Classic list

---

What is the gallbladder and what does it do?

The gallbladder is a small, pear-shaped sac located under the liver. It stores and concentrates bile, which is produced in the liver. When required for digestion of food, bile is released through the bile duct into the small intestine. Bile helps to break down fats and aids the digestion of fat soluble vitamins.

---

---

What causes gallstones?

It’s not clear why gallstones form, but it is thought that gallstones may result from:

• Too much cholesterol in bile – which may crystallise to form gallstones.
• Excess bilirubin – a chemical that is produced when your body breaks down red blood cells – may contribute to gallstone formation. This may occur due to certain blood disorders, infections or liver disease.
• Incomplete emptying of the gallbladder – may cause bile to become very concentrated, contributing to the formation of gallstones.

---

What factors make getting gallstones more likely?

The following factors appear to increase the risk of gallstones:

• Women are twice as likely to develop gallstones than men
• Gallstones are more common after 40 years of age
• Obesity
• Sedentary or physically inactive lifestyle
• Diet high in fat and cholesterol but low in fibre
• Regularly skipping meals or fasting
• Family members who have had gallstones
• Diabetes – due to high levels of fatty acids, called triglycerides, which increase the risk for gallstones
• Liver disease
• Certain blood disorders, such as sickle cell anemia or leukaemia
• Rapid weight loss – may lead to extra cholesterol in bile as fat is metabolised
• Excess oestrogen due to pregnancy, hormone replacement therapy, or contraceptive pills appears to increase cholesterol levels in bile and decrease gallbladder movement, both of which can lead to gallstones
• Drugs which lower blood cholesterol, as these can increase the amount of cholesterol secreted in bile.

---

Symptoms may include:

• Sudden and rapidly intensifying pain in the centre or upper right portion of the abdomen
• Back pain between your shoulder blades
• Pain in your right shoulder
• Nausea or vomiting
• Abdominal bloating
• Indigestion

Pain may last several minutes to a few hours. Symptoms vary between individuals and similar symptoms may occur with other medical problems. Therefore it is important to consult your doctor if you experience any of these symptoms. If gallstones cause serious complications, you may experience the following signs and symptoms which require immediate medical attention:

• Extreme abdominal pain
• Yellowing of the skin and the whites of your eyes (jaundice)
• High fever with chills
• Clay-coloured stools.

---

What problems can gallstones cause?

• Inflammation of the gallbladder (cholecystitis) can occur when a gallstone becomes lodged in the neck of the gallbladder. Cholecystitis can cause severe pain and fever.
• Blockage of the bile ducts through which bile flows from your gallbladder or liver to your small intestine. This is called choledocholithiasis and can cause severe pain, jaundice and bile duct infection.
• Pancreatitis (inflammation of the pancreas) can occur if a gallstone blocks the pancreatic duct. Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.
• Increased risk of gallbladder cancer. But as gallbladder cancer is very rare, the likelihood of gallbladder cancer is still very small.

---

How are gallstones diagnosed?

Your doctor will ask questions about your symptoms and medical history and carry out a physical examination. The following tests and procedures may be used to diagnose gallstones and related complications:

• Abdominal ultrasound
• Endoscopic ultrasound (EUS) – can help identify smaller stones that may be missed on an abdominal ultrasound
• Cholecystography – a type of X-ray using a contrast material to show the flow of fluid through the intestines into the gallbladder
• Computerized tomography (CT) scan or magnetic resonance imaging (MRI)
• Magnetic resonance cholangiopancreatography (MRCP)
• Endoscopic retrograde cholangiopancreatography (ERCP)  involves inserting an endoscope (small flexible tube with a camera) through the mouth and the stomach to reach the opening of the bile duct into the intestine. A contrast dye is used to see the bile ducts more clearly on X-ray. Gallstones discovered using ERCP can be removed during the procedure.
• Blood tests to look for signs of infection, jaundice, pancreatitis or other complications .

---

What is the treatment for gallstones?

Gallstones that don’t cause any signs and symptoms don’t usually need treatment. Where gallstones are causing problems, treatment options may include:

• Surgery to remove the gallbladder (cholecystectomy) can often be done using a minimally invasive (keyhole surgery) technique. Once the gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder. The gallbladder is not essential for digestion or health, although diarrhoea may be a side effect of its removal.
• Endoscopic retrograde cholangiopancreatography (ERCP) to remove gallstones in the bile duct using an endoscope, avoiding the need for surgery. Alternatively, small drainage tubes (stents) may be inserted around the stones to allow the bile to flow freely again.
• Oral dissolution therapy involves taking a medicine made from bile acid to dissolve the stones. This treatment is now rarely used as it may take months or years to dissolve gallstones, and they can recur if treatment is stopped.
• Extracorporeal shockwave lithotripsy (ESWL) uses shock waves to break stones up into tiny pieces that can pass through the bile ducts without causing blockages.

