Categories: Gastroenterology

Gallstones: The common problem

Look into symptoms, causes, and management:

The gallbladder is a small pear-shaped organ that plays a vital (but not indispensable) role in the digestion of fat. The presence of stones in the gallbladder is a common problem. Gallstone is the result of the hardening of the fluid material (bile) present in the gallbladder.

The stones once formed and causing symptoms can be treated surgically with laparoscopic (keyhole) removal of the gallbladder. The stones which are asymptomatic are usually not treated and are observed only for the development of any symptoms.

Why does gallstone form or what are the causes of gallstones?

  • If the bile in the gallbladder has a high concentration of cholesterol. This leads to the supersaturation of bile and formation of crystals leading to stone.
  • The gallbladder emptying is not proper. This leads to stagnation of bile and helps in crystallization.
  • These crystals formed, then aggregate and form larger stones.

What are the risk factors for gallstone formation?

  • Female sex
  • Obesity
  • Pregnancy
  • Increasing age
  • Ethnicity & demography: More common in Northern India

What are the symptoms of gallstone?

Gallstones can cause a variety of symptoms:

  • Pain: The typical pain of the gallstones occurs in the right upper abdomen and is associated with vomiting and/or nausea. The pain may radiate to back or sometimes to the right shoulder (usually with inflammation of the gallbladder, Acute Cholecystitis). This pain is spasmodic in nature and known as Biliary Colic.
  • Indigestion, dyspepsia, or bloating: Sometimes, gallstones can present with the same features as acidity.
  • Jaundice: If the stone slips in the bile duct, it can lead to jaundice which sometimes is the first complaint of a few patients.
  • Pancreatitis: Sometimes, the gallstones can cause inflammation of the pancreas which is known as pancreatitis. Acute pancreatitis can sometimes become life-threatening.

How the gallstones are diagnosed?

  • The gold standard investigation for the diagnosis of the gallstones is a simple ultrasound scan of the abdomen. The ultrasound is almost 100% sensitive and specific for gallstones. One does not need and other investigation to diagnose gallstones.
  • Other investigations like MRCP (Magnetic Resonance Cholangiopancreatography) is usually required when one suspects stones in the bile ducts or some complication of gallstones.
  • Blood investigations are usually non-contributory. But sometimes there might be a slight derangement of the liver functions which is usually associated with some form of complications.

What can be done to prevent gallstone formation?

  • Drink lots of water
  • Maintain a healthy weight
  • Avoid fatty foods
  • Rest other factors are unmodifiable

What are the indications for the treatment of gallstones?

  • Any symptomatic gallstone requires treatment irrespective of the size of the stones.
  • For asymptomatic stones: Patients who are having some disorders like thalassemia or sickle cell anemia, diabetes, or in some cases where there is calcification in the gallbladder (porcelain gallbladder).

How are the gallstone managed?

  • The main management of the gallstones is surgical. Medical management (Drugs like Ursodeoxycholic Acid and Chenodeoxycholic Acid) are usually not very effective. The gallstones get dissolved in only 25-30% of cases and recur in 100% cases once the drugs are stopped.
  • Laparoscopic Cholecystectomy (Removal of the gallbladder by keyhole surgery) is the mainstay of the treatment. It involves making 3-4 small incisions of ~5 mm size. The surgery is conducted through thin long instruments under the camera vision. The gallbladder is removed from one of the holes.
  • The surgery is very safe, and the risk of complications is ~1%. The surgery is usually 30 min to 60 min duration.
  • The recovery following the surgery is very fast and the patient is usually able to do his job within a few days.
  • There is usually no effect on the digestive system of the patient. The fat digestion remains normal. The diet of the patient also remains normal.

Can gallstone lead to the formation of cancer in the gallbladder?

  • There is no concrete proof that gallstone can lead to the formation of cancer in the gallbladder. It has been seen that gallbladder cancers have gallstone present in almost 97% of cases. But, if you follow gallstone long-term only a minority would develop cancer. It is believed that a single stone of size s>3 cm is a risk factor.
  • Thus, the gallstones are a common disorder that can be easily managed with a simple laparoscopic surgery. These should be treated at the first symptom development as the disease can sometimes lead to life-threatening situations.

Dr. Neeraj Goel, Clinical Lead and Senior Consultant – Gastrointestinal Oncology, Liver Transplant & HPB SurgeryDharamshila Narayana Superspeciality Hospital, Delhi

Narayana Health

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