Cholesterol gallstones.
	Pigment gallstones.
	Mixed cholesterol and pigment gallstones.

The more common gallstones are formed mainly of cholesterol.

Gallstones occur more frequently in women than in men and are more common from the age of thirty with approximately 50% of cases occurring in people aged 65 and over.

The cholesterol containing stones, that is either pure cholesterol or mixed, are related to obesity, the levels of female hormone in the blood and some cholesterol lowering drugs. A low fibre diet is thought to be a contributing factor also.

Pure pigment gallstones are found :-

	In association with bacterial infections of the gall bladder.
	In certain anaemia’s where there is increased destruction of blood cells.
	Where there is a slow flow of bile into the gall bladder from the liver and then of the gall bladder down into the bowel.

The presence of gallstones is generally not associated with symptoms. They are often discovered during routine x-ray examinations or during surgery. There may be a history of belching after a large or fatty meal with a feeling of fullness in the upper abdomen.

If the stone or stones are accompanied by inflammation of the gall bladder then, with an acute attack of inflammation, there can be severe pain in the right side of the abdomen just under the ribs which can radiate to the back of the right shoulder. Occasionally you can feel pain behind the breast bone and towards the centre of the stomach. There may be nausea and vomiting associated with fever. If a gallstone causes a blockage, then you may suffer from an acute attack of gall bladder colic. The pain can be excruciating across the upper part of the abdomen and up into the region of the shoulder. The attack can last for hours or it can go as quickly as it came. It is accompanied by nausea and vomiting and often occurs when you are lying in bed. It may be accompanied by jaundice.

The diagnosis of gallstones can be confirmed by X-rays and the use of ultrasound. Your local doctor, who should be consulted if you suspect gallstones, can establish the presence of gallstones and advise accordingly.

The treatment of gallstones associated with an established history of symptoms and a non-functioning gall bladder consists of surgical removal of the gall bladder. Gallstones discovered during routine investigations and not producing symptoms, pose a problem. As no one wants the trauma of surgery, it is best to leave well alone until symptoms appear. If the gallstones are associated with a healthy gall bladder and are only producing minor symptoms after a fatty meal, then the symptoms are often not relieved by operation.

There are some new techniques for dissolving gallstones and crushing them if they have already passed out of the gall bladder in the duct leading to the bowel. These approaches are not always possible and require expert assessment and guidance.