Gallstones Explained
By Dr. Lee Ser Yee
Worried about getting gallstones? And what actually are gallstones?

Dr. Lee Ser Yee, Senior Consultant Hepatopancreatobiliary Surgeon at Surgical Associates based in Mount Elizabeth Hospital explains what gallstones are, who is at risk of gallbladder disease and how to prevent it.

What is the Gallbladder?

The gallbladder is a small organ in your upper right abdomen that lies beneath the liver and is connected to the bile duct. The gallbladder stores a yellowish liquid produced by the liver called bile that helps your body digest oily and fatty food.

Before a meal, the gallbladder may be filled with bile and is about the size of a small pear. During and after meals, the gallbladder squeezes the stored bile into the small intestine through a tube called the common bile duct.

In another words, the gallbladder functions as a storage organ for bile and is thus not essential for life, as most of the bile produced by the liver will still flow into the intestines without the gallbladder.

Anatomy of Biliary Tree

What are Gallstones?

Small pebble-like deposits called gallstones can form in the gallbladder. Normally, bile acids and proteins prevent the formation of stones; however, when there is an imbalance in the bile constituents, gallstones can form.

Gallstone symptoms include intense or episodic abdominal pain, back pain, pain on the right shoulder or between the shoulder blades, bloatedness, discomfort or indigestion, nausea and vomiting.

Gallstones are the most common result of gallbladder disease and one of the most common causes of upper abdominal pain. The treatment of gallbladder disease will depend on the situation – whether it is asymptomatic, symptomatic or complicated. Most patients experience no symptoms even if they have gallstones (asymptomatic). For this group, gallstones are usually diagnosed during health screenings or tests for other health conditions e.g., blood tests or ultrasound scan. In some cases, the first realisation of having gallstones is a gallstone-related complication such as acute cholecystitis, jaundice or pancreatitis.

A scan is necessary to confirm gallstones. Most commonly, an ultrasound is performed. Stones and gallstone related complications may also be evaluated on CT scan or MRI of the abdomen. In addition, blood tests may be done to rule out any obstruction of the bile ducts and infection.

When a gallstone is confirmed, doctors will advise the patient on the most suitable gallstone treatment. In most cases, if necessary, the treatment for gallstones is surgery to remove the gallbladder and the stones within.(Cholecystectomy)

Who are at Risk of Gallstones?

Gallstones causes differ from one person to another. While it is not known why such imbalances in the bile components occur, some people are more prone to develop gallstones. Some of the reasons are:

  • Patients over 40 of age as compared to younger patients.
  • Women are twice as likely as men to develop gallstones due to higher oestrogen levels. Excess oestrogen after pregnancy, hormone replacement therapy and oral contraceptive pills tend to increase cholesterol levels in bile.
  • Gallstones tend to run in families, suggesting a genetic link. The underlying mechanism is still unclear and likely due to a variety of factors.
  • Obesity is a major risk factor for gallstones. Several factors such as a high-fat diet, diabetes, a sedentary lifestyle, and other co-existing medical conditions all play a role.
  • A diet high in cholesterol and fat but low in fibre increases the risk of gallstone formation.
  • Diabetic patients have higher fatty acids, which increases their risk of gallstones. They also tend to experience more severe infections and sometimes may have an unusual presentation like lack of fever or pain (“silent” infection).
  • While these drugs lower blood cholesterol, they increase the amount of cholesterol secreted into the bile, hence increasing gallstone formation.
  • Patients who have certain blood disorders, liver cirrhosis or Crohn’s Disease; as well as patients who are on prolonged intravenous feeding or certain medications might also be at a higher risk for developing gallstones and gallbladder disease.

How Can One Prevent Gallstones & Gallbladder Disease?

There is no proven way to prevent gallstones, but research suggests some possibilities. By modifying your lifestyle, you can potentially lower your risk of developing gallstones and gallbladder disease. Some of these lifestyle modifications include:

Fats, especially saturated fats found in meats, butter and animal products, are associated with gallstone attacks.

Some studies have found that a cup of coffee a day can lower the risk of gallstones as caffeine in coffee can stimulate gallbladder contractions and lower the cholesterol. This may be related with many other lifestyle confounders and the current evidence and understanding is not conclusive.

Some studies have found that while limited and moderate alcohol intake reduces the risk of gallstones, but heavy drinking may do the opposite. This may be related with many other lifestyle confounders and the current evidence and understanding is not conclusive.

It is important to highlight that pregnant women and those with liver disease should avoid alcohol.

Regular exercise, active lifestyle and a healthy balanced diet will minimise many of the risk factors of gallstones.

To know more about the treatment of gallstones and gallbladder disease, please read - Treatment of Gallstones

“Gallstones is a common condition. If your gallstones cause pain and discomfort or have caused health problems, seek medical advice early. Surgery in patients with problematic gallstones can help prevent future problems and potentially life-threatening complications such as inflammation of the pancreas (pancreatitis) or infection of the bile ducts (cholangitis)”