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About Gallstones
Home > About Gallstones
What Are Gallstones?
Gallstones are hard, pebble-like formations that develop in the gallbladder, a small organ located below the liver. The gallbladder’s primary role is to store and release bile, a digestive fluid produced by the liver that helps break down fats. When the balance of substances in bile—like cholesterol, bile salts, and waste products—is disrupted, gallstones can form.
These stones can range in size, from as tiny as a grain of sand to as large as a golf ball. While some people with gallstones experience no symptoms, others may face severe abdominal pain, nausea, or digestive issues when gallstones block the bile ducts.
The More You Know
How are gallstones formed?
The gall bladder is a small organ which is situated below your liver on the right upper part of your abdomen. It stores the bile that is produced from your liver which helps in the digestion of food, but it’s an organ that you can live without.
It is prone to develop stones (gall stones) due to the high concentration of bile in the gallbladder which then crystallises into deposits and will subsequently form stones.
Type of Gallstones
Gallstones are typically categorised into three main types based on their composition:
These are the most common type of gallstones, accounting for the majority of cases. They’re typically yellowish in colour and composed mainly of cholesterol. Cholesterol gallstones form when bile contains excessive cholesterol, not enough bile salts, or when the gallbladder doesn’t empty efficiently.
Pigment stones are smaller and darker, often black or brown, these are also more common in our part of the world here in Singapore. They are made of bilirubin, a substance produced when the body breaks down red blood cells. These stones are more likely to occur in individuals with certain medical conditions, such as liver disease, hemolytic anaemia, or infections in the bile ducts.
As the name suggests, these gallstones are a mixture of cholesterol and pigments. They often develop in various shapes and sizes and may form alongside other types of gallstones.
What causes Gallstones?
Gallstones develop when the chemical balance of bile is disrupted. Causes that contribute to gallstones include:
- Excess Cholesterol in Bile: When the liver produces too much cholesterol, it can solidify into crystals that grow into gallstones.
- Insufficient Bile Salts: Bile salts help dissolve cholesterol. When there aren’t enough, cholesterol can crystallise.
- Gallbladder Emptying Issues: If the gallbladder doesn’t fully empty or empties infrequently, bile becomes concentrated, increasing the likelihood of stone formation.
- Elevated Bilirubin Levels: Higher levels of bilirubin, often due to liver disease or infections, can encourage pigment gallstone formation.
Symptoms of Gallstones
Gallstones, while sometimes silent and symptom-free, can cause a range of uncomfortable and even severe symptoms when they obstruct the normal flow of bile. These symptoms often depend on the size, location, and number of gallstones, and they can differ from person to person. Here’s a detailed look at both common and less common symptoms associated with gallstones:
Common Symptoms
#1
Abdomen Pain
(Biliary Colic)
#2
Nausea & Vomiting
#3
Jaundice
Less Common Symptoms
#1
Fever & Chills
#2
Pain in the Right Shoulder or Back
#3
Loss of Appetite
How Symptoms Vary
Gallstone symptoms can differ significantly based on the size and location of the stones:
- Small Gallstones: These may pass harmlessly through the bile ducts with little or no symptoms. However, they can occasionally cause mild discomfort or irritation.
- Larger Gallstones: These are more likely to cause blockages in the bile duct, leading to severe symptoms such as intense pain and jaundice.
- Gallstone Location: Stones lodged in the gallbladder may cause different symptoms compared to those blocking the bile ducts or affecting the pancreas.
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Treatment Options for Gallstones
We understand that every patient is different and that there isn’t a one-size-fits-all treatment option. We therefore have a customised and personalised approach to treating gallstones, and some of these treatments include:
Medication
We may prescribe medications to dissolve gallstones. Medications you take by mouth may help to dissolve gallstones but it may take months or years of treatment to dissolve your gallstones in this way, and gallstones will likely form again if treatment is stopped.
This is why sometimes medications don’t work and isn’t recommended. Medications for gallstones are not commonly used and are reserved for people who can’t undergo surgery.
Surgery
You don’t need your gallbladder to live, and gallbladder removal doesn’t affect your ability to digest food. Your doctor may recommend surgery to remove your gallbladder, since gallstones frequently recur.
Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder.
Techniques for Gallbladder Surgery Include:
- Laparoscopic Cholecystectomy – ‘keyhole’ surgery
- Open Surgery
Frequently Asked Questions
It may be found incidentally during test for other problems or conditions and in these cases the gall stones are asymptomatic and causing no problems.
You may be experiencing the symptoms from them and the doctor will typically start off with a physical examination that includes checking your eyes and skin for any visible changes in colour.
Further tests such as Ultrasound, CT Scan, Gallbladder Radionuclide Scan, Blood Test, or an Endoscopic Retrograde Cholangiopancreatography (ERCP) can help detect the presence of any gallstones.
If unsure, consult an experienced Surgeon in Singapore like Dr Kan Yuk Man for a thorough examination!
Your doctor may recommend surgery if:
- You have repeated gallstone attacks.
- The pain from the attacks is severe.
- You have complications, such as inflammation/infection of the gallbladder or the pancreas, jaundice.
Gallstones themselves are not dangerous, and in fact, most patients that have gallstones, don’t experience any pain. Rather, pain occurs when the gallstones block the movement of bile from the gallbladder (Biliary Colic) and tends to happen after eating a fatty meal. When this happens, there maybe be severe pain which may resolve after a short period of time or it can be persistent, resulting in an admission to the hospital for strong pain killers.
It can cause inflammation and infection in the gallbladder. You will experience pain in the upper part of your stomach and fever. This is known as acute cholecystitis, which is dangerous and considered an emergency.
The stones can drop out the gall bladder into the duct that leads to the bowel and will cause a blockage to the flow of the bile. This can result in Jaundice or inflammation of the pancreas (Pancreatitis). Both of which are an emergency. Too much bilirubin in your body can cause jaundice, which is a yellowish tint in your eyes or on your skin. Your stools will become very pale and your urine will become very dark in colour.
In some cases, the infection can be so severe that the gall bladder become filled with pus (Gallbladder Emypema) or the lining of the gall bladder dies off and becomes necrotic. You will become extremely ill with this.
If you have no symptoms and it is found incidentally, then it is quite safe to leave the gall stones alone.
If you experience any of the above-mentioned symptoms, you should seek advice from Dr Kan right away. Delayed treatment can lead to complications such as:
- jaundice, a yellowish tint to your skin or eyes
- cholecystitis, a gallbladder infection
- cholangitis, a bile duct infection
- sepsis, a blood infection
- pancreas inflammation – pancreatitis
Gallbladder cancer
Most patients with gallstone symptoms will need surgery. Surgery will involve the removal your entire gallbladder (cholecystectomy) rather than just removing the stones as they can re-occur if you do not remove the gall bladder leading to more problems.
Techniques to remove the gallbladder include:
- Laparoscopic Cholecystectomy – ‘keyhole’ surgery. The surgeon passes instruments, a light, and a camera through several small cuts in the belly, allowing access for a range of instruments. The surgeon then removes the gallbladder through one of the incisions.
- Open Surgery – the surgeon reaches the gallbladder through a wider abdominal incision. You might need open surgery if you have scarring from prior operations or a bleeding disorder.
Unsure if you’re suffering from gallstones? Consult Dr Kan immediately to ensure a peace of mind!
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