---

1. Gallstones are more common than you think

Gallstones are very common. Research has shown that around one in six men and one in three women will have gallstones at some point in their life. Gallstones appear to be becoming more common and affecting younger people, possibly due to changes in our diets.

2. You may have gallstones without realising it

Many people with small gallstones have no symptoms, and so may be unaware that they have them unless they show up on a diagnostic test done for another reason. Gallstones can start to cause problems when they get lodged in the ducts which carry bile fluid needed for digestion, causing a blockage.

3. Cholesterol is the most common reason for gallstones

It’s not clear why gallstones form, but the most common type of gallstones develop when high cholesterol levels in bile fluid cause the cholesterol to crystallise to form gallstones. A less common type of gallstones, more common in people with liver disease or certain blood disorders and infections, form when the bile has too much bilirubin.

4. Women are more likely to get gallstones than men

Gallstones are found twice as often in women. Excess oestrogen due to pregnancy, hormone replacement therapy, or contraceptive pills appears to increase cholesterol levels in bile and decrease gallbladder movement, both of which can lead to gallstones. Gallstones are also more common after 40 years of age. Obesity and eating a diet high in fat and cholesterol but low in fibre can also increase the risk of gallstones.

5. Gallstones don’t always need treatment

If gallstones are found coincidentally and not causing any problems, they usually don’t need treatment, but can be monitored. Where gallstones are causing repeated or severe problems, they will need to be removed.

6. Left untreated, gallstones can cause more serious complications

An ‘attack’ due to a gallstone blocking a bile duct occurs most often after a fatty meal, or at night and may last from several minutes to a few hours. Symptoms include sudden abdominal pain, increasing in intensity – which may radiate to the back or right shoulder, and nausea or vomiting. An gallbladder ‘attack’ may mimic a heart attack and emergency medical assessment is required. If left untreated gallstones can also cause serious complications such as severe infections, fever, jaundice, and an increased risk of gallbladder cancer.

7. Your gallbladder is not essential for health

Surgery to remove the gallbladder (cholecystectomy) is a commonly recommended treatment, as this prevents gallstones recurring. Your gallbladder is not essential for digestion or health.  Once the gallbladder is removed, bile flows directly from the liver into the small intestine, rather than being stored in the gallbladder. Some people who have had their gallbladder removed may experience mild problems with bloating or pass softer stools more frequently. Remember: Symptoms caused by gallstones vary between individuals and similar symptoms may occur with other medical problems. Always consult your doctor if you have symptoms or concerns. Dr. Mahmoud Tabbal specializes in all conditions that are related to the liver, biliary system and pancreas as well as oncology and gastrointestinal surgery. Using the latest techniques and state-of-the art-services, Dr. Tabbal provides his patients with high quality care.

How will I know if I have gallstones?

Many people with small gallstones have no symptoms, and so may be unaware that they have them unless they show up on a diagnostic test done for another reason.

Gallstones can start to cause problems when they get lodged in the ducts which carry bile fluid needed for digestion, causing a blockage.

Gallstone ‘attacks’ may last from several minutes to a few hours, and tend to recur. They often happen a couple of hours after eating, or at night.

---

What are the signs and symptoms of a gallstone ‘attack’?

• • Sudden and rapidly intensifying pain in the centre or upper right portion of the abdomen – which may radiate to the back or right shoulder

• • Pain often does not improve with over-the-counter painkillers

• • Nausea or vomiting

• • Abdominal bloating

• • Indigestion

Symptoms vary between individuals. Other medical conditions may cause similar symptoms. Therefore it is important to consult your doctor for a medical assessment.

A gallbladder ‘attack’ may mimic a heart attack and emergency medical attention is required.

---

What are the signs of gallstone complications?

If left untreated gallstones can also cause serious complications such as severe infections, fever, jaundice, and an increased risk of gallbladder cancer. Look out for following signs which indicate that immediate medical attention is required:

• • Yellowing of the skin and the whites of your eyes (jaundice)

• • High fever with chills

• • Clay-coloured stools

Remember:

Symptoms caused by gallstones vary, and similar symptoms may occur with other medical problems. Always consult your doctor if you have symptoms or concerns.

Dr. Mahmoud Tabbal specializes in all conditions that are related to the liver, biliary system and pancreas as well as oncology and gastrointestinal surgery. Dr. Tabbal combines a compassionate approach with the use of the latest techniques to provide optimal care.

Book a consultation with Dr. Mahmoud Tabbal in Dubai.