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What is gallbladder?
The gallbladder is a small pouch that sits just under the liver. The gallbladder stores bile produced by the liver.
What are gallstones?
Gallstones are stones that form in your gallbladder. They are a common gastrointestinal problem. There are multiple types of gallstones and the reasons why do they form differs according to the type.
Types of gallstones
The most common type of gallstones are cholesterol gallstones, often appears yellow in colour.
Your liver produces a fluid called bile that is stored and thickened in your gallbladder between meals. When you eat food, your gallbladder empties bile into your intestines to help digest fats. Stones can develop in bile, particularly if you skip meals causing bile storage times longer or eat a diet rich in fat. Being female, obese, aged over 40, pregnant, diabetic and on hormone therapy can lead to gallstones. They run in families too. Losing weight fast is also a risk factor.
These gallstones are composed mainly of undissolved cholesterol, but may contain other components. Usually not seen in X-rays but can be seen in an ultrasound scan.
These dark brown or black stones form when your bile contains too much bilirubin.
This happens when bilirubin production goes up due to increased red blood cell damage or turnover in blood disorders such as haemolytic anaemia.
These gallstones are also not seen in X-rays but can be seen in an ultrasound scan.
What are the symptoms?
Gallstones may cause no signs or symptoms. However when they do, whatever the type or the cause, all the gallstones cause similar symptoms.
If a gallstone lodges in a duct and causes a blockage it can cause:
- Sudden pain in the upper right belly, in the center of your belly, back pain between your shoulder blades or pain in your right shoulder (biliary colic). This pain can last few hours. Needs medical attention.
- You may develop low to mid grade fever as well (cholecystitis). Then you need to get admitted.
- You may feel vomitish or can actually vomit.
- You may not feel like eating or drinking.
- If your eyes and skin turning yellow, then the stones may have moved out of your gallbladder into your common bile duct. You need to get admitted.
- Serious infection of your bile ducts (cholangitis) or inflammation of your pancreas (acute pancreatitis) will make you seriously ill with high fever with chills. These problems can be serious and can even cause death. Need immediate admission.
Complications of gallstones:
- Inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain and fever.
- Blockage of the common bile duct. Jaundice and bile duct infection can result.
- Blockage of the pancreatic duct. Which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.
- Gallbladder cancer. People with a history of gallstones have an increased risk of gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of cancer is elevated, the likelihood of gallbladder cancer is still very small.
How to reduce the risk of gallstones:
Don't skip meals. Try to stick to your usual mealtimes each day. Skipping meals or fasting can increase the risk of gallstones.
Lose weight slowly. If you need to lose weight, go slow. Rapid weight loss can increase the risk of gallstones. Aim to lose 1 or 2 pounds (about 0.5 to 1 kilogram) a week.
Maintain a healthy weight. Obesity and being overweight increase the risk of gallstones. Work to achieve a healthy weight by reducing the number of calories you eat and increasing the amount of physical activity you get. Once you achieve a healthy weight, work to maintain that weight by continuing your healthy diet and continuing to exercise.
How to diagnose gallstones?
- Ultrasound scan
- Computerized tomography (CT) scan
- Magnetic resonance cholangiopancreatography (MRCP)
- Hepatobiliary iminodiacetic acid (HIDA) scan
- Blood tests to look for complications:
- AST, ALT, ALP, Serum Bilirubins (Direct and total), Serum Amylase, Serum Lipase, FBC, CRP, INR, Serum Proteins
Surgery to remove the gallbladder is called cholecystectomy. Your doctor may recommend surgery to remove your gallbladder, since gallstones frequently recur. Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder.
You don't need your gallbladder to live, and gallbladder removal doesn't affect your ability to digest food, but it can cause diarrhoea in some, which is usually temporary.
What are the benefits of surgery?
You should be free of pain and able to eat a normal diet. Surgery should also prevent the serious complications that gallstones can cause. Your body will function perfectly well without a gallbladder
Medications to dissolve gallstones
There are some medications you can take by mouth may help dissolve gallstones. But these are very unpleasant medications and it may take months or years of treatment to dissolve your gallstones in this way and gallstones will likely form again if treatment is stopped. Sometimes medications don't work. Meanwhile symptomatic patients can develop serious complications of gallstones before the treatment is complete nessceciating surgery. Also this may not be cost effective. Therefore medications for gallstones aren't commonly used and are reserved for people who can't undergo surgery.
Stone removal by breaking
It is possible to shatter them into small pieces but these techniques can cause very painful side effects and a high failure rate. The gallstones usually come back. Furthermore, these alternatives will not cure the condition and symptoms are likely to come back
The operation is performed under a general anaesthetic and usually takes about an hour. Your surgeon will use laparoscopic (keyhole) surgery as this is associated with less pain, less scarring and a faster return to normal activities. For about 1 in 20 people it will not be possible to complete the operation using keyhole surgery. The operation will be changed (converted) to open surgery, which involves a larger cut usually just under your right ribcage. Learn more about Laparoscopic cholecystectomy