Gallstones

Gallstone disease is common; affecting around 80% of the population. However, of all the patients who have gallstones, only 20% are symptomatic.

There are 3 main types of gallstones:

- Cholesterol stones (80%): commonly occurs in patients who are obese or have high cholesterol and lipids.

- Pigmented stones: Black stones – associated with blood disorders (haemolysis), Brown stones – due to infection of the biliary tract.

- Mixed stones: cholesterol & pigmented types.


Risk factors for gallstones include:

- hereditary

- female sex

- obesity

- high cholesterol levels

- diabetes

- increasing age

- oral contraceptive pills

- post bariartric (obesity) surgery

- inflammatory bowel disease

- haemolytic anaemia

Patients with gallstones can present with:

- abdominal pain usually at the right upper quadrant (biliary colic)

- inflammation of the gallbladder (acute cholecystitis)

- swelling of the gallbladder due to collection of mucous (mucocoele)

- infection of the gallbladder (empyema)

- perforation of the gallbladder (gangrene & perforation)

- jaundice due to obstruction of the bile duct (Mirizzi’s Syndrome)

The gallstones can also migrate into the bile duct & cause obstruction, jaundice & infection.

Common investigations to diagnose gallstones include:

- ultrasound of the abdomen

- CT/MRI scan of the abdomen

- Endoscopic Retrograde Cholangio Pancreaticogram (ERCP): to assess the biliary tract and to remove any stones in the biliary tract.

Treatment:
- Surgery to remove the gallbladder (Cholecystectomy): usually done laparoscopically but can also be done as an open surgery in complicated cases.
- Patients with Acute Cholecystitis will have to be admitted to the hospital for intravenous antibiotics.

- Patients with empyema, gangrenous or perforated gallbladder will need emergency surgery to remove the gallbladder.