Conditions

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).

If you know what condition you want to find out more about, use the search option below. Alternatively, browse our database using the menu on the right.

Gallstones

Gallstones are very common and develop as we get older. Some people have gallstones but never have any symptoms, so saying exactly how many cases there are is difficult. It is thought about one in ten adults in the UK has gallstones to some degree.

Who gets gallstones?

An old saying in medicine is that a patient with gallstones is likely to be ‘fat, female and forty’, and there is some truth in this. Risk factors include:

  • 1Being overweight or obese: probably because of the effect of excess fat on the metabolism
  • 2Age: most cases of gallstones are in people over 40
  • 3Being female: women are up to three times more likely to get gallstones than men. Women who have had several pregnancies are particularly at risk
  • 4Having inflammatory bowel disease
  • 5Losing a lot of weight quickly, such as after weight-loss surgery.

Where do gallstones come from?

Gallstones start small and then get larger because more hard material is attracted on to the surface. They form from insoluble substances in the bile, which is stored in the gallbladder.

In a young healthy person, the bile flows freely and doesn’t contain any hard particles. As we get older, and if we have an excess of cholesterol or bilirubin in the bile, these form hard particles because the bile fluid cannot dissolve them.

Gallstones start off as grains that look like sand but can grow quite big to become the size of small pebbles. The gallbladder can be full of them, or there may be just a single large stone. Larger stones tend to cause fewer problems. Smaller stones can get washed into the bile duct and damage it as they pass through. This causes the bile duct to become inflamed, which causes an attack of biliary colic.

If a gallstone gets stuck in the bile duct and blocks it, this stops the bile flowing and leads to jaundice and repeated attacks of biliary colic. Complicated gallstone disease needs urgent surgery to remove the gallbladder and to relieve the blockage in the bile duct.

What are gallstones made of?

Gallstones are hard but they are not actually stone. They are either hardened cholesterol, which becomes a dense mass, or they form from a collection of solidified pigments. Bilirubin, the pigment that makes bile yellowy green, forms gallstones when it mixes with calcium and becomes calcified. Some stones are pure but many are a mixture of cholesterol and pigments and calcium.

Gallstone Treatment

The only successful long term gallstone treatment is removal of the gallbladder (cholecystectomy). Despite a host of treatments becoming advertised on the internet, that describe dissolution of the stones, none provide long term resolution. Once the gall bladder is removed as long as the bile duct is clear there should be no further medical problems relating to this pathology. The patient can resume a full normal diet and will no longer but at risk of potential stone related complications such as cholecystitis (inflammation of the gall bladder) and pancreatitis (inflammation of the pancreas), this is the recommend gallstone treatment for gallbladder conditions.

symptoms
Biliary colic: pain just under the ribs, either in the centre or just over to the right-hand side. Attacks can last about an hour but may only occur occasionally, with months without pain.
Nausea and vomiting during a painful attack.
Sweating and feeling unwell during an attack.
More frequent biliary colic with jaundice is termed complicated gallstone disease. [Link to article on complicated gallstones]
diagnosis
  • Incidental diagnosis: gallstones that cause no symptoms can be diagnosed by blood tests done for some other reason such as if a routine cholesterol check reveals high blood levels, or if you have a routine ultrasound scan of the abdomen.
  • Murphy’s test: this involves tapping the abdomen just over the gallbladder in patients who report symptoms. If this produces pain, gallstones are highly likely.
  • Ultrasound scanning: this is used to confirm that the gallbladder contains gallstones.
treatments
If attacks of biliary colic are very occasional, gallstones can be monitored but surgery is not urgent.
If symptoms become more intense with episodes of jaundice, the gallbladder then needs to be removed as soon as possible.
Laparoscopic gallbladder removal (laparoscopic cholecystectomy) is done where possible.