A common medical condition,often asymptomatic and discovered incidentally,gallstones are a concern for every health-conscious individual.It is so common that in my clinical practice,one out of four patients have a report suggestive of gallstone disease.
What are these stones actually? Do all stones need treatment?
Background
Gallstones refers to hardened deposits of bile(digestive fluid secreted from liver)within the gallbladder. The gallbladder is a small pear-shaped organ located beneath the liver on the right side of your abdomen.Bile helps in fat digestion.If a fatty meal is eaten, then the gallbladder is signaled to contract and to squeeze some stored bile into the common bile duct where it’s passed into the small intestine to mix with food.When the bile accummulates in the gallbladder, they form stones.
These stones can range dramatically in size from tiny grains to golf-ball sized pieces.Whether these become symptomatic depends on the size and the location.Interestingly,large stones may be asymptomatic while small ones during their passage into intestines may get stuck inside the bile duct and cause recurrent episodes of pain.
What is the composition of gallstones?
Gallstones can be either cholesterol rich or pigment stones(bilirubin) or mixed which is by far,the commonest variety.
When am I at risk for contracting gallstone disease?
The causation is multifactorial.Some of the most common risk factors are:
Obesity
Age >40 years
Female gender
Oral Contraceptive Pills usage
Sudden loss of weight
Liver diseases
Malabsorption diseases like Crohn’s disease
Drugs such as some antibiotics and diuretics.
Family history
What are the symptoms?
A majority of these patients might be asymptomatic.A good number of patients would come to know of the condition while taking an Ultrasound of the Abdomen for unrelated reasons. Symptoms develop usually when the stone(s) get dislodged from the gland and gets stuck in the duct.
The commonest manifestations would be:
Sudden and rapidly intensifying pain in the upper right portion or towards the middle of your abdomen
Pain over the right shoulder
Chest pain and/or backache
Nausea and vomiting
Jaundice-yellowish discolouration of eyes and urine.
Repeated attacks.
How is this condition diagnosed?
A simple Ultrasound study of the abdomen can effectively pick up stones.Advanced modalities like MRCP(Magnetic resonance cholangiopancreatography),ERCP ( Endoscopic retrograde cholangiopancreatography) and EUS(Endoscopic UltraSound) might be needed in some cases especially when the patient has jaundice suggestive of an obstructive stone in the duct.
Are there any complications if left untreated?
You might experience recurrent episodes of infection of your gallbladder(a condition termed as Cholecystitis) with each subsequent attack severe than its predecessor.
Jaundice with derangement of liver function over time.
Rupture of the gallbladder in severe cases.
Infection may concomitantly affect other organs such as pancreas leading to sepsis and high mortality risk.
Intestinal obstruction by a slipped stone,though quite rare.
What is the treatment?
Silent stones are left untouched if imaging also does not reveal findings suggestive of past infections.These patients need to be kept on follow-up only.However if they have ever been symptomatic,you need to get them treated as complications can be fatal.
Medical management
Medications to dissolve these stones are in use; however the efficacy is quite low and the duration is controversial.Usually these are given until definite surgical management is undertaken.
Surgical management
The standard of care is the surgical removal of the gallbladder thereby removal of the source.The gold standard of treatment of gallstones is Laparoscopic Cholecystectomy-surgical removal of the gallbladder by keyhole surgery.It is one of the most common operations done worldwide and the complications are minimal in experienced hands.
Open surgery is done only in complicated cases.
However if the patient has gallstones both in the gallbladder and the bile duct,the minimally invasive technique of ERCP can be initially employed to remove the stones in the duct,to be followed up with surgical removal of gallbladder,usually after 4 weeks.
Some common questions encountered in my clinical practice
1. How can I digest fatty foods after my gallbladder has been removed?
Once your gallbladder has been removed,the bile will flow directly from the liver(remember that liver produces bile and gallbladder is only a storehouse for it) to the small intestine.There might be a period of temporary discomfort which would settle in a couple of weeks.
2. Can gallstones be prevented?
You can reduce the risk of gallstones only,if you observe a few steps:
Do not skip meals and try not to be erratic with the timings.
High-fibre diet.
Lose weight slowly; rapid reduction of weight increases the risk for gallstones.
Always see to it that you maintain a healthy weight.
3. Can I have gallstones more than once?
Yes,you can! Remember that if you have had one episode of colic due to gallbladder inflammation,you are always at an increased risk for the same.
4. What are the dietary modifications I must adopt?
High fibre foods such as whole grains,fruits and vegetables to be included more.
Low-fat dairy products like cheese and milk.
Cut down high calorie fried foods.
Reduce the intake of meat.
Adequate hydration.
5.Whom should I visit if I have gallstones?
You must visit a General Surgeon or a Surgical Gastroenterologist .They would advise you regarding the management options and the timing of interventions.
Still have any queries? Feel free to ask in the comments section below!
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