are treated by removing the gallbladder, because stones re-form if only the stones are taken out. You can live and digest normally without a gallbladder.

Symptoms

• No symptoms in most people
• Biliary colic: steady severe pain under the right ribs or in the upper middle abdomen lasting 30 minutes to several hours, often after a fatty meal or at night
• Pain spreading to the right shoulder blade or back
• Nausea and vomiting with the pain
• Fever with persistent pain, suggesting an inflamed gallbladder
• Yellow skin and eyes, dark urine and pale stools if a stone blocks the bile duct

Causes and risk factors

Stones form when bile holds more cholesterol or pigment than it can keep dissolved, or when the gallbladder empties poorly. Risk rises with female sex, pregnancy, oestrogen treatment, age over 40, obesity, rapid weight loss including after bariatric surgery or weight-loss injections, diabetes, family history and certain ethnic backgrounds. Pigment stones occur with haemolytic blood disorders and cirrhosis. Crohn's disease of the small bowel and long periods of intravenous feeding also predispose.

How it is diagnosed

• Abdominal ultrasound: The test of choice. Detects gallbladder stones in over 95 in 100 cases and shows wall thickening or a widened bile duct. Done after fasting for about 6 hours.
• Liver blood tests, amylase or lipase: Raised bilirubin and liver enzymes suggest a stone in the bile duct. Raised lipase indicates pancreatitis.
• MRCP: An MRI scan of the bile ducts, without radiation or contrast, to look for duct stones before deciding on ERCP.
• Endoscopic ultrasound: The most sensitive test for small duct stones and sludge when other imaging is inconclusive.
• HIDA scan: Assesses gallbladder emptying when pain is typical but ultrasound is normal.

Treatment options

• No treatment: Stones found by chance without symptoms do not need surgery in most people.
• Laparoscopic cholecystectomy: Removal of the gallbladder through four small incisions under general anaesthetic, taking 45 to 90 minutes. Day case or one night. The standard treatment for symptomatic stones.
• ERCP with stone extraction: An endoscope passed through the mouth opens the bile duct outlet and removes duct stones, usually before or soon after gallbladder removal.
• Open cholecystectomy: Needed in a small percentage when inflammation or scarring makes keyhole surgery unsafe.
• Pain relief and antibiotics: Anti-inflammatory painkillers for colic, and antibiotics with early surgery for acute cholecystitis.
• Ursodeoxycholic acid: Dissolves small cholesterol stones slowly in selected people unfit for surgery. Stones often return, so it is seldom used.

When it is urgent

Go to an emergency department locally for upper abdominal pain lasting more than 5 to 6 hours, pain with fever or shivering, yellowing of the skin or eyes, dark urine with pale stools, or severe central pain going through to the back with vomiting. These suggest cholecystitis, a blocked or infected bile duct, or pancreatitis, none of which can wait for a trip.

Travelling to Türkiye for treatment

Planned laparoscopic cholecystectomy for recurrent biliary colic is well suited to travel: tests, surgery and a check can be done within about 5 to 7 days, and most people fly comfortably a week after surgery. Do not travel in the middle of an attack or with jaundice. If a bile duct stone is suspected, MRCP and ERCP may be needed first, which adds a few days.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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