Gallstones

Gallstones are stones that form in the gallbladder — a small pear-shaped organ under the liver that stores bile. Most gallstones cause no symptoms and don't need treatment. Some cause pain, inflammation, or blockage and then need to be treated.

Who gets them

• Female, forty, fat, fertile, fair — the classic risk set ("5 Fs"), though gallstones also occur in men and slim people.
• Rapid weight loss.
• Diabetes, metabolic syndrome, fatty liver.
• Family history.
• Pregnancy and multiple pregnancies.
• Certain haemoglobin disorders (haemolysis-related pigment stones — important in sickle cell, thalassaemia).

Symptoms when they appear

• Biliary colic — episodes of severe, steady pain in the upper right or upper middle belly, often after a fatty meal; may radiate to the right shoulder/back; lasts 30 minutes to a few hours.
• Nausea, vomiting with the attack.

Red flags — dial 112 or go to hospital

• Severe, worsening pain with fever and chills — possible cholecystitis or cholangitis.
• Jaundice (yellow eyes) with pain — bile duct stone.
• Pain with vomiting, fast heartbeat, confusion.
• Severe pain lasting more than 5-6 hours.
• Pancreatitis is a known complication.

Treatment

• No symptoms — no treatment needed for most people. (Exceptions: some high-risk groups.)
• Symptomatic gallstones — surgery to remove the gallbladder (laparoscopic cholecystectomy) is the standard treatment. Day-care or short-stay procedure; life without a gallbladder is normal for most.
• Stones in the bile duct are removed by ERCP (an endoscopy that unblocks the duct), often before or with gallbladder surgery.
• Medicines to dissolve stones work only in very select small-stone cases and are rarely used.
• Widely available at Indian hospitals and medical colleges; most insurance and government schemes cover it.