Knee Arthroscopy

Next review due March 2023

Knee arthroscopy is a type of keyhole surgery used to diagnose and treat knee pain or other . It can be used for inflammation, damage, injury and infections.

Types of gallstone

There are three main types of gallstone:

• Cholesterol gallstones form if you have too much cholesterol in your bile. These are the most common type.
• Pigmented gallstones form when there’s too much calcium and bilirubin in your bile. Bilirubin is a waste product that’s produced when your body breaks down red blood cells. These stones mostly happen in people who have inherited red blood cell disorders like sickle cell anaemia.
• Mixed gallstones are a combination of cholesterol and pigmented stones. These are also common.

Symptoms of gallstones

Most people with gallstones don’t have any symptoms. Sometimes, gallstones are found if you have a scan to investigate something else.

Abdominal pain (biliary colic)

The most common symptom of gallstones is pain in the middle or right side of your upper abdomen, just under your ribs. This is known as biliary colic. It can happen when a gallstone blocks the flow of bile out of the gallbladder.

The pain may be severe, and is constant – it doesn’t come and go. It may spread to the centre of your back and the tip of your right shoulder blade. You may develop this pain after a heavy meal, especially in the evening or during the night. The pain usually lasts for at least 30 minutes and may go on for up to eight hours. You may also sweat, feel sick and vomit.

Sometimes an episode of biliary colic leaves you with a dull ache or discomfort over the gallbladder area for several days afterwards.

Other less common symptoms

Gallstones may block the flow of bile for a long time, or leave the gallbladder to cause problems in the bile duct and nearby pancreas. See our section on complications below for more information about what can happen. Symptoms may then include the following.

• A high temperature, perhaps with shivering and ‘chills’ or shaking (rigors).
• Pain that doesn’t go away.
• Yellow skin and a yellowing of the whites of your eyes (jaundice).
• Dark urine and very pale poo.
• Itchy skin.

If you have severe pain in your tummy which does not resolve by itself or after taking over-the-counter painkillers, contact your doctor.

If you become very unwell and develop a high fever, jaundice or any of the other symptoms listed above, seek medical attention as soon as possible because you may need urgent hospital treatment.

Diagnosis of gallstones

You may only discover you have gallstones when you have a test such as an ultrasound of your abdomen for some other reason.

If you do have symptoms, your doctor will ask about these and about your medical history. This will help to identify possible causes and any other conditions. They’ll feel your tummy area to see if it’s tender or swollen.

You might have blood tests to check for any inflammation or infection, a problem with your liver or a blocked bile duct.

Your doctor may refer you to your local hospital for more tests, some of which are described below. If your doctor thinks you have complications that need immediate treatment, you may have to go to hospital straightaway.

• An ultrasound scan – this uses sound waves to produce an image of the inside of your body. Gallstones usually show up well on this type of scan, but very small stones may be missed. See our FAQ further down the page: Do negative tests mean I don't have gallstones?
• A type of MRI scan, called a magnetic resonance cholangiopancreatography (MRCP) – this can produce images of the inside of your body, including your pancreatic and bile ducts.
• An endoscopic ultrasound scan – this may be recommended if you can’t have an MRCP for some reason. A narrow, flexible, tube-like telescopic camera called an endoscope goes into and through your stomach via your mouth. It can spot small gallstones which lie in the bile duct.
• A CT scan – this can produce detailed images of your bile ducts, liver and pancreas. Gallstones can be missed on CT scan, unless they contain a lot of calcium.

Treatment of gallstones

If gallstones aren’t giving you any symptoms, your doctor may suggest leaving them alone. If your gallstones start to cause problems, your doctor may refer you for further investigations and treatment.

Medicines

You may be able to manage your symptoms by taking over-the-counter painkillers like paracetamol or ibuprofen. Your doctor may prescribe stronger painkillers if you need them.

