Gallstones are stones which are made in the gall bladder.
The gall bladder is a muscular bag sitting below the liver
which takes the bile coming out of the liver
along the bile tubes or ducts
and between meals, the bile flows into the gall bladder
which gradually expands and the bile's concentrated there.
Bits of cells that come off the surface lining of the gall bladder
act as the focus for crystals to form.
These crystals of cholesterol, in general, can gradually expand.
The gall bladder contracts when you have a meal,
especially a meal that contains fat.
Very often these crystals are expelled, nothing happens.
But if they're not expelled, they begin to grow like a pearl in an oyster,
and gradually expand.
Then, on one occasion, if the gall bladder contracts
to help push the bile out to digest the food,
one may catch in the neck of the gall bladder and cause pain.
The pressure goes up because of the contractions taking place,
but the bile can't leave.
Generally, if I had the idea that I might have gallstones,
what I would want would be to see my doctor
and for him to arrange two things.
One would be an ultrasound scan of the gall bladder.
Very often people with pain in that area don't have gallstones.
That's a very accurate way of ruling them out.
The second thing is I'd want him to measure my liver blood tests.
If there was a stone getting into the bile duct,
it might have upset my liver blood tests
and it would indicate a different form of treatment.
If he found gallstones and thought the pain was compatible with that,
I would expect him to refer me to either a gastroenterologist
or a gastrointestinal surgeon for treatment.
The most common site of pain is in the right upper quadrant,
where the liver is, under the lungs, under the ribs on the right side,
although the pain may be in the back,
sometimes in the chest and even mistaken for heart attacks,
and can go up into the right shoulder.
The attacks of pain are usually quite severe,
often with vomiting, and may go on for several hours.
They tend to build up over a period of a few minutes to a crescendo
and stay at that sort of level for several minutes
and then continue for two to four hours.
Often people are taken to hospital because of the severity of pain
and sometimes given injections of morphine-like drugs to clear it.
So it's not generally a mild indigestion type of pain.
If you've got gallstones in the gall bladder
and you're getting symptoms such as I described from them,
then the general advice is for removal of the gallstones,
and the gall bladder that contains them, surgically.
There are certain groups of people who are more likely to get gallstones.
People who have had the last part of their small intestine removed
or who've got a disease such as Crohn's disease
affecting the small intestine are more likely to get gallstones.
People who have cirrhosis or other liver diseases
are more likely to get gallstones.
But the vast majority of gallstones are not related to this
and they're just occurring in ordinary individuals
as a common problem.
Although the main problem with gallstones
is pain in the gall bladder, biliary colic,
sometimes if a gallstone passes into the bile tube,
it can cause other complications
such as obstructive jaundice or pancreatitis,
both of which have different features and complications
but are both usually painful conditions.
If gallstones pass from the gall bladder into the bile duct,
they can cause a couple of other conditions
which are generally medical emergencies.
They are either obstructive jaundice or acute pancreatitis.
Both of these are very painful
and usually take people to A&E departments in hospitals.
The treatment is different from the treatment of stones in the gall bladder
and it's important therefore that the diagnosis is made.