Mr Charles Imber offers expert abdominal surgery. The operations that he performs can treat a variety of conditions that affect the organs inside the abdomen (pancreas, gallbladder, liver, spleen, small and large intestine) or the abdominal wall (hernias).
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Complicated gallstone disease
Uncomplicated gallstone disease produces only infrequent symptoms. A patient can have an attack of biliary colic – intense gallstone pain in the upper abdomen that lasts an hour or so and makes them feel sick and feverish – only once every few months. If attacks start to make everyday life difficult, and the patient starts to show jaundice, their gallstone disease has become more serious.
A blockage in the bile duct
If small gallstones are washed out of the gallbladder and try and exit the bile duct but get stuck, this blocks the duct. Bile can no longer leave the liver and enter the intestine, which means that all the waste products and pigments it contains start to build up.
The earliest sign that the bile duct has become blocked is a severe attack of biliary colic. The gallstone pain in the upper part of the abdomen can continue, or come and go several times a day. Jaundice causes the skin and eyes to become yellow and leads to nausea, vomiting, tiredness and a loss of appetite.
The pain of biliary
The typical pain from gallstones is known as “biliary colic”. It is situated under the right rib cage (pain under right rib) and can radiate through to the back or even the right shoulder. It is thought to be due to a gallstone becoming impacted in the mouth of the gall bladder and contraction of the muscular bag against a point of obstruction. Sometimes it is brought on by eating a rich or fatty meal.
Bile duct inflammation
When the bile duct is blocked by a gallstone, this causes the walls of the bile duct to become inflamed. The bile can also become infected, causing further swelling and damage to the bile duct. Severe bile duct inflammation is known as acute cholangitis.
If the blockage is not relieved, the inflammation and swelling in the bile duct can spread to the walls of the gallbladder. This can cause general inflammation in the gallbladder itself. Gallbladder inflammation, known as cholecystitis, can also result from damage to the internal walls of the gallbladder caused by the stones themselves.
If the gallbladder is not removed, repeated attacks of inflammation in the gallbladder walls can cause scar tissue to form, and symptoms get worse. This is chronic cholecystitis, which is a risk factor for gallbladder cancer and bile duct cancer.
The gallbladder and pancreas are close to each other in the body. The bile duct and pancreatic duct share an opening into the intestine, so disease in the gallbladder can affect the pancreas.
If the bile duct becomes blocked by a small gallstone, the bile duct can become blocked and this can block the pancreatic duct too. This causes inflammation in the pancreas, which causes a serious illness known as acute pancreatitis.
It happens quite rarely, but larger stones can sometimes manage to pass through the bile duct and enter the small intestine. Sometimes these can block the ileum, causing an obstruction of the small bowel. This produces a condition known as a gallstone ileus and causes severe vomiting. It needs emergency surgery to remove the obstruction.
Chronic complicated gallstone disease can increase the risk of both bile duct cancer and gallbladder cancer. This is rare with only 600 people diagnosed in the UK each year, but untreated gallstones is one of the main risk factors.
- Frequent biliary colic with nausea and vomiting: Pain just under the ribs, either in the centre or just over to the right-hand side. Painful episodes occur almost daily, reducing quality of life.
- Severe upper abdominal pain due to acute pancreatitis.
- Jaundice: Yellow skin, yellowing of the whites of the eyes, itching, dark urine, pale faeces.
- Consultation with an expert gastroenterologist with experience in surgery for gallstone disease.
- Ultrasound scanning to confirm the presence of gallstones.
- ERCP – an endoscopic technique used to look at the bile duct to see if it is blocked and inflamed.
- Laparoscopic gallbladder removal (laparoscopic cholecystectomy) is done where possible. Open gallbladder removal (open cholecystectomy).