Gallstones are extremely common and do not cause any symptoms in a majority of people. It is estimated that two thirds of all gallstone disease goes undetected. However, when symptoms do occur, they are quite distressing and include features of severe pain in the abdomen which could represent either inflammation or infection of the gallbladder or inflammation of the pancreas (acute biliary pancreatitis). This could be accompanied by fever, which is likely to represent an infection of the gallbladder (cholecystitis).
Surgery is the main method of treatment when these complications of gallstone disease occur. The timing of surgery depends on the stage at which the patient presents to the surgeon.
Understanding the Gallbladder, Gallstones and Bile Production
Bile is a greenish coloured fluid produced by the liver. It contains substances which help in digestion and absorption of the food and nutrients we consume. Bile which is produced by the cells of the liver (hepatocytes) is transported via a network of ducts which progressively join together like the branches of a tree to drain into the small intestine. The main bile duct which drains into the origin of the small intestine (duodenum) is called the Common bile duct. The Gallbladder functions as an organ which stores bile and is connected to the common bile duct via a small duct called the cystic duct. When food enters the small intestine from the stomach, the gall bladder contracts and releases the stored bile into the small intestine.
Gallstones are formed when bile gets concentrated forming stones. Gallstones commonly contain lumps of fatty (cholesterol-like) material that has solidified and hardened. Sometimes bile pigments or calcium deposits form gallstones. Sometimes just a few small stones are formed; sometimes a great many. Occasionally, just one large stone is formed. About one in three women, and one in six men, form gallstones at some stage in their life. Gallstones become more common with increasing age. The risk of forming gallstones increases with pregnancy, obesity, rapid weight loss, having a close relative with gallstones, diabetes and if you take certain medicines such as the contraceptive pill.
What complications can Gallstones cause?
- May not cause any problems at all – Most Gallstones are detected on an Ultrasound scan of the abdomen done for another ailment.
- Biliary Colic – Severe Pain in the right side of the abdomen below the ribs on that side. It is caused by a gall stone getting stuck in the cystic duct as the gallbladder tries to contract to excrete bile.
- Inflammation of the gall bladder – Cholecystitis – This can lead to an infection of the gall bladder.
- Jaundice – This is an uncommon complication and this happens when a Gallbladder stone slips down the main bile duct and causes an obstruction to the passage of bile from the liver to the small intestine. The patient in this case might need an operation to relieve the obstruction and the gall bladder needs to be removed via a laparoscopic cholecystectomy to prevent the recurrence of this condition.
- Pancreatitis – Gallstone induced pancreatitis is the commonest cause of acute or suddenly developing pancreatitis and it is managed by treating the pancreatitis initially followed by removal of the Gallbladder via a laparoscopic cholecystectomy to take care of the root cause.
- Other complications – infection of the bile ducts (cholangitis), obstruction of the bowel and other uncommon problems do occur and need to be assessed and treated as the need arises.
Diagnosis of Gallstones – How are Gallstones detected?
Ultrasound scans are the first line of treatment. Sometimes symptoms may mimic other conditions like Gastric ulcer disease, Irritable Bowel syndrome, Tumours in the upper abdomen etc. In these cases, further testing by endoscopy or more advanced scanning may be required.
What is the treatment for Gallstones?
In many cases No Treatment may be required if the gallstones are not causing any symptoms.
However, if the presence of Gallstones leads to development of any of the above symptoms it is preferable to get the same treated. The standard modality of treatment is by performing a Laparoscopic Cholecystectomy which is a key-hole procedure done to remove the gall bladder and the stones it contains.
This is one of the most commonly performed surgeries by an experienced surgical gastroenterologist and the complication rates are low. In the presence of severe inflammation and adhesions it may need to be a conventional open procedure in order to prevent injury to the bile ducts and important vessels which supply the liver.
What happens after the Gallbladder is removed – are there any aftereffects?
The gallbladder is not essential for digesting food. Bile still flows from the liver to the gut once the gallbladder is removed. However, there is no longer any storage area for bile between meals. The flow of bile is therefore constant, without the surges of bile that occur from a gallbladder when you eat a meal.
A normal diet can be consumed after removal of the gallbladder without any major complications. In a few patients, symptoms of bloating can persist, especially after consuming a fatty meal. This can be controlled with appropriate medication.
How we can help?
Get in touch with the specialists at SIGMA Gastrocare for all queries and questions related to Gallstones and other Gallbladder conditions. We will be glad to help.
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