What are gallstones and gallstone disease

Gallstone disease (cholelithiasis) is the presence of stones within the gallbladder. The gallbladder is a small, pear-shaped organ located beneath the right side of the liver. It stores and concentrates bile and contracts after the consumption of fatty meals, releasing bile into the intestine. Bile is a greenish-yellow fluid produced by the liver that helps with the digestion and absorption of fats. Changes in the composition of bile, due to various factors, can lead to the formation of gallstones inside the gallbladder. Gallstone disease is a common condition affecting up to 10% of the population. In the majority of cases it remains asymptomatic, with only approximately 20% of patients with gallstones developing symptoms.

Symptoms

The typical symptom (biliary colic) is pain in the upper right or/and central abdomen, which may radiate to the right shoulder or back. The pain often occurs after a fatty or heavy meal and may be accompanied by nausea and/or vomiting, bloating or indigestion. It can last from a few minutes to several hours.

Possible complications

• Acute Cholecystitis: Inflammation of the gallbladder, usually associated with persistent pain and tenderness in the upper right abdomen and possibly fever.

• Choledocholithiasis: Obstruction of the common bile duct (the duct connecting the gallbladder to the intestine) by gallstones. It may cause right upper abdominal pain, jaundice (yellowing of the skin and eyes), and dark-coloured urine.

• Cholangitis: Inflammation of the bile ducts, presenting with abdominal pain and high fever.

• Pancreatitis: A serious inflammation of the pancreas, causing severe upper abdominal pain, which often radiates to the back.

Diagnosis

• Medical history and clinical examination

• Blood tests to assess for possible complications

• Abdominal ultrasound: the first-line imaging examination

• If complications are suspected, further investigations may be required, such as: Computed tomography (CT scan), Endoscopic ultrasound (EUS), Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Retrograde Cholangiopancreatography (ERCP)

Treatment

The definitive treatment for gallstone disease is the surgical removal of the gallbladder (cholecystectomy). However, the diagnosis of gallstones does not necessarily mean that surgery is always required. Surgical treatment is recommended when gallstones cause symptoms or when complications develop. In patients without symptoms, surgery is usually not necessary, unless there are specific high-risk factors, such as: large gallstones (>3 cm), a “porcelain” gallbladder, Gallbladder polyps larger than 1 cm. Cholecystectomy is performed almost always using a laparoscopic approach (through 3–4 small incisions), resulting in minimal postoperative pain and a faster return to normal daily activities.