Gallstones are real stones of bile that can develope in your gallbladder. Your gallbladder is a pear-shaped sac adjacent to your liver.The gallbladder stores a digestive fluid which helps digestion in small intestine .It facilitates digestion of fats.
Gallstones range in size from small like lentils to bigger even 5 cm Some patient has only one big other has multiple small gallstones.In middle east gallstone incidence rate is around 30 % of population.
Gallstones cause problems to patients like pain in upper abdomen.People who experience symptoms from their gallstones usually require gallbladder removal surgery.
At the moment we don’t know any other effective treatment for symptomatic cholelithiasis(gallstone ) but surgery. Conservative treatment with diet just can gives window period not a life length solution.
What are the reasons for gallstones?
Gallstones may develop when there is too much cholesterol in the bile secreted by your liver. Bile has a role of breaks down cholesterol. But if your liver makes more cholesterol than your bile can process, hard stones may develop.
Other causes include the following:
Local infection in your Gallbladder
Bilirubin is a chemical produced when your liver destroys old red blood cells. Some conditions such as cirrhosis of the liver and certain blood disorders cause your liver to produce more bilirubin than it should. Stones form when your gallbladder cannot break down the excess bilirubin. These hard substances are also called pigmented stones.
Motility problem occurs to gallbladder
If bile becomes over concentrated then around a small piece of squamous cell core many outer layers can develop like onion peels.
Who Is at Risk for Gallstones?
You may be at risk if you have one or more of the following risk factors:
Common factors :4 F syndrome(female, fatty, fourty, fertile)
- over the age of 40
- Native American or Hispanic descent
- cirrhosis of the liver
- on a low-calorie diet that leads to rapid weight loss after bariatic surgery and excessive weight loss like 50 kg, in 30% gallstone can develope
What Are the Symptoms of Gallstones?
When you don’t have abdominal symptoms you may have silent gallstones. When symptoms are present, you may experience:
- pain in your upper abdomen (normally on the right side or in the middle)radiating to your back(across the body)grabing colic pain for a couple of hours after eating
- fever(just in complicated cases with infection of gallbladder)
- a yellowish tint in your skin or eyes (jaundice) complicated cases with obstruction of bile
- nausea or vomiting(quite common symptoms)
- clay-colored stools(complicated case)
Getting a diagnosis
Your doctor will ask you about your previous history of your medical health, your exsisting symptoms and other general and specific questions which eill be followed p a physical examination that includes a total and detailed abdominal examination,including your sclera and skin colour. Too much bilirubin in your body causes jaundice (yellowish skin and sclera colour.)
After physical examination and taking previous history your doctor will ask Ultrasoud scan and blood test. If patient has any other abdominal symptoms elsewhere, then a abdominal CT scan should be performed also.
Abdominal CT Scan
This is an imaging test that takes pictures of your liver and abdominal region.
Ultrasound tests produce images of your abdomen. US scan is the gold standard diagnostic procedure as not working with radiation, sensitive , provides detailed report, repeatable ,comparable and cheap.
MRCP- kind of magnetic resonancy test,invented for biliary system. Mostly functional test.
Your doctor may order blood tests that measure the amount of bilirubin in your blood. The tests also gauge how well your liver is functioning.
Treatment fo gallstones
Your doctor may use any of several treatment options to remove stones or improve your condition.
Surgery is often the first option if you have symptoms. A surgeon may perform a commonly used technique called laparoscopic gallbladder removal.
General anesthesia is required. Three to four incisions are made on your abdomen. The surgeon inserts a small, lighted device into one of the incisions and carefully removes your gallbladder. You usually go home on the day of the procedure if you have no complications.
Drugs that dissolve gallstones caused by cholesterol are an option if you cannot undergo surgery. These medications may take several years to eliminate the gallstones.
Cholecystitis is inflammation of the gallbladder. Cholecystitis is an advanced, complicated form of gallstone problems.It happens when a small stone blocks the cystic duct(connecting duct between common bile duct,and gallbladder).If it starts causes thickening of gallbladder wall becomes edematous and swollen the entire gallbladder.
Gold standard for treatment of cholecystitis is laparoscopic gallbladder removal in first 48-72 hours after beginning of symptoms.
If left untreated, cholecystitis can lead to serious, sometimes life-threatening complications, such as a gallbladder perforation .
Signs and symptoms of cholecystitis may include:
- Severe pain in your upper right abdomen
- Pain that radiates from to your right shoulder or back
- Tenderness over your abdomen when it’s touched(peritoneal irritation)
Reasons for cholecystitis(infection of gallbladder)
- Gives a continuous irritation on gallbladders wall and there is a persisting chronic infection which turns occasionally to acute infection.
Bile duct blockage. Kinking or scarring of the bile ducts can cause blockages that lead to cholecystitis.
Treatment for cholecystitis usually involves a hospital stay to stabilize the gallbladder inflammation and possible surgery.
If you’re diagnosed with cholecystitis, you’ll likely be hospitalized. Your doctor will work to control your signs and symptoms and to control the inflammation in your gallbladder. Treatments may include:
- Antibiotics to fight infection.(as this one is bacterial infection)
- Pain medications.(symptomatic treatment)
Your symptoms are likely to subside in a day or two.
Surgery to remove the gallbladder
Indication for gallbladder removal:
-symptomatic gallstone problem, even with single gallstones, for young patients
-asymptomatic gallstones-especially with multiple gallstones and for young patients
-Cholecystitis is absolute indication for gallbladder removal.if symptoms are within the 72 hours from beginning then immediately considering general health condition.
-Silent, asymptomatic gallstones are relative indication, for example before pregnancy.
Cholecystectomy is most commonly performed(99%) using laparoscopic camera system via three or four tiny holes.
This is less invasive way to remove gallbladders comparing to old fashioned open cholecystectomy which is performed by big hole on abdominal wall.
Once your gallbladder is removed, bile flows directly from your liver into your duodenum rather than being stored in your gallbladder. Human body can compensate the absence of gallbladder.