 So, we've already had a look at what gallstones are. We looked at the types of gallstones, what the risk factors are and what you can do to prevent getting gallstones. We also mentioned how common gallstones are and that most people will have gallstones without even knowing about it. They are asymptomatic. We use the term gallbladder disease in all patients who develop symptoms because of their gallstones. The most common problem caused by gallstones is uncomplicated gallstone disease otherwise known as biliricolic or a gallbladder attack. So you've just had an attack of severe right-sided upper abdominal pain and together with that you might have experienced some nausea or even vomiting. Usually that follows a large meal, specifically dinner and if there's a lot of fat in the dinner and that means it usually occurs at night. For most people this pain will only last for about half an hour up to several hours but then disappears. If the pain disappears before you seek medical help there's about an 85% chance that you might develop further attacks. When you do get to hospital you'll get an ultrasound to confirm the presence of gallstones. If your symptoms were very specific for biliricolic and they didn't find stones we might ask you to come back in about two weeks time so we can just do another ultrasound to look for missed stones. During the ultrasound they'll also check for other complications of gallstone disease. You might also have your blood drawn to look for diseases of the liver, complications where the stone lands up in the bile ducts or even blocks the pancreatic duct leading to pancreatitis. It is good practice to give patients with biliricolic some good analgesia. If you had severe nausea and vomiting you might also get intravenous fluids just to replace that water and the lost electrolytes. So why did all of this happen? Let's have a look at this image of the gallbladder full of stones. One of the stones are migrated to the opening of the cystic duct. Now the cystic duct connects the gallbladder with the biliri tree and that is where the bile runs back and forth. After a meal, especially a fatty meal, chemicals will be released from the duodenum that is your small bowel when food reaches it from your stomach. This chemical goes through your bloodstream and acts on the smooth muscle cells in the wall of the gallbladder causing contraction. The stone will then block the flow of bile and that causes severe pain as the gallbladder spasms up. The attack is relieved as that stone drops back into the gallbladder. As I mentioned your chances of getting another attack are quite high. So in most cases we will recommend that you undergo removal of your gallbladder. That is a colisostectomy usually done laparoscopically. Since this is not an absolute emergency we might book this on the next elective list. This will of course happen only if you are fit for surgery. If not, we might embark on expectant therapy and in most cases that will only involve simple analgesia. That is where you will be given analgesics just to take care of those acute attacks of pain. The reason why most surgeons will suggest a colisostectomy is that the risk factors for complicated gallstone disease are higher than the complications due to the surgery. If you are going to have surgery of course always discuss the benefits and the risks of that surgery. There are alternatives to the removal of the gallbladder. The most common alternative for my therapy is dissolution of the gallstones. Now there are products on the market that can dissolve certain stones. Unfortunately dissolution therapy fails in most cases. That is not something that we use routinely. Lithotripsy that is where external shockwaves are used to crack up those gallstones unfortunately have no place in the management of gallstones. Biliricolic is a severe attack of pain. Fortunately, most people with gallstones will never have symptoms at all. If you do suffer about a biliricolic and the pain persists, really do seek some medical advice. Pain that persists is really the first symptom of colisostitis and that is complicated gallstone disease. I hope you found this video informative. Please subscribe and hit that notification bell so that when I do release new videos you will be the first one to know about it.