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Gall bladder functions as an optional storage for bile, secreted by the liver .It contracts to eject high concentration of bile into the intestine when a fatty meal is consumed. It does the same when any other meal is eaten. Its a mystery why we even have a gall bladder. Since patients who have had a cholecystectomy do well without it , it seems as if, its main function is to keep doctors busy ! Liver secretes bile acids that are important to make fat soluble before it is digested and absorbed in the intestine. It also secretes cholesterol and bilirubin into the bile.The cholesterol is not always stable and can crystallize to form stones. Also soluble bilirubin when converted to free bilirubin can precipitate. The problem starts when this cholesterol crystals and precipitated bilirubin settles and stores in the gall bladder as stones. Patients with gallstones will have unstable bile, have sluggish gall bladder activity and are more prone to nucleate crystals to grow into large stones.
It is not necessary that all patients with gall stones should undergo a surgery , and only those with symptoms should be offered surgery as they are at risk for complications. It is therefore the duty of a doctor to identify , categorize and correctly advise.In case of doubt , the patient should be referred to a specialist who deals with gall bladder problems and seek their advise. Unfortunately many patients undergo unnecessary surgery just because of an incidental finding on an ultrasound.On the other hand, patient with symptoms should not delay treatment as they are at risk of complications which at times , can be life threatening. True symptoms of gall bladder stones include, acute cholecystitis, biliary colic, jaundice and acute pancreatitis with elevated enzyme levels.Out of these, biliary colic announces that the stones are ready for treatment. When gall stones are proved to be the cause of severe symptoms, cholecystectomy is the best treatment. It cures biliary colic and prevents attacks of acute pancreatitis.But doctors should carefully categorize patients with and without symptoms and then offer their patients with the best option.

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