Gallstones

Gallstones are small, solid stones that form inside the gallbladder, a small organ under your liver that stores bile. Bile helps digest fat.¹ Stones may also move into the bile ducts, which connect the liver, gallbladder and pancreas.¹

• Cholesterol stones– the most common type in South Africa¹
• Pigment stones– formed from bilirubin and often associated with infections or bile duct disease²

Sizes range from grains of sand to larger stones, and you may have one or many.¹

Many gallstones are silent and cause no symptoms. Symptoms develop when a stone blocks a bile duct.¹

Typical symptoms (biliary colic)

• Sudden pain in the upper right abdomen
• Pain spreading to the right shoulder or back
• Pain lasting 30 minutes to several hours¹
• Nausea or vomiting¹
• Pain triggered by fatty or oily meals²

When to seek medical advice

• Pain lasting longer than 30 minutes
• Repeated pain after eating
• Pain affecting eating or drinking¹

Seek urgent care if you have:

• Severe or persistent abdominal pain
• Pain with vomiting
• Fever, chills, sweating²
• Jaundice– yellow eyes/skin, pale stools, dark urine¹

These may indicate inflammation, pancreatitis or a blocked bile duct — all requiring urgent treatment.²

Gallstones form when bile becomes imbalanced.¹ Risk increases with:

• Age over 40¹
• Female sex (oestrogen effect)¹
• Overweight or obesity²
• Rapid weight loss or fasting²
• Pregnancy
• Diabetes¹
• High-fat, low-fibre diet³
• Family history³
• Digestive conditions such as Crohn’s disease¹

1. Abdominal Ultrasound

Most accurate first investigation.¹

2. Blood Tests

Check liver function and infection.³

3. Additional tests if needed:

• MRCP(MRI of bile ducts)²
• CT scan
• HIDA scan– less commonly used locally.³  It involves the injection of a radioactive dye intravenously so that the gall bladder and bile ducts can be visualised with imaging.
• ERCP– used to diagnose or remove stones in the bile duct⁴ The procedure is described below.

If you have no symptoms

No treatment is needed for most silent gallstones.¹

If you have symptoms

Diet & lifestyle changes

• Reduce oily, rich or fried foods
• Eat smaller, regular meals²
• Increase fibre (fruit, vegetables, whole grains)³
• Maintain a healthy weight
• Avoid rapid weight-loss diets²
  These adjustments may improve symptoms, and prevent the development of new stones but will not remove stones.¹

Medication & pain relief

• Paracetamol or ibuprofen
• Short-term stronger pain relief if needed¹

Medicines to dissolve gallstones are rarely used in South Africa.³

Surgery – Cholecystectomy

The most effective treatment for symptomatic gallstones.¹

• Usually done as laparoscopic (keyhole) surgery⁴
• Same-day or next-day discharge common
• Open surgery is used in complex or inflamed cases⁴

Life without a gallbladder is normal — bile flows directly to the intestine.

Treating stones in the bile duct

ERCP may be used to remove these:

• Camera passed via the mouth to the small intestine
• Bile duct opening widened
• Stones removed⁴

Although not common, gallstones can cause:

• Cholecystitis— inflamed gallbladder (pain, fever, vomiting)¹
• Pancreatitis— inflammation and enzymatic destruction of the pancreas causing intense pain spreading to the back²
• Choledocholithiasis— stones blocking the bile duct⁴
• Cholangitis— infection of the bile ducts (fever + jaundice + pain)⁴

These require urgent medical attention.

Ways to reduce risk:

• Eat a balanced, low-fat, high-fibre diet³
• Avoid rapid weight changes²
• Maintain a healthy weight
• Stay physically active

This brochure is for educational purposes only and is not intended to provide a diagnosis or treatment or replace the advice of your doctor, pharmacist, primary health care nurse or other health care provider. You are advised to discuss any questions or concerns you have with your health care provider.