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Understanding stomach disorders

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Dr Peter Carr-Boyd is a Specialist general surgeon with comprehensive sub-speciality training in the surgical management gallbladder and liver conditions. He is uniquely place to manage both routine and complex gallbladder disorders. He uses minimally invasive procedures to reduce risk and recovery time for his patients.

Gallbladder Function and Gallbladder Disease

The liver produces bile, a digestive fluid that helps break down fats in the small intestine. The gallbladder stores and concentrates bile, releasing it into the intestine through the bile ducts when fatty foods are eaten.

Gallbladder disorders occurs when this process is disrupted.

Common gallbladder conditions include gallstones, gallbladder inflammation (cholecystitis), bile duct obstruction due to gallstones (choledocholithiasis), infection of the bile duct due to blockage (cholangitis). These conditions can interfere with bile flow and lead to significant digestive symptoms.

gallstones

​What are gallstones?

Gallstones are solid deposits that form in the gallbladder or bile ducts when components of bile form crystals, than larger stones. Gallstones are very common and often asymptomatic, but they can cause significant upper abdominal pain and serious complications when they obstruct bile flow.

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Types of Gallstones

There are two main types of gallstones:

  • Cholesterol gallstones – the most common type in Western populations

  • Pigment gallstones – subdivided into:

    • Black pigment stones, associated with chronic haemolysis conditions like Hereditary spherocytosis, autoimmune haemolytic anaemia and Sickle cell disease, for example.

    • Brown pigment stones, associated with bile duct infection and bile stasis

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risk factors for Gallstones

  • Females

  • Increasing age

  • Obesity or rapid weight loss

  • Pregnancy

  • Type 2 diabetes

  • Non-alcoholic fatty liver disease (NAFLD)

  • Haemolytic anaemia

  • Other family members with gallstones

  • Certain medications, including oestrogen therapy and GLP-1 receptor agonists (e.g. Wegovy, Mounjaro

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Symptoms of Gallstones

The typical symptoms of gallstones is characterised by:

  • Sudden, severe, steady pain in the right upper abdomen or middle upper abdomen

  • Pain often triggered by fatty meals

  • Radiation of pain to the right shoulder or back can occur

  • Associated nausea and vomiting

  • Persistent pain, fever, or raised inflammatory markers may indicate complications such as acute cholecystitis, which requires urgent assessment.

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Assessment and Management of Gallbladder Disease

Gallbladder conditions are assessed using a combination of clinical history, blood tests, ultrasound, CT or MRI imaging, and specialised functional studies where appropriate. Treatment depends on the underlying condition and symptom severity and may include medical management or gallbladder surgery (laparoscopic cholecystectomy).

Early evaluation of persistent upper abdominal pain or digestive symptoms is important to prevent complications and ensure appropriate treatment.

When Should You See a Specialist?

We recommend you book an assessment if you experience:

  • Recurrent right upper abdominal or epigastric pain

  • Pain triggered by fatty meals

  • Gallstones detected on ultrasound with symptoms

  • Fever, jaundice, or persistent pain

  • A history of gallstone pancreatitis or bile duct stones

Early assessment allows timely treatment and reduces the risk of complications.

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Diagnosis of Gallstones

The primary investigation for gallstones is abdominal ultrasound, which is the gold standard for diagnosis. Additional investigations may be required in more complex cases, including:

  • Liver function tests

  • HIDA scan (to assess gallbladder function)

  • MRCP (to evaluate bile ducts and detect choledocholithiasis)

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Complications of Gallstones

If left untreated, gallstones can lead to serious complications, including:

  • Acute cholecystitis: Acute cholecystitis is most commonly caused by obstruction of the cystic duct by a gallstone, leading to gallbladder inflammation. Symptoms include persistent right upper quadrant pain, fever, nausea, and a positive Murphy sign on examination. Diagnosis is primarily by abdominal ultrasonography, which shows gallbladder wall thickening, pericholecystic fluid, and stones. Early laparoscopic cholecystectomy within 72 hours is the preferred treatment; critically ill patients may require percutaneous cholecystostomy. Supportive care includes IV fluids, analgesia, and antibiotics.

  • Choledocholithiasis (bile duct stones): Choledocholithiasis refers to gallstones in the common bile duct, usually originating from the gallbladder. Symptoms may include jaundice, right upper quadrant pain, and sometimes cholangitis or pancreatitis. Diagnosis is by ultrasonography, MRCP, or endoscopic ultrasound; MRCP and endoscopic ultrasound are more sensitive than standard ultrasound. Treatment is endoscopic stone extraction via ERCP, followed by cholecystectomy to prevent recurrence.

  • Ascending cholangitis: Ascending cholangitis is a bacterial infection of the biliary tree, typically due to obstruction from choledocholithiasis. Classic symptoms are fever, jaundice, and right upper quadrant pain (Charcot’s triad); severe cases may present with hypotension and altered mental status (Reynolds’ pentad). Diagnosis is clinical, supported by laboratory evidence of infection and imaging showing biliary dilation. The World Society of Emergency Surgery recommends prompt IV antibiotics and urgent biliary decompression, usually by ERCP.

  • Gallstone pancreatitis: Gallstone pancreatitis occurs when a gallstone transiently obstructs the pancreatic duct causing pancreatic inflammation. Symptoms are acute, severe epigastric pain radiating to the back, often with nausea and vomiting. Diagnosis requires two of three criteria: typical pain, elevated lipase/amylase (>3× normal), and imaging evidence of pancreatitis. Initial management is supportive: IV fluids, analgesia, and nutritional support. Cholecystectomy during the index admission is recommended for mild cases; ERCP is reserved for persistent biliary obstruction or cholangitis.

 

Treatment of Gallstones

 

Treatment depends on symptoms and the presence of complications:

  • Asymptomatic gallstones: usually managed conservatively with observation

  • Symptomatic gallstones: laparoscopic cholecystectomy is the first-line treatment

  • Pain management: typically with NSAIDs or opioids in the acute setting

  • Bile duct stones: may be able to be manage at the same time of the cholecystectomy or an

  • Medical dissolution therapy (e.g. ursodeoxycholic acid): reserved for select patients who are not surgical candidates and is not routinely recommended

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Early assessment of persistent upper abdominal pain or gallstone symptoms is important to prevent complications and guide appropriate treatment.​​

Why Choose a Specialist Gallbladder Surgeon?

As an experienced upper gastrointestinal and hepato-pancreato-biliary surgeon, Dr Carr-Boyd manages the full range of gallbladder, bile duct and liver conditions — from straightforward gallstone surgery to complex cases requiring advanced procedures.

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Your Surgical Experience

 

During your consultation we will cover:

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  • Your symptoms and concerns

  • Review of your imaging

  • Whether surgery is needed

  • What to expect before, during and after surgery

  • Risks, benefits, and alternatives

  • Recovery times and lifestyle considerations

 

After surgery

 

You will have:

  • A clear recovery plan

  • Access to advice if symptoms arise

  • Follow-up to ensure you are healing well

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