If your gallstones have caused an infection, your doctor may prescribe antibiotics. These may be given intravenously (into a vein) in hospital.

Diet

There is no special diet for gallstones, but your doctor may advise you to avoid any food or drinks that you notice make your pain worse. For more information, see our FAQ: Should I change my diet if I have gallstones? below.

Surgery

The main treatment for gallstones which give symptoms is an operation to remove your gallbladder. Your gallbladder isn’t essential, and most people don’t notice any difference without it.

The decision to remove your gallbladder may depend on how often you get symptoms, how severe they are and what problems your gallstones are causing. Your decision should also take into account your age and general health. Your doctor or surgeon can explain your options and answer any questions you may have.

An operation to remove the gallbladder is called a cholecystectomy. There are two main ways this can be done.

• Laparoscopic cholecystectomy (keyhole surgery). Your surgeon will remove your gallbladder through small cuts in your tummy (abdomen). This is the most common way to have your gallbladder removed.
• Open cholecystectomy. Your surgeon will make one large cut to remove your gallbladder. This technique is used less often but you may have it if keyhole surgery isn’t suitable for you.

Non-surgical treatment

If your doctor thinks you might have gallstones in your bile duct, they may suggest having an endoscopic retrograde cholangiopancreatography (ERCP). This uses a combination of endoscopy and X-rays to find and treat your gallstones. Your doctor passes an endoscope through your mouth down to where the bile duct opens into your intestine. They can then widen the end of the bile duct and take out the gallstones.

If an ERCP isn’t possible, your doctor may recommend a procedure called a percutaneous transhepatic cholangiogram (PTC). In a PTC, the gallstones in the bile duct are removed by passing a tube through the skin below your ribs, and into the liver.

Most people will still need to have an operation afterwards to remove their gallbladder because there may be more gallstones in it. 

Causes of gallstones

Your chance of getting gallstones increases as you get older, especially once you’re over 40.

You’re also more likely to get gallstones if you:

• are female – women are more than twice as likely to get gallstones as men
• are overweight
• have high cholesterol
• have someone in your family who has had them
• have lost weight quickly – through weight loss surgery, for example
• eat a lot of fat and refined carbohydrates but not much fibre
• have a health condition that affects your blood, such as sickle cell anaemia
• have diabetes
• have Crohn’s disease
• take hormone replacement therapy (HRT) or the pill (oral contraceptive)
• take certain medicines

Complications of gallstones

Most gallstones stay in your gallbladder; occasionally they can pass out of your system without any problems. But sometimes they can move and cause complications. They may block ducts to your internal organs, like your gallbladder, liver, pancreas and small intestine and cause inflammation, swelling or infection.

Some of the most common complications are as follows.

• Biliary colic. This is the most common complication. If gallstones move, your gallbladder or duct (connecting tube) could tighten around them causing pain. See our section on symptoms above for more information about biliary colic.
• Cholecystitis. This is an inflamed gallbladder and is the second most common problem. It can lead to a severe infection, and damage to your gallbladder. If you have an infection, you’ll need antibiotics, usually given intravenously (into a vein) in hospital.

Other complications, including those listed here, are much less common but can be more harmful.

• Jaundice. If gallstones pass out of your gallbladder and block your bile duct, the flow of bile may stop. This will make your skin and eyes look yellow.
• Pancreatitis. Gallstones may travel down your bile duct and block the opening of the pancreatic duct. This causes inflammation in your pancreas, which is a serious medical condition.
• Cholangitis. If a gallstone obstructs your bile duct, the duct may become infected. Severe cholangitis can lead to kidney, heart, breathing and liver problems.
• Gallstone ileus. If large gallstones (over 2.5cm) pass out of your gallbladder, there is a chance that they may get stuck and block your bowel.
• Gallbladder cancer. Rarely, gallstones can lead to gallbladder cancer.

If you have one of the complications of gallstones, your doctor will explain any tests and treatments they recommend.