About the gallbladder and bile. The liver makes bile, which then trickles down channels of tiny tubes called bile ducts. These tiny tubes join together and form the main bile duct. Bile constantly flows through the bile ducts, into the main bile duct and then into the first part of the gut, which is the duodenum. The gallbladder is a sac lying under the liver and joins the main bile duct through the 'cystic duct'. It is filled with bile and acts like a 'reservoir' for bile. When we eat, the gallbladder contracts (or squeezes), pumping bile into the duct systems and ultimately into the duodenum and helps with digestion of fat.

Gallstones - What are they? Gallstones are solidified bile in the gallbladder. Bile is normally fluid, gallstones occur when it forms stones. There are many types of gallstones, some people get multiple small stone while others get one large stone, some have a mix of both. Gallstones commonly contain bits of cholesterol-like stuff that has hardened and occasionally are formed by bile pigments or calcium deposits.

How common are they? According to an epidemiology study, gallstones are very common, be it symptomatic or asymptomatic. Approximately one out of every three women and one out of every seven men, form gallstones at some stage in their lives. Other risk factors associated with gallstone formation include increasing age, pregnancy, obesity and certain drugs. If you are a vegetarian and if you consume a moderate amount of alcohol, the chances of you getting gallstones are less. Other rarer causes include a special type of anemia called hemolytic anemia and certain blood-borne infections.

What are the symptoms of gallstones? Usually none. Most people form gallstones in their gallbladder without realizing their presence. Most of the time, gallstones sit in the gallbladder without causing any symptoms. Given this reason, gallstones are usually picked up incidentally when people go for scans or x-rays of their abdomen. These tests may be done for other reasons. If gallstones are found they do not mean that treatment is needed, in fact most people who die from other diseases, do not know that they have gallstones.

Symptomatic gallstones only happen in about three out of 10 people who have them. These symptoms or problems include:

Biliary colic. Colic means intermittent, wavelike pain. Biliary pertains to the gallbladder. So biliary colic basically means pain that originates in the gallbladder. It is usually felt in the upper abdomen on the right side, just under the rib (where the gallbladder sits!). Usually described as sharp in nature and can be very distressing. A stone that gets stuck in the cystic duct usually causes it. The pain usually eases off when the stone falls back into the gallbladder. People with biliary colic commonly describe of having the pain after consuming a hearty, fatty meal. This is because fat in the duodenum stimulates the gallbladder to contract, thus causing the stone to jam at the cystic duct. The pain can last for several minutes to an hour or so.

Cholecystitis or inflammation of the gallbladder. This is usually caused by infection of the gallbladder. Symptoms include fever, constant pain in the upper abdomen, nausea, vomiting and being generally unwell. You will usually be admitted to the hospital and have your gallbladder removed urgently if you develop cholecystitis.

Jaundice. A term used to describe yellow discoloration of the skin and the sclera (white part of the eye). This is uncommon. This occurs when the stones come out of the gallbladder and get stuck in the main bile duct. Bile cannot flow forward and thus moves in the opposite direction and ultimately seeps into the bloodstream. A procedure called ERCP is usually needed to get the stones out of the way.

Other problems include pancreatitis (inflammation of the gallbladder) and cholangitis (inflammation of the main bile duct).

What are the treatments? In most cases, no treatment is necessary. It is often better to leave gallstones alone if they cause little symptoms.

Surgery. Keyhole surgery is the commonest way to remove a gallbladder. It is commonly referred to as laparoscopic cholecystectomy. Several small cuts are made in the abdomen with few remaining scars afterwards.

Medicine. Medicines are usually used to control pain and to fight infections in gallstone diseases. Medicine cannot cure gallstones, thus surgery is the preferred way to go.