Gallstone & Complex Gallbladder surgery



A gallstone, is a solid lump formed by cholesterol or bile pigment and can vary in size from a small grain to a golf ball.

Types of gallstones and causes

  • Cholesterol Stones

  • Pigment Stones

  • Mixed Stones – The most common type. They are comprised of cholesterol and salts.

Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Scientists believe cholesterol stones form when bile contains too much cholesterol with not enough bile salts, or when the gallbladder does not empty as It would normally.

Pigment stones are small, dark stones made of bilirubin. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anaemia in which too much bilirubin is formed.

Other causes are related to excess excretion of cholesterol by liver through bile. They include the following

  • Gender: Women between 20 and 60 years of age are twice as likely to develop gallstones as men.

  • Obesity: Obesity is a major risk factor for gallstones, especially in women.

  • Oestrogen: Excess oestrogen from pregnancy, hormone replacement therapy, or birth control pills

  • Cholesterol-lowering drugs.

  • Diabetes: People with diabetes generally have high levels of fatty acids called triglycerides.

  • Rapid weight loss: As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones.


Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called “silent stones.” Gallstone symptoms can mimic

heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis.

Symptoms may vary and often follow fatty meals, and they may occur during the night.

  • Abdominal Bloating

  • Recurring intolerance of fatty foods

  • Steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours

  • Pain in the back between the shoulder blades

  • Pain under the right shoulder

  • Nausea or vomiting

  • Indigestion & belching


Ultrasound is the most sensitive and specific test for gallstones. It can also look at any presence of inflammation around the gallbladder or within.

Other diagnostic tests may include

  • Computed tomography (CT) scan may show the gallstones or complications.

  • Endoscopic retrograde cholangiopancreatography (ERCP). The patient swallows an endoscope–a long, flexible, lighted tube connected to a computer and TV monitor. The doctor guides the endoscope through the stomach and into the small intestine. The doctor then injects a special dye that temporarily stains the ducts in the biliary system. ERCP is used to locate and remove stones in the ducts.

  • Blood tests. Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice.

Complications of gallstone disease

Gallstones are washed out of the gallbladder and try and exit the bile duct but get stuck, this blocks the duct. Bile can no longer leave the liver and enter the intestine, which means that all the waste products and pigments it contains start to build up.

The earliest sign that the bile duct has become blocked is a severe attack of biliary colic. The gallstone pain in the upper part of the abdomen can continue, or come and go several times a day. Jaundice causes the skin and eyes to become yellow and leads to nausea, vomiting, tiredness and a loss of appetite.

The pain of biliary colic

The typical pain from gallstones is known as “biliary colic”. It manifests as pain under right rib which may radiate through to the back or the right shoulder. It is thought to be due to a gallstone becoming impacted in the mouth of the gall bladder and contraction of the gallbladder muscle against a point of obstruction. It may be worse or triggered by eating a rich or fatty meal.

Bile duct inflammation

When the bile duct is blocked by a gallstone, this causes the walls of the bile duct to become inflamed. The bile can also become infected, causing further swelling and damage to the bile duct. Severe bile duct inflammation is known as acute cholangitis which can be life threatening.

Gallbladder inflammation

Blockage of the gallbladder opening can lead to general inflammation in the gallbladder which is known as cholecystitis.

If the gallbladder is not removed, repeated attacks of inflammation in the gallbladder walls can cause scar tissue to form, and symptoms get worse. This is chronic cholecystitis, which is a risk factor for gallbladder cancer .

Acute pancreatitis

The gallbladder and pancreas are close to each other in the body. The bile duct and pancreatic duct share an opening into the intestine, so disease in the gallbladder can affect the pancreas.

If the bile duct becomes blocked by a small gallstone, the bile duct can become blocked and this can block the pancreatic duct too. This causes inflammation in the pancreas, which causes a serious illness known as acute pancreatitis.

Bowel obstruction

It happens quite rarely, but larger stones can sometimes manage to pass through the bile duct and enter the small intestine. Sometimes these can block the ileum, causing an obstruction of the small bowel. This produces a condition known as a gallstone ileus and causes severe vomiting. It needs emergency surgery to remove the obstruction.

Gallbladder cancer

Chronic complicated gallstone disease can increase the risk of both bile duct cancer and gallbladder cancer. This is rare , but untreated gallstones is one of the main risk factors.

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