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Dr Susanna Kent - Gall stones - 5 May


Gall stones are common, particularly as we age. But what exactly are they and where is the gall bladder?

The gall bladder is a pear shaped organ tucked under the liver. Its job is to concentrate bile which is then squirted out via small ducts into the small intestine. The purpose of bile is to help digest fat.

Bile is made up of cholesterol, water, bile salts and bilirubin.

The majority of gall stones are cholesterol stones. These occur because of changes of concentrations of the different substances in the gall bladder.

The other type is pigment stones and these are less frequent and occur in people with various gut or blood disorders.

Who gets gallstones?

About 1 in 10 people have gall stones in Aotearoa but many people do not have symptoms. You are more likely to have them if:

- You are female
- Pregnant
- Over 40
- Obese or overweight  (due to higher cholesterol levels)
- Those who lose weight rapidly  (buring up fat stores can make your liver put out more cholesterol into the bile)
- Hormones - contraceptive pills or hrt
- Diabetes
- Cholesterol lowering drugs

Who is at risk of gallstones?

About one in 10 New Zealanders have gallstones, although many of these people do not have symptoms. People at risk of gallstones are:

- women - twice as likely as men to have gallstones between the ages of 20 an 60 years 
- pregnant women 
- elderly people - about 15% of elderly people have gallstones 
- overweight or obese people - due to their increased cholesterol levels 
- people who lose weight rapidly - burning or metabolising your fat stores causes your liver to secrete extra cholesterol into your bile 
- women using the contraceptive pill or hormone replacement therapy 
- people with a family history of gallstones 
- people with diabetes 
- some people who take cholesterol-lowering drugs.

Symptoms of gallstones

Many people have gallstones but do not get symptoms. If this is you, then you need to avoid fatty meals. It is also a good idea to get your cholesterol checked and lose weight in a controlled fashion.

Pain from gallstones can occur at any time but is most likely to occur a few hours after eating a fatty meal. The pain is often felt in the right upper abdomen or to the right of the back under the rib cage. Sometimes people can feel it in their shoulder blade. You can be nauseous or vomit with it.

Sometimes it can feel in the centre of the chest and can be mistaken for a heart attack.
The pain can last from 15 minutes up to several hours.

Complications

Depending on where the stones get stuck, the liver can be affected and the person can become jaundiced. The pancreas can be affected and the person will be very unwell. Infection and fever can occur as well.

Treatment

If you don't have symptoms, then having a low fat diet can help avoid getting symptoms. If you do have symptoms then you will need to see a surgeon to discuss having your gall bladder removed. This is most often done via  a laparoscope - a thin tube that is passed into your abdomen. The gall bladder is removed via this tube. Healing takes place rapidly and you may only need a day in hospital.


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