The gall bladder is a small pouch situated on the right side of the abdomen, above the umbilicus and below the liver. Bile, a digestive liquid formed by the liver, is excreted through tubes called bile ducts into the gall bladder. When food is eaten, the stimulus makes the gall bladder pump bile into the intestines.

The liver filters and removes excess cholesterol from the blood. It also makes bilirubin, a yellowish pigment made mainly during the normal breakdown of red blood cells. If either material is in excess, it tends to get deposited in the gall bladder to form cholesterol or pigment stones. These can be deposited as sludge or as multiple stones. They can vary in size — like grains of rice or a single large stone.

Gall stones can remain asymptomatic and be discovered during an ultrasound scan of the abdomen for some other reason. It can cause symptoms of upper abdominal pain, nausea, vomiting, fever and chills.

The pain can radiate to the back and the right shoulder. It can produce jaundice, particularly if the stones block the free flow of bile.

Asymptomatic gall stones can be ignored. However, once symptoms occur, even if the initial attack of pain and fever subside, they can recur. Therefore, symptomatic gall stones eventually require treatment.

Complications can occur if gall stones are ignored. The typhoid bacteria can live among the stones, making a person an asymptomatic carrier who spreads the disease. The stones can block the bile ducts, causing severe pain as well as jaundice. They can travel into the pancreatic duct (the pancreas is situated just under the gall bladder), causing a severe illness called pancreatitis). The gall bladder can become infected with bacteria. The infection may spread from the gall bladder, even causing dangerous septicaemia.

Surgery is usually the preferred option for treating gall bladder stones. It can be endoscopic or an open laparotomy. Endoscopic surgery is what people usually opt for as it is minimally invasive. The patient can be discharged faster — in two or three days. Open surgery may be required if there are complications such as an infected gall bladder, which is scarred or stuck to other abdominal organs. It may also be done if endoscopic removal fails. Then the entire gall bladder has to be removed.

It is not possible to take out the stones alone. The removal may cause diarrhoea for a few days. This usually settles down on its own. Digestion is unaffected by the removal. After open surgery, the person can lead a normal life and eat a normal diet after a month.

Some individuals cannot have surgery. They can opt for medications. Capsules of ursodiol or chenodial can be given orally. These medications do not work on large stones. The stones do not dissolve. They break into small bits, which are then excreted in the bile. Medication has to be taken for many months. The stones can recur if medication is stopped.

Gall stones are more likely:
- In older women (over 40);
- If BMI (weight divided by height in metre squared ) is more than 30;
- If there is a family history;
- The lifestyle is sedentary, without 150 minutes of aerobic exercises every week;
- Diet lacks fibre;
- The diet is high in fat.

An attempt can be made to prevent the formation of gall stones by eating regular and timely meals that are low in fat and high in fibre. The body, then, gets used to a rhythm
— it knows when food will enter the system and the gall bladder has to contract.

Regular exercise keeps body organs active and prevents weight gain. A fad diet with weight loss of more than one kilo a week can also precipitate gall stones.

The writer is a paediatrician with a family practice at Vellore and the author of Staying Healthy in Modern India. If you have any questions on health issues please write to yourhealthgm@yahoo.co.in