Gallstones: description, complaints and treatment

Gallstones are in the gallbladder. Bile is stored here. Bile helps you digest (fatty) food. Gallstones can get in the way of bile getting to the intestines. This causes pain. What is a gallbladder, gallstones and what is done about them?

What is a gallbladder?

The gallbladder is a small pear-shaped hollow organ. It is located in the upper right side of the abdomen. Bile is produced in the liver, which is used in the intestine for digestion, especially fats. The gallbladder is, as it were, a storage place for excess bile. When food needs to be digested again later, especially fatty food, the gallbladder squeezes like a kind of balloon to squeeze the stored bile into the intestine. So the gallbladder is actually nothing more than a storage place for bile, which helps with the digestion of food.

Gallstones

Gallstones are clumps of bile that can form a kind of stone or marble. This can come in all shapes and sizes. The stones are tried to pass through the bile ducts by squeezing the gallbladder. This can cause severe pain because it does not fit. The cause of gallstones is not entirely clear. A possible cause is too much cholesterol in the bile, which causes gallstones. The functioning of the gallbladder can also have an influence, for example if the gallbladder squeezes itself empty and some bile remains, which thickens and clots because it never comes out.

Risk group

Just as for many diseases, risk groups for gallstones have also been indicated:

  • Women
  • Overweight people
  • Elderly

However, it does not necessarily mean that a 20-year-old man with normal body weight cannot get gallstones. The point is that certain aspects increase the risk, but that the opposite of the aspects does not rule out getting gallstones!

Gallstones: the symptoms

Some gallstones do not cause any symptoms. These are called silent stones. Nothing further needs to be done about this, you probably don’t even notice that you have them or you find out by chance through a scan or ultrasound. Only if there is pain involved, something is done about it. Complaints arise when the gallbladder squeezes itself empty and a gallstone becomes stuck in the bile ducts. This impedes the flow of bile fluid. What pain complaints can you experience?

If the gallstone is stuck in the bile ducts:

  • If a gallstone is stuck, the gallstone will still try to squeeze out by squeezing vigorously. This can cause pain in the right upper abdomen. This can last for about one to four hours. This is called a colic attack.
  • Nausea
  • Vomit
  • Jaundice

If the gallstone does not dislodge:

  • An inflammation of the bile ducts.
  • An inflammation of the gallbladder.
  • Acute pancreatitis (a serious complication that can arise when a gallstone becomes lodged at the papilla of Vater. This is the duct of the pancreatic duct).

Generally:

  • Discoloured stools (bile provides the brown color in stools and since gallstones block the bile, the stool becomes discolored).
  • Sometimes the pain from the upper right abdomen also radiates downwards or to the back.
  • Often (more severe) pain after eating fatty things or other certain foods (varies per person).

Therapy

There are a number of treatments. These depend on the severity and type of the complaints.

Diet and medication

Firstly, a diet can be chosen if there are mild gallstone complaints. Sometimes medication can also be administered in the event of an acute attack of colic to relieve pain and also immediately relieve the spasm of the gallbladder and bile duct.

ERCP

If the gallstone is located between the main bile duct between the liver and intestine, it can often be removed by endoscopy. The gallstone is then removed via the esophagus and stomach with a kind of grasper. This method is also called ERCP.

Operation: keyhole surgery

The final option is surgery to remove the gallstones and gallbladder. Simply removing the stones does not help, because after removal of the gallstones, new ones are formed (which is why crushing and dissolving stones through medication is no longer done much). Surgery can be performed by keyhole surgery (laparoscopic gallbladder removal). Only small incisions are made (just below the navel and on either side of the gallbladder). This ensures a faster recovery time.

Operation: conventional gallbladder removal

If this is not possible or causes problems during removal, for example because the gallbladder is strongly fused to the tissue around it, a conventional gallbladder removal is done. The surgeon then makes an incision in the abdominal wall (obliquely under the right ribs) of approximately 10 to 15 centimeters. A wound drain is placed to allow excess fluid to be removed.

Aftercare

For keyhole surgery, a short hospital stay or day treatment is often sufficient. After-pain is often well tolerated with regular painkillers. Drinking and eating will also be possible again quite soon. Conventional gallbladder surgery often requires a longer hospital stay (approximately 3 to 7 days) due to the larger wound. This often causes more pain, especially when moving, breathing deeply and coughing. The intestines often work less temporarily, which makes drinking and eating even more difficult. The wound drain also needs to be removed. This happens after a few days.

At home

The wound often heals quickly, especially during keyhole surgery, and then you can basically eat everything (read: fatty food) again. However, this mainly depends on how quickly you recover. Complaints may arise regarding the stool: diarrhea or loose stools just after the operation are normal. This is because the body has to get used to the new situation.