Digestive health centre

Gallstones

Gallstones form in the gall bladder, a small organ located under the liver. The gall bladder helps the digestive process by storing bile and secreting it into the small intestine when food enters. Bile is a fluid produced by the liver and is made up of several substances, including cholesterol, bilirubin and bile salts.

What are gallstones?

Gallstones are pieces of solid material that form in the gall bladder. These stones develop because cholesterol and pigments in bile sometimes form hard particles.

The two main types of gallstones are:

Mixed stones (approximately 80% of gallstone cases) are often called cholesterol stones as their main constituent is cholesterol, with bile pigments and calcium salts. These are usually yellow-green in colour.

Pigment stones: These stones are smaller and darker and are predominantly made up of bilirubin.

What causes gallstones?

Several factors may come together to create gallstones, including:

• Genetics (others in your family have had gallstones)
• Body weight
• Decreased motility (movement) of the gallbladder
• Diet

Gallstones can form when there is an imbalance in the substances that make up bile. For instance, mixed stones may develop as a result of too much cholesterol in the bile. Another cause may be the inability of the gall bladder to empty properly.

Pigment stones are more common in people with certain medical conditions, such as cirrhosis (a liver disease in which scar tissue replaces healthy liver tissue) or blood diseases such as sickle cellanaemia.

What are the risk factors for gallstones?

Risk factors for getting gallstones include:

• Obesity. This is one of the biggest risk factors. Obesity can cause a rise in cholesterol, and can also keep the gall bladder from emptying completely.
• Oestrogen. Women who are pregnant or who take oral contraceptive pills or hormone replacement therapy have higher levels of oestrogen. This can cause a rise in cholesterol, as well as a reduction in gall bladder motility.
• Gender and age. Gallstones are more common among women and among older people.
• Cholesterol medication. Some cholesterol-lowering medications increase the amount of cholesterol in bile, which may increase the chances of developing cholesterol stones.
• Diabetes. People with diabetes tend to have higher levels of triglycerides (a type of blood fat), which is a risk factor for gallstones.
• Rapid weight loss. If a person loses weight too quickly, his or her liver secretes extra cholesterol, which may lead to gallstones. Also, fasting may cause the gall bladder to contract less.

What are the symptoms of gallstones?

Less than 20% of people with gallstones have symptoms because the stones usually stay in the gallbladder and do not cause any problems.

A person usually learns he or she has gallstones while being examined for another illness.

When symptoms do appear, they include the following:

• Pain in the upper abdomen and upper back. The pain may last a long time (several hours).
• Nausea
• Vomiting
• Other gastrointestinal problems, including bloating, indigestion, and gas