Gall stones – in a nut-shell….

Health

A weekly column prepared by Dr. Balwant Singh’s Hospital Inc.

By Dr Anirban Banerjee, MS, MRCS  (Consultant Surgeon)

Gallstones are solid pebble-like collections that form inside the gallbladder. The gallbladder is located in the right upper abdomen, under the liver. The primary purpose of the gallbladder is to store and concentrate bile, a greenish-brown fluid that is produced by the liver. Bile is needed for digestion and absorption of fatty foods, as well as for the absorption of important fat soluble vitamins.

What are gallstones?

Gallstones are collections of solid material that form inside the gallbladder. Stones can form in the gallbladder if there is a change or imbalance in the composition of bile or incomplete emptying of the gallbladder.

The number of gallstones varies from one person to another. Gallstones may be as small as tiny specks or as large as the gallbladder itself.

Gallstones are of two major types, cholesterol or pigment. Cholesterol gallstones account for approximately 80 per cent of gallstones and pigment stones for about 20 per cent.
Cholesterol stones
Pigment stones

Why do gallstones develop?

The exact reason why gallstones develop is not known. However, there are a number of factors that increase the risk of gallstones. About 1 in 3 women, and 1 in 6 men, form gallstones at some stage in their lives. Gallstones become more common with age. The risk of forming gallstones increases with pregnancy, obesity, rapid weight loss, and if you take certain medicines such as the contraceptive pill.

What problems can gallstones cause?

Most people with gallstones do not know they have them. It is common to have stones in the gallbladder that cause no symptoms.

About 3 in 10 people with gallstones develop symptoms or problems. These include:

●  Billiary colic: This is a severe pain in the upper abdomen. The pain is usually worse on the right-hand side, just below the ribs. It is caused by a stone that gets stuck in the cystic duct (small tube that takes bile from the gallbladder to the bile duct). The gallbladder then squeezes hard to dislodge the stone, and this causes pain. Pain from billiary colic can last just a few minutes, but more commonly lasts several hours. A severe pain may only happen once in your lifetime, or it may flare up from time to time. Sometimes less severe pains occur now and then, particularly after a fatty meal when the gallbladder contracts most.

●  Inflammation of the gallbladder: This is called cholecystitis. This can lead to infection in the gallbladder. Symptoms usually develop quickly and include abdominal pain, fever, and being generally unwell.

● Complications of gallstones: Complications can develop if gallstones move and block an area where bile exits (a condition known as choledocholithiasis).

1. Jaundice is a yellow discoloration of the skin and eyes.

2. Acute cholangitis is an infection of the bile ducts that causes pain, chills, and fever. This requires prompt treatment, usually involving removal of the gallstone with retrieval of stone from the bile tube.

3. Acute pancreatitis is the sudden onset inflammation of the pancreas, which is associated with severe abdominal pain.

How to diagnose gall bladder stones?

There are two aspects to the diagnosis of gallstones: determining if gallstones are present, and determining if gallstones are the cause of symptoms.

Gallstones are most commonly detected using ultrasound, a painless test that uses sound waves to create an image of the gallbladder. Gallstones can also be seen on other imaging tests such as a CT scan or endoscopic ultrasonography.

What are the treatments for gallstones?

Surgery

An operation to remove the gallbladder is the usual treatment if you have symptoms caused by gallstones. Different techniques to remove the gallbladder may be recommended depending on its site, size, and other factors.

Key-hole surgery is now the most common way to remove a gallbladder. The medical term for this operation is laparoscopic cholecystectomy (here commonly known as laser surgery though it’s in no way related to laser). It is called key-hole surgery as only small cuts are needed in the abdomen. The operation is done with the aid of a special telescope that is pushed into the abdomen through one small cut. This allows the surgeon to see the gallbladder.

Some people with gallstones need a traditional operation to remove the gallbladder. This is called cholecystectomy. In this operation a larger cut is needed to get at the gallbladder.

What are the advantages of performing surgery laparoscopically?

Rather than a five to seven inch incision, the operation requires only four small openings in the abdomen.
Patients usually have minimal post- operative pain. Patients usually experience faster recovery than open gallbladder surgery patients.
Most patients go home within one day and enjoy a quicker return to normal activities.

Medication

Taking a medicine called ursodeoxycholic acid may sometimes ‘dissolve’ small stones. This may take years of treatment, is not usually successful, and therefore not commonly used. The main disadvantage of the non-surgical treatment option is that gallstone recurrence is possible. With oral therapy, stones recur in about 50 per cent of patients in the first five years.

What can be the effect after removal of gallbladder?

You do not need a gallbladder to digest food. Bile still flows from the liver to the gut once the gallbladder is removed. You can usually eat a normal diet without any problems after your gallbladder is removed. However, up to half of people who have had their gallbladder removed have some mild abdominal pain or bloating from time to time. This may be more noticeable after eating a fatty meal. Some people notice an increase in the frequency of passing stools after their gallbladder is removed.



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