IntroductionWe would have heard about stones in the kidneys and how painful it can be, similarly, stones can form in the gallbladder leading to pain, infection and other major complications. It is common in women, mothers after their deliveries, people who are obese or have high blood cholesterol and people who lose weight rapidly, it is often mistaken for acidity like pain (gastritis) hence a delay in seeking medical help. The treatment of gallstones causing symptoms is almost always surgical removal of the gallbladder with the stones.
Gallstones, How and Why? In layman terms, the liver in human body synthesizes and secretes the bile juice (golden yellow) that is important in the digestion of fatty foodstuffs. The bile from the liver flows into two tubes/ducts that unite to form a single duct called as the common hepatic duct. Cystic duct form the gallbladder joins the common hepatic duct to form the common bile duct that ends in the second part of the duodenum (which continues below as rest of small intestine and above as stomach). The function of the gallbladder is to thicken the bile (golden yellow/dark green). The thick bile from the gallbladder is expelled out at times of need.
The thick bile has sediments (bile salts and bile pigments); these along with cholesterol form the basis of the gallstones. The stones can be of variable size (few mm to few cm), different shapes and consistency (soft, hard). Once the stones form, they keep moving in the gallbladder as based on the size, the smaller ones can go across the cystic duct, into the common bile duct and pass into the duodenum. In some young adults and children, there can be an increased breakdown of red blood cells leading to an increased load of the bile pigment bilirubin leading to stone formation.
Gallstones and its effects
AsymptomaticFew individuals are lucky enough to have no troubles due to gallstones for many years even after diagnosis. It is difficult to say which patient will develop symptoms and which patients will not.
DiagnosisUsually, gallstones are seen on routine ultrasound scans of the abdomen. CT scan also would show stones but not always. Blood tests are done when the doctor suspects an infection, jaundice or pancreatitis. When a stone is suspected to be in the bile ducts, then the doctors perform a test called as MRCP, it's an MRI scan referred to as Magnetic resonance cholangiopancreatography. When going for such scans, it is advisable to check and disclose any metal implants (small or big) that would have been inserted into the body.
There are many forms of alternative remedies available that claim to dissolve the stones completely. I cannot comment on these are I'm not an expert in those fields.
Traditional open surgery (Open Cholecystectomy) would involve a cut or incision below the right lower rib cage in the upper abdomen. The recovery for this open operation takes a long time with prolonged pain for a few days that increases hospital stay and need for medications.
Key-hole gallbladder surgery (Laparoscopic Cholecystectomy) is almost a day care procedure or with an overnight stay. Three to four small incisions (5mm-10mm) are made to facilitate removal of the gallbladder and the stones. Recovery is faster, hospital stay and the need for medications is lesser and hence early return to normal activities and work.
Advances in gallbladder surgeryThere are skilled surgeons who can remove the gallbladder with just one hole at the umbilicus; this is called Single Incision Laparoscopic Surgery. However, it is important to remember that all patients would not be suitable for this and there is a chance that during the surgery, the surgeon may have to change over to the standard 3-4 hole surgical method.
Presently, Robotic surgical techniques are also available to remove the gallbladder and the gallstones, this would be an expensive procedure, all cannot afford and or all would not need this specialised robotic surgery.
Unusual situationsPatients with Jaundice or pancreatitis related to the gallstones would need symptomatic treatment along with an endoscopic procedure to remove the stone in the bile duct, Endoscopic retrograde cholangio pancreaticography (ERCP). This is similar to having an endoscopy done for stomach ulcer or acidity. The ERCP and duct clearance is followed by removal of the gallbladder during the same hospital admission or subsequently depending on the patient's condition and the severity of the illness.
Life after gallbladder removalSome individuals take time to settle down after gallbladder removal with respect to their digestive system. Some can have hurried bowel emptying or intestinal hurry after food. Usually, this settles with time, some may need medications to slow the bowel or to reduce the bile salts.
Further medical careAfter gallbladder removal, the patient needs to see his or her surgeon or physician on a regular basis initially to check that the wounds have healed well, there is no infection or jaundice and at a later date to check whether they are developing a hernia.
Some patients do not undergo surgery when they first come to hear that they have gallstones, in such patients medical treatment is given to tide over the current infection etc. It is important that they visit the physician or the surgeon once more because the same symptoms or illness can recur.
Tips to avoid chances of gallbladder stones These are not foolproof but general healthy living measures are worth mentioning
ConclusionsIn humans, the gallbladder is a storehouse of bile which can result in stone formation within the gallbladder. These stones cause a range of illness ranging from the upper abdominal pain to life-threatening infections of the gallbladder and the bloodstream. In the absence of effective medical therapy coupled with the fact that gallbladder is not important for life, the standard of care is the removal of the gallbladder and the stones by means of a surgical procedure that can be done traditionally and by laparoscopic techniques. If you need further details or known someone with gallstones, please seek medical advice from your family physician, surgeon or gastroenterologist.