Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. The liquid, called bile, is used to help the body digest fats. Bile is made in the liver, then stored in the gallbladder until the body needs to digest fat. At that time, the gallbladder contracts and pushes the bile into a tube—called the common bile duct—that carries it to the small intestine, where it helps with digestion.
The two types of gallstones are cholesterol stones and pigment stones. Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or almost any combination.
Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason.
The cause of pigment stones is uncertain. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders, such as sickle cell anemia, in which too much bilirubin is formed.
Other Factors:
- Obesity
- Weight Loss in excess
- Hormonal Pills
- Cholesterol lowering Drugs
- Diabeties
- Ladies Above 40 yrs of age
Symptoms of gallstones are often called a gallstone "attack" because they occur suddenly. A typical attack can cause
- Steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours
- Pain in the back between the shoulder blades
- Pain under the right shoulder
- Nausea or vomiting
Other gallstone symptoms include
- Abdominal bloating
- Recurring intolerance of fatty foods
- Colic
- Belching
- Gas
- Indigestion
- Chills
- Low-grade fever
- Yellowish color of the skin or whites of the eyes
- Clay-colored stools
Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called "silent stones." They do not interfere with gallbladder, liver, or pancreas function, and may not need treatment. But a regular followup is advised.
- Ultrasound of the Abdomen
- Computed tomography (CT) scan
- Magnetic resonance cholangiogram
- Cholescintigraphy (HIDA scan)
- ERCP: Endoscopic retrograde cholangiopancreatography
- Blood tests.
The gallstones can enter the bile ducts and cause obstructive jaundice which can lead to increased pressure and infection of the biliary system - Cholengitis
The gallstones can block the opening of the pancreatic duct and cause inflammation of the pancreas - Pancreatitis
SURGERY
Laparoscopic Cholecystectomy:
In this procedure, the surgeon uses a video camera and highly specialized tools to remove the gallbladder without making a large surgical incision. Instead, the surgeon creates four very small incisions. One of these holes is made in or near the patient’s navel so that the surgeon can insert a special instrument called the laparoscope. The laparoscope is a long, rigid tube that is attached to a tiny video camera and a light. Before the laparoscope is inserted, the patient’s abdomen is distended with an injection of carbon dioxide gas, which
allows the surgeon to see inside the body. Once the laparoscope has been inserted, the
surgeon then guides the laparoscope while watching the view it provides on a video monitor. The other small incisions are made in the abdomen; two of them are on the right
side below the ribcage, and one is in the
upper portion below the sternum, or breast- bone. Other specialized instruments are placed through each of these three incisions.
Two instruments are used to grasp and retract the gallbladder and the third to free the gallbladder from its attachments.
The surgeon will use an electrocautery device to cut free the gallbladder. Once the gallbladder has been cut free, the surgeon collapses the organ and removes it through the incision at the navel. After the operation, patients are usually back on their feet and on their way home within 3- 4 days. Many return to work within a week to 10 days. Once healed, the scars left from the four incisions are so small that they are barely noticeable.
It is estimated that in about one in ten cases during a laparoscopic operation, the surgeon discovers a problem, such as a severely diseased gallbladder or an excessive amount of inflammation, that requires the performance of a conventional operation . Because the surgeon cannot see the gallbladder in detail till the laparoscope is inserted during the operation, some complications cannot be predicted and are only discovered once the operation has begun. Thus, patients should understand that there is a possibility of having to undergo a conventional cholecystectomy.
In conventional cholecystectomy, the surgeon makes an incision that is approximately four to six inches long. The incision is made either longitudinally (up and down) in the upper portion of the abdomen, or obliquely (at a slant) beneath the ribs on the right side. During some operations, drains may be
inserted into the abdomen, which usually will be removed while the patient is still in the hospital.
The most common complication in gallbladder surgery is injury to the bile ducts. An injured common bile duct can leak bile and cause a painful and potentially dangerous infection. Mild injuries can sometimes be treated non surgically. Major injury, however, is more serious and requires additional surgery.
If gallstones are in the bile ducts, the physician may use ERCP to locate and remove them before or during the gallbladder surgery. In ERCP, the patient swallows an endoscope—a long, flexible, lighted tube connected to a computer and TV monitor. The doctor guides the endoscope through the stomach and into the small intestine. The doctor then injects a special dye that temporarily stains the ducts in the biliary system. Then the affected bile duct is located and an instrument on the endoscope is used to cut the duct. The stone is captured in a tiny basket and removed with the endoscope.Occasionally, a person who has had a cholecystectomy is diagnosed with a gallstone in the bile ducts weeks, months, or even years after the surgery. The two-step ERCP procedure is usually successful in removing the stone.
Nonsurgical approaches are used only in special situations—such as when a patient has a serious medical condition preventing surgery—and only for pure cholesterol stones.
