Gallstones

Gallstones are solid deposits that form in the gallbladder, a small organ that stores bile produced by the liver. These deposits range from tiny granules to larger stones several centimetres in diameter. While some individuals with gallstones experience no symptoms, others may develop severe abdominal pain and complications that affect their digestive system and quality of life.

Dr. Chok Aik Yong

Colorectal Surgeon & General Surgeon

MBBS | MRCS (UK) | MMed (Surgery) | FRCS (UK)

Symptoms causes types diagnosis treatments prevention FAQ

Symptoms of Gallstones

Individuals with gallstones may experience a range of symptoms when stones block the bile ducts or irritate the gallbladder wall.

Sudden Abdominal Pain: Sharp pain in the upper right abdomen or centre of the abdomen that typically lasts several hours. This pain, known as biliary colic, often occurs after meals and may intensify gradually.
Referred Pain: Pain that radiates to the right shoulder or back. This occurs due to shared nerve pathways between these areas and the gallbladder.
Nausea and Vomiting: These symptoms frequently accompany gallstone pain and may persist until the pain subsides. The severity often correlates with the intensity of abdominal pain.
Digestive Disturbances: Bloating, indigestion, and intolerance to fatty foods develop when bile flow becomes restricted. These symptoms may become more pronounced after meals.
Jaundice: Yellowing of the skin and whites of the eyes occurs when gallstones block the common bile duct, preventing bile from reaching the intestine.

Causes and Risk Factors

Gallstones form due to a combination of factors, and some individuals are more likely to develop them than others.

Cholesterol Imbalance

Excess cholesterol in bile leads to crystal formation. This occurs when the liver produces more cholesterol than the bile can dissolve effectively.
Bile Composition

Imbalances in bile salts or bilirubin can hinder cholesterol breakdown, leading to gallstones. Diet, medications, and underlying conditions may contribute to this.
Age

People over 40 have an increased likelihood of developing gallstones. The risk rises with age due to changes in cholesterol metabolism and gallbladder function.
Gender

Women are twice as likely as men to develop gallstones, especially during childbearing years or hormone therapy, due to hormonal effects on bile composition.
Rapid Weight Changes

Quick weight loss or frequent weight fluctuations increase the risk of gallstone formation by affecting cholesterol metabolism and gallbladder emptying.
Family History

Genetic factors influence gallstone formation, raising the risk for those with close family members who have had them.
Medical Conditions

Diabetes, liver disease, and certain blood disorders increase the likelihood of developing gallstones through various metabolic mechanisms that affect bile composition.

Types of Gallstones

Cholesterol Stones

Yellow-green stones primarily composed of cholesterol crystals. They form when bile contains excess cholesterol and can grow larger over time, occurring as single or multiple stones. Sizes range from a few millimetres to several centimetres.

Pigment Stones

Dark brown or black stones composed primarily of bilirubin compounds. These develop when bile has excess bilirubin, often due to liver conditions or blood disorders. Typically smaller than cholesterol stones, they usually form in multiples.

Mixed Stones

Contain varying amounts of cholesterol and pigments, forming due to multiple factors affecting bile composition. They fall between pure cholesterol and pure pigment stones, differing in appearance and size.

Diagnostic Methods

CT Scan

Produces cross-sectional X-ray images to detect gallstones and assess complications, such as bile duct obstruction, gallbladder inflammation, or pancreatic involvement. This method provides detailed views of surrounding organs, helping to identify infections, swelling, or structural abnormalities related to gallstone disease.
Ultrasound Scan

Uses sound waves to create images of the gallbladder and nearby structures. This non-invasive test detects stones larger than 2mm and signs of inflammation or blockage. Ultrasound is the primary tool for diagnosing gallstones.
Blood Tests

Analyse liver function and signs of infection or bile duct obstruction. Elevated enzyme levels and other markers indicate inflammation or complications, aiding diagnosis and treatment planning.
HIDA Scan

A radioactive tracer assesses gallbladder function by tracking bile flow through the liver, gallbladder, and intestines. This test, lasting 1–4 hours, helps detect blockages and emptying issues.

