Gallstones Treatment

Gallstones Treatment

Gallstones are hard substances formed from the digestive juices present in the gallbladder (an organ situated below the liver wherein a digestive juice called bile is stored and is released into the small intestine for the digestion of food)

What Are Gallstones?

Gallstones are hard, pebble-like deposits that form in your gallbladder. Gallstones can range in size from the size of a sand grain to a golf ball. The gallbladder is a small pear-shaped organ that is located on the upper right side of your abdomen.

 Your gall bladder is a pouch that houses the greenish-yellow fluid known as bile, which helps in the digestion of fats. Typically, the chemical composition of your bile juices is sufficient to break down the cholesterol that the liver excretes. But, if your liver excretes more cholesterol than your bile can break down, it may crystallize and eventually turn into gallstones.

Types of gallstones:

• Cholesterol gallstones: These are yellow in colour and are made up of undissolved cholesterol along with other components.
• Pigment gallstones: These are dark brown or black stones formed due to excessive bile pigment in the bile.

Causes Of Gallstones

Though the exact cause of bile stones is unknown, it is believed that a chemical imbalance within the gallbladder can cause gallstones. The potential causes of gallstones are;

• Excessive bilirubin level: These gallstones are produced by the excess of bilirubin. It is basically the byproduct when the liver breaks down the red blood cells. Bilirubin is called the pigment stone
• Excessive cholesterol level: If your liver is producing more of the cholesterol than your bile can dissolve, you will end up getting yellow color gallstones.
• When the gallbladder does not empty completely: If the gallbladder doesn't empty entirely, bile particles like cholesterol or calcium salts may thicken due to protracted storage in the gallbladder. These eventually grow into stones.

Who Has A Higher Risk Of Developing Gallstones

Gallstones are more common among

Gender: Women are more likely to develop gallstones because of hormonal imbalances.

Age: Older people, above the age of 60, are more prone to developing gallstones. 

Obesity: Obese people are at higher risk of developing Gallstones 

Estrogen Level: Increased cholesterol levels in bile and decreased gallbladder activity, both of which can result in gallstones, appear to be caused by excess estrogen from pregnancy, hormone replacement therapy, or birth control pills.

Rapid weight loss: Rapid weight loss leads the liver to release additional cholesterol into the bile, which can result in gallstones, as the body metabolizes fat.

Fasting. Fasting reduces gallbladder movement, which results in an excess of cholesterol in the bile.

What Are The Symptoms Of Gallstones?

• Intense pain in the upper abdomen (on the right side) may spread to the back, which may radiate to the shoulder on the same side
• Nausea
• Vomiting 
• Flatulence (gas) and indigestion
• Diarrhea
• Darker colored feces and urine

At times, you may not even experience any symptoms, and these may be found on the x-rays or during surgery in the surrounding area.

Diagnosis For Gallstones

The doctor starts with history-taking, followed by a clinical or physical examination. This will be followed by blood investigations and imaging techniques that the doctor feels are appropriate.

The blood tests may include a complete blood count, liver function tests (which will reveal levels of bilirubin, which is important in the diagnosis of gallstones), a lipid profile, which reveals levels of cholesterol, and HDL (good) cholesterol, which may be causative for the formation of the gallstones.

Other tests may be imaging techniques such as 

• Abdominal Ultrasound 
• EUS (endoscopic ultrasound)
• Oral Cholecystography
• Hepatobiliary Iminodiacetic acid (HIDA) scan 
• Computerized Tomography (CT)
• Magnetic Resonance Cholangiopancreatography (MRCP) 
• Endoscopic Retrograde Cholangiopancreatography (ERCP).

How To Treat Gallstones

If the gallstones are present but there are no symptoms, the patient is advised to maintain a healthy diet with plenty of fluids, take supplements, and do light exercises directed by the doctor.

If the patient is symptomatic, there are non-invasive treatments, surgical treatments both open and minimally invasive, or laparoscopic surgery.

Non-invasive Treatments:

In non-invasive techniques, depending on the type of gallstone, bile salts can be used to dissolve stones formed due to cholesterol, but this cannot be used for gallstones formed due to bile pigments.

Shock Wave Therapy: It is a method where shock waves are used to break the stones down into finer pieces, followed by the administration of bile salts.

ERCP (endoscopic retrograde cholangiopancreatography) - This is a kind of endoscopy in which an instrument is inserted through the endoscope to remove the stones.

In most of these non-invasive procedures, recurrence is common and hence not successful long term. The gall bladder serves an important function, but it is not required for a healthy life. 

Surgical Treatment for Gallstones (Gallbladder Removal)

When the symptoms of gallstones are persistent, then surgery to remove the gallbladder should be considered. There are two types of cholecystectomy surgeries open and laparoscopic.

Laparoscopic cholecystectomy: In a laparoscopic cholecystectomy, the surgeon will make four small incisions in your abdomen. Then a tube that has a tiny video camera is inserted into your abdomen through one of the incisions.

With the help of a video monitor, the surgeon sees and inserts the other surgical tools through the other incisions in the abdomen and removes the gallbladder. Later, these small incisions are sutured. This takes about 1-2 hours.

Open Laparoscopy: This is the traditional procedure where a large incision is made to repair an organ or tissue in your body. Open surgery is a major procedure in which the surgeon makes an incision as large as 10 inches with a scalpel to access the organ.

What Are The Complications Of Gallstones?

Untreated gallstones may lead to complications such as:

• Jaundice (yellowish skin and eyes)
• Pancreatitis – Inflammation of the pancreas
• Acute cholecystitis -the stone blocks the bile duct and causes infection in the gallbladder
• A complication of infection leading to sepsis 
• Acute cholangitis –bile ducts become blocked and infected
• Cancer of the gallbladder

How To Prevent Gallstones?

There are two effective ways to prevent the formation of gallstones:

• Maintaining a healthy diet: Include lots of fruits, vegetables, and nuts, You can reduce your risk of gallstone disease by eating more fiber, foods high in mono- or polyunsaturated fats, cereals, and little to no red meat.
• Daily Exercises: Doing regular exercise can help lower the risk of acquiring gallstones.
• Avoiding certain medications: Avoiding some classes of cholesterol-lowering medications and hormone replacement therapy, such as post-menopausal hormones or oral contraceptives, can also help prevent gallstone formation

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