Gall Stone Disease
What is the biliary tract?
Your biliary tract, which is made up of your gallbladder and bile ducts, helps with digestion by releasing bile.The gallbladder is a pear-shaped organ that sits just below your liver on the upper right side of your abdomen. Your gallbladder collects and stores bile — a digestive fluid produced in your liver
How common are gallstones?
Gallstones are very common, affecting 6 to 9 percent of the Adult Indian population.
What are gallstones?
Gallstones, also called cholelithiasis, are hard, pebble-like pieces of material, usually made of cholesterol or bilirubin, that form in your gallbladder.Gallstones can range in size from a grain of sand to a golf ball. The gallbladder can make one large gallstone, hundreds of tiny stones, or both small and large stones.
What causes gallstones?
Gallstones may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Researchers do not fully understand why these changes in bile occur. Gallstones also may form if the gallbladder does not empty completely or often enough. Certain people are more likely to have gallstones than others because of their risk factors for gallstones, including obesity and certain kinds of dieting.
What are the types of gallstones?
- Cholesterol stones
- Pigment stones
Cholesterol stones are usually yellow-green in color and are made of mostly hardened cholesterol. In some countries, cholesterol stones make up about 75 percent of gallstones.
Pigment stones are dark in color and are made of bilirubin.
Some people have a mix of both kinds of stones.
Who is more likely to develop gallstones?
Certain groups of people have a higher risk of developing gallstones than others.
- Women are more likely to develop gallstones than men. Women who have extra estrogen in their body due to pregnancy, hormone replacement therapy , or birth control pills may be more likely to produce gallstones.
- Older people are more likely to develop gallstones.
- People with a family history of gallstones have a higher risk.
You are more likely to develop gallstones if you have one of the following health conditions:
- Hemolytic anemias, conditions in which red blood cells are continuously broken down, such as sickle cell anemia
- Some intestinal diseases that affect normal absorption of nutrients, such as Crohn’s disease
What are the complications of gallstones?
Complications of gallstones can include:
- Inflammation of the gallbladder
- Severe damage to or infection of the gallbladder, bile ducts, or liver
- gallstone pancreatitis, which is inflammation of the pancreas due to a gallstone blockage
- Many people do not have symptoms of gallstones until they have complications.
What are the symptoms of gallstones?
If gallstones block your bile ducts, bile could build up in your gallbladder, causing a gallbladder attack, sometimes called biliary colic. Gallbladder attacks usually cause pain in your upper right abdomen, sometimes lasting several hours. Gallbladder attacks often follow heavy meals and usually occur in the evening or during the night
Gallbladder attacks usually stop when gallstones move and no longer block the bile ducts.
However, if any of your bile ducts stay blocked for more than a few hours, you may develop gallstone complications.
Most people with gallstones do not have symptoms. Gallstones that do not cause symptoms are called silent gallstones. Silent gallstones don’t stop your gallbladder, liver, or pancreas from working, so they do not need treatment.
See a doctor right away if you are having these symptoms during or after a gallbladder attack:
- Pain in your abdomen lasting several hours
- Nausea and vomiting
- fever—even a low-grade fever—or chills
- yellowish color of your skin or whites of your eyes, called jaundice
- tea-colored urine and light-colored stools
These symptoms may be signs of a serious infection or inflammation of the gallbladder, liver, or pancreas. Gallstone symptoms may be similar to symptoms of other conditions, such as appendicitis, ulcers, pancreatitis, and gastroesophageal reflux disease, all of which should be treated by a doctor as soon as possible.
Gallstone complications can occur if your bile ducts stay blocked. Left untreated, blockages of the bile ducts or pancreatic duct can be fatal.
How do doctors diagnose gallstones?
Doctors use your medical history, a physical exam, and lab and imaging tests to diagnose gallstones.
A health care professional may take a blood sample from you and send the sample to a lab to test. The blood test can show signs of infection or inflammation of the bile ducts, gallbladder, pancreas, or liver.
Health care professionals use imaging tests to find gallstones.
Ultrasound is the best imaging test for finding gallstones. Ultrasound uses a device called a transducer, which bounces safe, painless sound waves off your organs to create an image or picture of their structure. If you have gallstones, they will be seen in the image. Sometimes, health care professionals find silent gallstones when you don’t have any symptoms.
Computed tomography (CT) scan.
CT scans use a combination of x-rays and computer technology to create images of your pancreas, gallbladder, and bile ducts. CT scans can show gallstones, or complications such as infection and blockage of the gallbladder or bile ducts. However, CT scans also can miss gallstones that you may have.
Magnetic resonance imaging (MRI).
MRI machines use radio waves and magnets to produce detailed images of your organs and soft tissues without x-rays. MRIs can show gallstones in the ducts of the biliary tract.
Cholescintigraphy—also called a hydroxyl iminodiacetic acid scan, HIDA scan, or hepatobiliary scan—uses a safe radioactive material to produce pictures of your biliary tract. You’ll lie on a table while a health care professional injects a small amount of the radioactive material into a vein in your arm. The health care professional may also inject a substance that causes your gallbladder to squeeze. A special camera takes pictures of the radioactive material as it moves through your biliary tract. Doctors use cholescintigraphy to diagnose abnormal contractions of your gallbladder or a blockage in the bile ducts.
Endoscopic retrograde cholangiopancreatography (ERCP).
ERCP combines upper gastroendoscopy and x-rays to treat problems of your bile and pancreatic ducts. ERCP helps the health care professional locate the affected bile duct and the gallstones. This test is more invasive—or involves more instruments inside your body—than other tests. Doctors use it selectively, usually to remove a gallstone that is stuck in the common bile duct.
