What causes gallstones?

What causes gallstones is unclear but genetic and metabolic factors are likely important contributors¹.

Types of Gallstones

Types of gallstones that can form in the gallbladder include:²

• Cholesterol gallstones. Cholesteral gallstones often appears yellow and are spherical (round). They are mostly composed of unresolved cholesteral
• Pigment gallstones. Pigment gallstones are mostly dark brown or black. They often form from products of blood breakdown
• Mixed gallstones. These are the most common form, usually composed of cholesterol and pigment together

Symptoms

Not every gallstone needs removal, with many remaining symptomatic (with symptoms).  However blockages that can be accompanied by infection are the most common ways for gallstones to cause problems. These signs could include: ³

• Sudden and intense pain in the upper abdomen either just below the breastbone or underneath the ribs on the right side.
• This can also seem to spread to the shoulder or the shoulder blade.
• There can be associate nausea and vomiting and sometimes the pain can be associated with a fever, sweats, chills or yellowness around the eyes and the skin.

Gallstone pain can last minutes to several hours. After each episode, the pain can ease to an ache or go completely.

When to see your GP or family doctor?

If you are worried that you have gallstones, take our risk assessment questionnaire and make an appointment with your GP or family doctor.

Ask your GP or family doctor to refer you to Auckland Gallbladder Surgery if your symptoms indicate gallstones.

Seek immediate advice if you develop symptoms of a serious gallstone complication, such as:

• Abdominal pain so intense that you canʼt sit still or find a comfortable position
• Yellowing of your skin and the whites of your eyes (jaundice)
• High fever with chills.

Diagnosis

If you are experiencing symptoms of gallstones and have been referred to our clinic, we will contact you to arrange the appropriate investigations.
These may include:

• Abdominal ultrasound. This is the most commonly used test to look for gallstones. A handheld device is moved across your upper abdomen and uses sound waves to image the gallbladder, liver and associated structures
• Blood tests. Blood tests are done to check that the gallstones are not causing problems beyond the gallbladder
• Further specialised tests may be indicated and will be discussed if required.

Our experienced Auckland Gallbladder Surgery team will determine if treatment for gallstones is necessary based on your symptoms and the results of diagnostic testing. 

Treatment

What does the gallbladder do and what happens when it’s removed?

The gallbladder stores bile made by the liver and when needed, passes the bile down those same tubes to your intestine.  Bile acts like a detergent to help you digest fatty foods.

After a gallbladder is removed, bile is still made in the liver as before but now passes directly to the intestine rather than being stored in the gallbladder.  Most people don’t experience any change to the absorption of fatty foods after gallbladder removal. However, one person in five might find that fatty or oily foods pass through them more quickly which can cause mild diarrhoea.  This is nearly always temporary and medications can assist if this occurs.

Complications of gallstones

• Gallstone pain (also known as biliary colic).  This is upper abdominal pain that occurs when gallstones block the gallbladder from emptying.  This usually happens after eating fatty/oily food and tends to last for minutes up to 2 hours
• Inflammation of the gallbladder (also known as cholecystitis). If the gallstones blocking the gallbladder do not shift, the gallbladder can become inflamed. This causes longer lasting pain with added fever and symptoms of illness
• Blockage of the common bile duct. Gallstones can escape the gallbladder and block the ducts that take bile to the small intestine. This can cause pain, jaundice (yellowness of the eyes and skin) and bile duct infection
• Blockage of the pancreatic duct. The pancreatic duct is a tube that connects the pancreas to the common bile duct just as it enters the duodenum (the first part of the small intestine). Gallstones that escape the gallbladder can also block this pancreatic duct, which can cause pancreatitis (inflammation of the pancreas). Symptoms are severe, constant abdominal pain and usually require hospitalisation
• Gallbladder cancer. People with a long history of gallstones have an increased risk of gallbladder cancer. As gallbladder cancer is very rare, the likelihood of gallbladder cancer is still very small.

Prevention

You can reduce your risk of developing gallstones by adopting a healthy lifestyle with a balanced diet:³

• Don’t skip meals. Try to stick to your usual mealtimes each day. Skipping meals or fasting can increase the risk of gallstones
• Lose weight slowly. If you need to lose weight, go slow. Rapid weight loss can increase the risk of gallstones. Aim to lose 0.5 to 1 kilogram
  (1 to 2 pounds) a week
• Eat more high-fibre foods. Include more fibre-rich foods in your diet, such as fruits, vegetables and whole grains
• Maintain a healthy weight. Obesity and being overweight increase the risk of gallstones. Work to achieve a healthy weight by reducing the number of calories you eat and increasing the amount of physical activity you get. Once you achieve a healthy weight, work to maintain that weight by continuing your healthy diet and continuing to exercise.

If you are worried that you have gallstones, take our risk assessment questionnaire and make an appointment with your GP or family doctor.

Ask your GP or family doctor to refer you to Auckland Gallbladder Surgery if your symptoms indicate gallstones.

References

1. Cleveland Clinic. Gallstones, 2022. Gallstones (Cholelithiasis): Symptoms, Causes & Treatment (clevelandclinic.org). Accessed September 2022
2. Surgeon LK.  Gallbladder Stones (surgeon.lk). Accessed January 2023
3. Mayo Clinic. Gallstones. 2021. Gallstones – Symptoms and causes – Mayo Clinic. Accessed August 2022.