Gallbladder stones 

What is the purpose of the gallbladder?

The gallbladder is a pear-shaped organ located below the liver in the upper right part of the abdomen. It serves as a reservoir for the bile produced by the liver. The gallbladder does not produce bile itself.

When we eat, a hormonal signal is sent to the gallbladder to release stored bile. This is released to the intestine to help with digesting the food we have just eaten.

Bile is produced by the liver. It is excreted through the bile ducts in the first part of the intestine (duodenum) just after the stomach. Among other things, bile contains bile salts, fats (cholesterol), water and bilirubin.

Its main functions are:

→ Assisting in the digestion and absorption of fats.

→ Help in the absorption of vitamins A, D, E and K

Yes, it does not affect the patient’s life expectancy. Digestion proceeds normally after the procedure because bile produced by the liver continues to flow in the intestine to aid digestion.

How gallstones form is not fully understood.

When there is an imbalance between cholesterol, bilirubin and bile salts, the fluidity of bile cannot be maintained and a precipitate forms. This precipitate can further evolve from a precipitate to sludge (mud) which in turn forms stones with time.

→ Cholesterol-based stones:

The most common stones. Undissolved cholesterol precipitates and forms stones. Yellow-coloured stones.

→ Stones containing mainly bilirubin:

Dark brown or black stones with predominant bilirubin content.

• Female gender
• > 60 years of age
• Obesity
• Diet high in fat and cholesterol
• Low-fibre diet
• Family history
• Diabetes
• Rapid weight loss (bariatric surgery)
• Medication:

– Hormone therapy: oestrogen

– Lipid lowering drugs

Yes, very frequent:

→ > 50 years: > 25%

→ > 80 years: > 60%

Hepatic colic

As a result of a stone stuck at the exit of the gallbladder, bile cannot drain.

It is more frequent after a high-fat meal. The pain can be located in the upper abdomen, in the centre (epigastric) or in the right costal region (right hypochondriac). The pain radiates band-like to the back more specifically to the right shoulder. The pain persists for 2 to 4 hours. The pain is frequently accompanied by nausea and vomiting.

Acute cholecystitis

Bile that cannot drain from the gallbladder due to the blocked stone at the exit of the gallbladder becomes infected due to bacteria migrating upwards from the intestines along the bile ducts. The pain often becomes more intense and prolonged in duration and is often accompanied by fever.

Jaundice

A stone that escapes from the gallbladder and gets stuck in the bile duct. The stone blocks the flow of bile from the liver to the intestine. The bile and bilirubin that are no longer secreted through the intestine are absorbed into the blood through the liver.  It accumulates in the blood and the patient’s body turns yellow. The more bilirubin accumulates in the body, the more yellow the patient becomes, resulting in itching (pruritus). If the bile proximal to the stone cannot drain and becomes infected in a similar way as in acute cholecystitis, it is called angiocholitis. Angiocholitis is an emergency. The patient’s general condition deteriorates rapidly with fever and jaundice.

Pancreatitis

When a stone blocks the exit of the pancreatic duct, the pancreatic enzymes cannot flow out and the pancreas itself is affected and inflamed.

A gallstone blocking the exit of the gallbladder

• Bile cannot flow out.
• Hepatic colic: pain in the right hypochondrium (right costal region) with or without radiation to the back.
• Acute cholecystitis: infection by bacteria ascending from the intestine along the bile ducts infecting the gallbladder.

Gallstone stuck in the bile duct

• Jaundice: bile can no longer drain.
• Angiocholitis: stagnant bile becomes infected by bacteria migrating up from the intestine.

Gallstone stuck at the outlet of the bile duct and pancreas into the intestine

• Jaundice: the bile can no longer drain.
• Angiocholitis: the stagnant bile is infected by bacteria migrating up from the intestine.
• Pancreatitis: the secretion from the pancreas cannot flow out into the intestine, stagnates and causes inflammation of the pancreas.

When should gallstones be treated?

Stones are treated only if they are symptomatic.

20-30% of patients with gallstones will develop symptoms within 20-30 years.

The timing of symptom onset is completely unpredictable.

Treatment of symptomatic gallstones is removal of the gallbladder (cholecystectomy). The surgery is performed laparoscopically in the vast majority of cases (laparoscopy)

See surgical procedure: Laparoscopic cholecystectomy