Gallstones

Symptom-free thanks to professional treatment

A great many people have gallstones, many of whom do not notice anything. Gallstones only become a problem if symptoms and complications occur. Those affected complain of cramps, pain, stabbing pains or digestive problems. Sometimes, cholestasis and inflammation of the gallbladder occur. If such complications occur, treatment is urgently needed.

At Schoen Clinic, we specialise in treating gallstones. Internal medicine specialists and surgeons often work together. In doing so, they do all they can to alleviate your symptoms. 

Causes & symptoms

What is gall?

The word ‘gall’ can be used to refer to different things:
  • Bile
    It is permanently formed by the liver and contains, among other things, bile acids with typical greenish-yellow bile pigments and cholesterol. It is required to digest fat. 
  • Gallbladder
    This blind sac-like organ leads into the common bile duct and stores bile for periods of increased need. Cream, fatty fried foods and egg yolk, for example, can irritate the gallbladder. 

Causes: How gallstones develop

Women, in particular, have an increased risk of suffering from gallstones. It is assumed that the female sex hormone oestrogen promotes the development of gallstones. Further risk factors include being overweight, age (40+) and family predisposition. Diabetes, cirrhosis of the liver, underactive thyroid glands, overactive parathyroid glands and chronic inflammatory bowel diseases also promote the development of gallstones.

Gallstones: Symptoms that may occur

Most gallstones remain clinically unnoticed. These are referred to as asymptomatic gallstones, which are usually found by chance during a routine ultrasound examination. 

In the case of biliary colic, however, patients complain of cramping, wave-like pain in the upper abdomen that extends to the back or under the right shoulder blade, possibly in connection with vomiting. These symptoms can last from a few minutes to many hours.

There are also inflammatory diseases of the gallbladder. These include: 
  • Acute inflammation of the gallbladder
    Occurrence of mostly dull continuous pain, radiating from the right upper abdomen in different directions. Fever may also occur. The situation is usually caused by a gallstone that is stuck at the exit of the gallbladder and prevents emptying. Overstretching makes the blood supply to the gallbladder wall worse, bacteria can now attack the gallbladder wall. 
  • Chronic inflammation of the gallbladder
    In general, gallstones also cause inflammation relapses here, too, with recurring unspecific symptoms. 
  • Inflammation of the bile ducts
    Here, fever occurs in conjunction with signs of a disturbance to the flow of bile. The accumulation of bile in the liver can be a sign of jaundice with yellowing of the skin, the dermis of the eye and darkening of the urine. In contrast, a lack of bile in the stool manifests itself in discoloration (cement grey). Possible causes of bile retention:  Gallstones in the bile duct, scarring of the sphincter muscle, formation of tumours.

Diagnostics

Diagnosis: How we diagnose gallstones

There are various diagnostic options if gallstones are suspected. The first is an ultrasound examination. Depending on the type of symptoms, we use further imaging procedures to get to the bottom of your illness. 

Ultrasound

First, we perform an ultrasound examination of the abdominal cavity. This method allows us to identify gallstones as well as measure a possible dilatation of the bile duct. In the event of acute inflammation, a thickening of the gallbladder wall can be identified. In addition, the elevation of special liver and inflammation values in a blood sample can provide information and lead to further examination steps. In some cases, computed tomography can be a useful extension to the examination.

Magnetic resonance imaging

If there are signs of bile duct occlusion, magnetic resonance imaging can be used in the next step. It can help to further narrow down the cause; in particular, it is possible to detect both gallstones and tumour formation. 

Endoscopic retrograde cholangiography (ERC)

Alternatively, endoscopic retrograde cholangiography (ERC) can be used as an endoscopic examination method. The bile ducts through the stomach and duodenum are looked at (retrograde) and shown using a contrast medium (cholangiography). During this examination, it is also possible to provide immediate treatment because the opening of the bile duct into the duodenum can be widened (papillotomy), gallstones can be grasped and pulled out, or a drain tube (stent) can be inserted

Endoscopic ultrasound

We use endoscopic ultrasound for inconclusive bile flow disruptions: As with a gastroscopy, a special endoscope is inserted into the duodenum. There, the adjacent tissue can be evaluated using ultrasound. In special cases, the examiner can remove cells under ultrasound guidance in order to assess them microscopically. The examination procedure is particularly suitable if the symptoms originate from the pancreas.

Supplementary diagnostics

Symptoms in the upper abdomen can also have other causes. For example, an ulcer in the stomach or duodenum can cause similar symptoms to gallstones. An additional gastroscopy is useful in these cases, especially if the gallstones are not definite.