Gallstones are mainly found in the gallbladder. Depending on their size, they also enter the bile duct from there and can become an obstacle to the outflow of both bile and pancreatic secretions. Gallstones can even form in the bile ducts inside and outside the liver after a gallbladder removal. Diet, weight and exercise have a strong influence on the risk of developing gallstones.

Gallbladder stones do not necessarily lead to symptoms and the gallbladder does not have to be removed in every case of calculosis. In contrast, stones in the bile duct always require medical intervention.

Causes of gallstones

The liver produces bile, which is necessary for digestion. This fluid mainly contains water, cholesterol, phospholipids, and bilirubin. The bile passes through the large bile duct from the liver into the small intestine, more precisely into the duodenum. The gallbladder, a mobile sac below the liver, stores a supply of additional bile. After high-fat meals, for example, the gallbladder contracts and releases the thickened stored bile into the bile duct and thus into the small intestine to aid digestion. Gallstones are caused by a dysfunction in the composition of the bile. There are different types of gallstones: cholesterol stones, pigment stones made of calcium and bilirubin pigments, and mixed forms.

Symptoms

Most gallstones in the gallbladder cause no symptoms and can go unnoticed for years, even decades. In such cases, the stones are usually only monitored by a doctor. Stones larger than 3 cm and symptomatic gallstones (colic, pain in the middle and upper right abdomen radiating to the back or right shoulder, accompanied by sweating and nausea) are removed by removing the gallbladder. Small gallbladder stones can pass through the bile duct on their own and be excreted in the faeces. These stones often lead to complications, as they represent an obstacle to the passage of bile and possibly also pancreatic secretions. While bile stasis leads to an inflammation of the bile ducts with previous itching or jaundice, stasis of pancreatic secretions can lead to a life-threatening inflammation of the pancreas (pancreatitis).

Diagnosis

An ultrasound examination is often sufficient to make a diagnosis. This can also reveal changes such as gallbladder polyps or a thickening of the gallbladder walls. Patients should not eat anything before the ultrasound to ensure that the gallbladder is well filled with fluid. If necessary, the liver, pancreas, and cholestasis values can also be examined.

Treatment

Only gallstones that are symptomatic, larger than 3 cm in size or lead to complications are treated. The standard treatment is minimally invasive surgical removal of the gallbladder (laparoscopic cholecystectomy). Minimally invasive keyhole surgery is usually sufficient. In rare cases, however, open surgery may be necessary. Non-surgical procedures are no longer offered as they are ineffective at best and therefore put patients at risk.