TREATMENT FOR GALLSTONES
How do health care professionals treat gallstones?
If your gallstones are not causing symptoms, you probably don’t need treatment. However, if you are having a gallbladder attack or other symptoms, contact your doctor. Although your symptoms may go away, they may appear again and you may need treatment. Your doctor may refer to you a gastroenterologist or surgeon for treatment.
The usual treatment for gallstones is surgery to remove the gallbladder. Doctors sometimes can use nonsurgical treatments to treat cholesterol stones, but pigment stones usually require surgery.
Your doctor may recommend a cholecystectomy if you have:
- Gallstones in the gallbladder (cholelithiasis)
- Gallstones in the bile duct (choledocholithiasis)
- Gallbladder inflammation (cholecystitis)
- Large gallbladder polyps (see below )
- Pancreas inflammation (pancreatitis) due to gallstones
Surgery to remove the gallbladder, called cholecystectomy, is one of the most common operations performed on adults . The gallbladder is not an essential organ, which means you can live normally without a gallbladder.
A health care professional will usually give you general anesthesia for surgery.
Surgeons perform two types of cholecystectomy:
Minimally invasive (laparoscopic) cholecystectomy
During a laparoscopic cholecystectomy, the surgeon makes four small incisions in your abdomen. A tube with a tiny video camera is inserted into your abdomen through one of the incisions. Your surgeon watches a video monitor in the operating room while using surgical tools inserted through the other incisions in your abdomen to remove your gallbladder.
Next you may undergo an imaging test, such as an X-ray or ultrasound, if your surgeon is concerned about possible gallstones or other problems in your bile duct.
Then your incisions are sutured, and you’re taken to a recovery area. A laparoscopic cholecystectomy takes one or two hours.
A laparoscopic cholecystectomy isn’t appropriate for everyone. In some cases your surgeon may begin with a laparoscopic approach and find it necessary to make a larger incision because of scar tissue from previous operations or complications.
A surgeon performs an open cholecystectomy when your gallbladder is severely inflamed, infected, or scarred from other operations. Your doctor may perform a cholecystectomy if problems occur during a laparoscopic cholecystectomy
Traditional (open) cholecystectomy
During an open cholecystectomy, the surgeon makes a 6-inch (15-centimeter) incision in your abdomen below your ribs on your right side. The muscle and tissue are pulled back to reveal your liver and gallbladder.Your surgeon then removes the gallbladder.The incision is sutured, and you’re taken to a recovery area.An open cholecystectomy takes one or two hours.
What happens after gallbladder removal?
Once the surgeon removes your gallbladder, bile flows out of your liver through the hepatic duct and common bile duct and directly into the duodenum, instead of being stored in the gallbladder.
A small number of people have softer and more frequent stools after gallbladder removal, because bile now flows into your duodenum more often. Changes in bowel habits are usually temporary; however, discuss them with your doctor
All surgeries come with a possible risk of complications; however, gallbladder surgery complications are very rare.
A cholecystectomy carries a small risk of complications including:
- Bile leak
- Injury to nearby structures, such as the bile duct, liver and small intestine
- Risks of general anesthesia, such as blood clots and pneumonia
You may need one or more additional operations to repair the bile ducts or other complications Your risk of complications depends on your overall health and the reason for your cholecystectomy.
What you can expect?
Before the procedure
A cholecystectomy is performed using general anesthesia, so you won’t be aware during the procedure. Anesthesia drugs are given through a vein in your arm.
Once the drugs take effect, your health care team will insert a tube down your throat to help you breathe.
Your surgeon then performs the cholecystectomy using either a laparoscopic or open procedure.
During the procedure
Depending on your situation, your surgeon will recommend one of two surgical approaches:
A tube is placed thorugh your nose into your stomach for decompression of gas/liquid
After the procedure
You’ll be taken to a recovery area as the anesthesia drugs wear off. Then you’ll be taken to a hospital room to continue recovery. Recovery varies depending on your procedure:
Laparoscopic cholecystectomy. People are often able to go home the same day as their surgery, though sometimes a one-night stay in the hospital is needed. In general, you can expect to go home once you’re able to eat and drink without pain and are able to walk unaided. It takes about a week to fully recover.
Open cholecystectomy. Expect to spend two or three days in the hospital recovering. Once at home, it may take four to six weeks to fully recover.
Doctors use nonsurgical treatments for gallstones only in special situations, like if you have cholesterol stones and you have a serious medical condition that prevents surgery. Even with treatment, gallstones can return. Therefore, you may have to be regularly treated for gallstones for a very long time, or even for the rest of your life.
A doctor may use the following types of nonsurgical treatments to remove or break up cholesterol gallstones:
Endoscopic retrograde cholangiopancreatography (ERCP). Sometimes doctors use ERCP to remove a gallstone that is stuck in the common bile duct.
Oral dissolution therapy. Ursodiol are medicines that contain bile acids that can break up gallstones. These medicines work best to break up small cholesterol stones. You may need months or years of treatment to break up all stones.
Shock wave lithotripsy. A doctor can use shock wave lithotripsy to blast gallstones into small pieces. Doctors use this procedure only rarely, and sometimes along with ursodiol.
Cholescystostomy A temporising measure in moribund patients with severe infection of the gall bladder a doctorcan placed a Ultrasound guided tube through the abdominal wall into the gall bladder . The patient will require a definitive surgery late once the acute crisis tides over .