Treatment Options

The choice of treatment depends on symptom severity, the size and number of gallstones, and the presence of complications.

Non-Surgical Treatment

Observation

Asymptomatic gallstones may not require immediate treatment, but regular monitoring helps track any changes. Routine check-ups ensure early detection of symptoms or complications, allowing timely intervention if necessary.

Pain Management

Medications can relieve acute pain episodes until further treatment is considered. Mild discomfort may be managed with simple analgesics or anti-inflammatory drugs, while stronger prescription medications are available for severe pain. Treatment is tailored to symptom severity and individual response.

Dietary Modifications

Adjusting diet can help prevent gallstone attacks. Reducing fat intake, eating small, frequent meals, and avoiding trigger foods may ease symptoms. A well-balanced diet supports gallbladder function, with gradual changes being more effective and sustainable than sudden dietary restrictions.

Stone Dissolution

Oral medications can gradually dissolve small cholesterol stones in patients who cannot undergo surgery. Treatment may take months or years and is only effective in select cases. Regular monitoring is required to assess progress and determine if alternative treatment is needed.

Surgical Treatment

Laparoscopic Cholecystectomy

A minimally invasive procedure to remove the gallbladder through four small incisions. A camera and surgical instruments are inserted to perform the operation. Recovery usually takes 1–2 weeks, with minimal scarring and a shorter hospital stay compared to open surgery.

Open Cholecystectomy

A traditional approach involving a larger abdominal incision. This method is used for complex cases or when laparoscopy is not feasible. Recovery takes 4–6 weeks, and a larger scar remains. Open surgery may be necessary for patients with severe inflammation, scar tissue, or anatomical variations.

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Prevention and Management

Regular physical activity and maintaining a healthy weight help lower the risk of gallstone formation. A diet rich in fibre and low in saturated fats supports healthy bile composition. Eating balanced meals at consistent times prevents bile stasis, while avoiding rapid weight loss reduces the likelihood of stone development. Individuals with existing gallstones should follow medical advice regarding diet and attend regular check-ups to monitor their condition.

Frequently Asked Questions (FAQ)

Can gallstones pass naturally?

Small stones occasionally pass into the intestine through bile ducts. However, this process can cause complications and should not be relied upon as a treatment method. Most symptomatic gallstones require medical intervention.

How does pregnancy increase gallstone risk?

Pregnancy hormones alter bile composition and slow gallbladder emptying. These changes increase the risk of gallstone formation during pregnancy and in the months following delivery. Regular prenatal care helps monitor for gallstone development.

Can gallstones return after surgery?

Gallstones cannot form after complete gallbladder removal. However, stones can develop in the bile ducts in rare cases, requiring different treatment approaches. Regular follow-up helps monitor for such complications.

Dr. Chok Aik Yong

Colorectal Surgeon & General Surgeon

MBBS|MRCS (UK)|MMed (Surgery)|FRCS (UK)

Expertise lies in managing colorectal diseases, particularly advanced colorectal cancer and inflammatory bowel disease.

Dr Chok graduated with degrees in Bachelor of Medicine and Surgery from the National University of Singapore. He was conferred the Master of Medicine (Surgery) in Edinburgh (UK) and a member of the Royal College of Surgeons, UK. He subsequently completed his specialist training in colorectal surgery and became a Fellow of the royal college of Surgeons in Edinburgh in 2016.
Dr Chok was awarded the Health Manpower Development Plan (HMDP) award in 2019 to further advance his colorectal training at Royal Marsden Hospital, one of the top 5 cancer centres in the world. While in London, Dr Chok trained with pioneers in the surgical management of advanced colorectal cancer and inflammatory bowel disease (IBD) and gained extensive experience while appraising the latest clinical and research evidence.

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