Dr Deepak Varma Gastro Surgeon Cochin

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Gall bladder stones

Gallstones or gallbladder stones are also known as cholelithiasis. They originate in the gallbladder when concretions form in the bile stored in the gall bladder. During the digestive process, the gall bladder stores bile (a fluid produced by the liver), which is released into the small intestine every time the food enters it. Bile is a combination of bile acids and other biliary salts.

There are many types of gallstones: The common types are

Pigment gallstones

they are small, dark stones made up of bilirubin

Cholesterol gallstones

these are yellowish-green in colour

Mixed gallstones

A mixture of many bile salts

Causes and risk factors

  • Predominantly occurs in the women
  • Ancestral factors Native American or European
  • Aging
  • Obesity
  • Multiple pregnancies
  • Drugs
  • Heredity
  • Excessive hepatic cholesterol secretion
  • Disorders of haemolysis such as sickle cell anaemia, beta-thalassemia, hereditary spherocytosis
  • Rapid weight loss, cholesterol lowering drugs and type II diabetes are known to cause gallstones.

Signs and symptoms

Symptoms of biliary colic:

  • Pain in the epigastrium
  • Intense and dull post-prandial pain especially occurs in the night
  • Constant pain not relieved by antacids, emesis, defaecation, flatus or changes in position
  • Other non-specific symptoms may include: belching, dyspepsia, bloating and indigestion

Tests and diagnosis

Blood and lab tests will include CBC with differential, amylase, lipase and liver function panel

Imaging studies:

  • Abdominal radiography
  • EUS or endoscopic ultrasonography (for bile duct stones)
  • ERCP or endoscopic retrograde cholangiopancreatography (for bile duct stones)


Complications of gallbladder stones:

Acute cholecystitis: This is an acute inflammation or infection of the gallbladder. Severe right upper abdominal pain associated with vomiting and fever. The pain is continuous which persists for more than 24 hours. This condition warrants immediate treatment. If the patient does not have other diseases and if the infection is severe, an urgent laparoscopic cholecystectomy is done (if within 72 hours of symptoms).

Common Bile Duct stones: In some situations, one or more gallstones can slip into the bile duct (the channel which carries bile from the gallbladder to the small intestine). This can cause continuous pain, pain radiating to back, fever with chills and rigor and many times can cause jaundice. In such situations, an emergency ERCP is needed to remove the bile duct stone followed by laparoscopic cholecystectomy in the same admission.

Gallstone pancreatitis: When the stones slip down the bile duct, it can cause temporary obstruction to the duct of the pancreas also. This can trigger inflammation in the pancreas leading to pancreatitis. This condition can be severe enough to warrant ICU admission. Occasionally if it is severe, it can be life-threatening. Emergency ERCP to remove the bile duct stone is the procedure of choice. This is a definite indication for removal of the gallbladder, as this situation can arise again if gallstones are left behind.


When gallstones are symptomatic, surgery is an essential modality. Medical management is not usually successful as the stone recur when the medicines are discontinued. Complications of gallbladder stones are a definite indication for surgical removal of the gallbladder.

We favourably treat symptomatic gallstones with cholecystectomy or complete gallbladder removal and have an expertise of doing more than 1000 cholecystectomies.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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