The gall bladder is a small pear-shaped organ on the underside of the liver that is used to store bile. Bile is made in the liver and is stored in the gall bladder until it is needed to help the digestion of fat.

It is thought that approximately two thirds of patients will have no trouble at all from their gallstones and only one third of patients will at some time experience symptoms. These symptoms can be extremely variable but usually present in one of three ways.

Chronic cholecystitis (biliary colic)

This is a chronic inflammation of the gall bladder and causes:
sporadic pains in the middle of the upper abdomen, or just below the ribs on the right side.
pain which becomes worse over an hour and then stays the same.
the pain may spread to the right shoulder or between the shoulder blades.
the pain can be accompanied by nausea and vomiting and sometimes excessive wind.
the attack can last from a few minutes to two to three hours before getting better.
the frequency and severity of attacks is very variable.
attacks can be triggered by eating fatty foods such as chocolate, cheese or pastry.
it can be difficult to distinguish the pain from other diseases, such as: gastric ulcer, back problems, heart pains, pneumonia and kidney stones.

Acute cholecystitis (acute inflammation or infection of the gall bladder)
persistent pain and a temperature lasting more than 12 hours.
pain and tenderness under the ribs on the right side.
the pain is made worse by movement or coughing.
patients with acute cholecystitis may not always have gallstones but usually do.
the condition must be treated by a doctor and usually requires admission to hospital.
the treatment consists of a course of antibiotics but if this is not effective emergency surgery may be required to remove the gall bladder.

Jaundice (yellow discolouration of the skin and whites of eyes)

This is caused when there is an obstruction to the flow of bile from the liver. Jaundice is not always caused by gallstones. The symptoms are:
increasingly yellow eyes and skin.
the skin can become itchy.
pale bowel motions and dark urine.
the condition is often preceded by symptoms similar to those of cholecystitis.
fever and shaking chills are serious symptoms and must be treated by a doctor - they are suggestive of infection travelling through the bile duct system.

Gallstones are seen in all age groups but they are rare in the young. The possibility of developing gallstones increases with age. The following groups are considered to be at increased risk:

people who have relatives with gallstones.
obese people.
people with a high blood cholesterol level.
women who take drugs containing oestrogen, eg contraceptive pills.
people with diseases such as chronic intestinal inflammation (Crohn's disease and ulcerative colitis).