Upper GI Conditions



What are gallstones?

They are stones formed in a small organ called the gallbladder which is attached to the ducts coming from the liver.  The gallbladder is usually filled with bile which is made and excreted by the liver.  In humans, the gallbladder has very little function.  It acts as a store of extra bile and it contracts and releases this bile into the bowel when a person has a heavy oily or creamy meal. This bile helps to aid digestion of fat.  Stones can form from crystallization of the bile in the gallbladder. When there are stones in the gallbladder, it often does not work properly anymore and the rest of the liver ducts take over its function.  Hence the gallbladder can be removed from the body without any noticeable change in body function. 

The gallbladder resembles the the size and shape of a small balloon filled with yellow fluid. 


What problems can gallstones cause?

Gallstones may be present in the gallbladder for quite some time without causing much trouble.  However, in over 75% of people, they can cause moderate to severe symptoms.  They can cause severe bouts of abdominal pain associated with vomiting if the stones get stuck in the opening or neck of the gallbladder and prevent it emptying.  If the gallbladder becomes infected from that, it can lead to fever and sepsis and a persistent tender abdomen, in a condition called acute cholecystitis.  In most cases, the infection settles down if it is treated with antibiotics but in severe cases, this can lead on to a gangrenous or ruptured gallbladder. 

Sometimes the gallstones can escape from the gallbladder and pass down into the liver (or bile) ducts.  If it gets stuck at the lower end of the bile duct, this can block the flow of bile from the liver and lead to the patient developing jaundice.  Sometimes it can also cause inflammation of the pancreas leading to a condition called acute pancreatitis.

How do I know if the abdominal pains I have is due to gallstones?

The pain from gallstones is often associated with eating a heavy, fatty or creamy meal.  The pain can start several hours after a meal and usually starts in the middle or to the right of the upper abdomen, just under the ribcage.  It can then spread out around the whole upper abdomen, and sometimes into the back and to the shoulder, particuarly on the right side.  It may be associated with feeling sick or vomiting.  The pain is often very intense for one or two hours and gradually subsides.  If the stones get stuck, the pain may not go away, but persist, and you may become feverish if you develop an infection.

To diagnose gallstones, you will need to have an ultrasound scan of the abdomen, which can be organised by your GP.

What is the treatment for gallstones?

The treatment for gallstones is aimed at first treating the acute problem ie the pain or infection and secondly removing the gallstones and the gallbladder permanently.  If you are in pain or have an infected gallbladder then the treatment is usually pain relief with antibiotics and perhaps a short period of fasting to allow the gallbladder to return to normal.  An operation to remove the gallbladder with its gallstones is then planned.  This operation is called a cholecystectomy and nowadays should be performed laparoscopically (keyhole surgery).  The operation may sometimes need to be done as an emergency if the gallbladder is very infected or inflammed or if non-operative treatment does not settle the symptoms down.

For further information about the operation, go to Laparoscopic Cholecystectomy