Gallstones — known medically as cholelithiasis — are solid deposits that form inside your gallbladder, a small pear-shaped pouch tucked under your liver. The gallbladder's job is to store bile, the fluid your liver makes to help digest fats. Gallstones form when components of the bile precipitate out and harden, usually from cholesterol or a substance called bilirubin.
Gallstones are very common — around 15% of Australian adults have them. They are more common in women, with age, during pregnancy, and with obesity. The reassuring news is that the great majority of people who have gallstones — about 80% — never have any trouble from them at all, and may live their whole lives without knowing they are there.
For practical purposes there are two questions that matter most:
- Are the stones in the gallbladder, or have they moved into the bile duct? Stones that stay in the gallbladder cause one set of problems. Stones that have escaped into the bile duct — the tube that carries bile from your liver into your bowel — cause different and usually more serious problems. This is called choledocholithiasis, and it needs different treatment.
- What kind of stones are they? Most stones in Australia are cholesterol stones; pigment stones are less common and are usually associated with certain blood conditions. The type of stone does not usually change the treatment.
Many people with gallstones have no symptoms at all. When symptoms do occur, they tend to fall into one of several recognisable patterns:
- Biliary colic — the most common pattern. A severe cramping pain in the upper right or central abdomen, often coming on after fatty meals, lasting anywhere from 30 minutes to a few hours, then settling. The pain can radiate to the right shoulder or back. There is no fever — the gallbladder itself is not inflamed, it is just being squeezed against a blocked outflow.
- Acute cholecystitis — when the gallbladder itself becomes inflamed. Persistent pain in the upper right abdomen, tenderness, and usually a fever. This needs prompt treatment.
- Cholangitis — a serious infection of the bile duct, usually caused by a stone blocking it. The classic picture is fever, jaundice (yellowing of the skin and eyes), and upper abdominal pain. This is an emergency.
- Pancreatitis — if a stone temporarily blocks the pancreatic duct, the pancreas can become acutely inflamed. The pain is severe, often radiating to the back, with nausea and vomiting. This is also an emergency.
The same person can have biliary colic for years without complications, or progress quickly to one of the more serious presentations — there is no completely reliable way to predict who will. This is why symptomatic gallstones are usually treated rather than watched indefinitely.
Ultrasound is the standard first test if your doctor suspects gallstones. It is quick, painless, and very accurate at picking up stones in the gallbladder.
If there is concern that stones may have moved into the bile duct — usually suggested by abnormal liver blood tests, jaundice, or pancreatitis — further imaging is arranged:
- MRCP (magnetic resonance cholangiopancreatography) is a type of MRI scan that shows the bile ducts in detail. No incisions, no injected dye — just half an hour or so in the scanner. It is the best test for confirming whether stones are sitting in the duct.
- ERCP (endoscopic retrograde cholangiopancreatography) is a procedure rather than a test — a flexible camera passed through your mouth into the small bowel that can locate and remove stones from the bile duct in the same sitting. It is used when there is something that needs treating, not just looking at.
Treatment depends on whether your gallstones are causing trouble.
If your gallstones are not causing symptoms, they generally do not need to be treated. Most people in this situation are simply reassured and asked to come back if symptoms develop.
If your gallstones are causing symptoms — biliary colic, cholecystitis, or any complication — the standard treatment is removal of the gallbladder, performed as a keyhole operation called laparoscopic cholecystectomy. It is one of the most common operations performed in Australia and has a well-established safety and effectiveness record at preventing further trouble.
If stones have also moved into the bile duct, they need to be removed too — usually by ERCP before or after the gallbladder operation.
Mr Nguyen performs laparoscopic cholecystectomy at Warringal Private Hospital and Epworth Eastern, usually as a day procedure or with one overnight stay. For most patients the operation takes about an hour and is straightforward.
If your stones have also moved into the bile duct and you need an ERCP, Mr Nguyen works closely with his gastroenterology colleagues to coordinate both procedures so that everything is sorted in a timely, joined-up way. Urgent presentations — including acute cholecystitis — are always prioritised. If you are unsure how urgent your situation is, please call our rooms; we can help work it out.
See your GP if you are having recurrent episodes of upper abdominal pain after meals — this is the typical pattern of biliary colic and is worth investigating.
Seek urgent assessment (through your GP or your nearest emergency department) if you develop a fever with right-sided abdominal pain, yellowing of the skin or eyes (jaundice), or severe upper abdominal pain that does not settle. These are signs that your gallstones may be causing a more serious complication that needs prompt attention.
Your GP will send a referral, usually with the ultrasound report confirming gallstones. Most patients are seen within one to two weeks; urgent presentations (acute cholecystitis, jaundice, suspected duct stones) are seen sooner.
At the consultation your symptoms and imaging are reviewed, what the gallstones are doing is explained, and whether surgery is the right step for you is discussed. If surgery is recommended, most people are home the same day or the next morning, back to light activities within a week, and fully recovered within two to three weeks. A follow-up appointment is arranged a few weeks afterwards to confirm everything has healed well.
Yes, and very comfortably. The gallbladder stores bile, but your body manages perfectly well without it — after surgery, bile flows continuously from your liver directly into your bowel. Most people eat a completely normal diet. Some notice slightly looser stools for a few weeks while their body adjusts, but this almost always settles.
For most people, no. In the first few weeks after surgery it is sensible to go easy on very fatty or greasy foods. Long-term, the great majority of people return to eating normally without any restrictions at all.
Not in any reliable or practical way for most people. Medication is not used in routine practice for symptomatic gallstones — surgery is the standard and most effective treatment.
Some people continue with episodes of biliary colic for years without ever developing a more serious complication. Others progress quickly to cholecystitis, cholangitis, or pancreatitis. Because there is no reliable way to predict which group you will be in — and because the more serious presentations can be very unpleasant or even dangerous — surgical removal is recommended once gallstones have caused symptoms.
Most people are home the same day or the next morning, back to desk work within about a week, and fully back to normal activity within two to three weeks. Heavy lifting and vigorous exercise are best held off until around the four-week mark. See the Cholecystectomy Aftercare guide for the practical details.
Have questions about gallstones?
Mr Nguyen sees patients at his consulting rooms in Heidelberg and operates at Warringal Private and Epworth Eastern. A GP or specialist referral is required.