by Dr Phanipriya Garikapati, MS, FMAS
Gall stones, or Stones in the Gall Bladder, are the commonest problems which afflict the organ. Gall stones can occur in any one – man/woman; child/grown-up, even the aged; thin/fat, and any race or ethnic group. Women are more prone to gall stones than men. The incidence is high in the pregnant status during which time complications too seem to be higher. It is sometimes seen to be present in different members of a family.
The earlier belief – that a Fat Fertile Female of Forty is the kind of person who gets a gall-stone – is no longer considered to be true.
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There are no specific factors which predict someone will develop a gall stone.
Anatomy and Physiology of the Gall Bladder:
The Gall Bladder (GB) is a small, pear-shaped organ in the abdomen, just under the surface of the liver. It stores a fluid, called the Bile, which is released into the small intestine – specifically, the duodenum – in response to a fatty meal.
The bile contains various salts, called the Bile salts, responsible for digestion of fat in the diet. These salts are synthesized in the liver and stored in the GB, to be released whenever a diet rich in oil and fat is consumed.
Why do stones form in the gall bladder?
Gall stones form in the gall bladder because the gall bladder is not functioning normally. The cholesterol and bile salts precipitate because of stasis and over a period of time form sand (also called sludge) and later stones.
Rare conditions, such as Sickle Cell disease, spherocytosis, and other hemolytic anemias can lead to pigment stones in the gall bladder.
Rapid weight loss as in slimming diets and weight losing bariatric surgeries makes people prone to gall stone disease.
Is there any link to diet?
No diet has been shown to increase the tendency to form gall stones; neither do dietary habits increase the chances. So you may be on a Mediterranean diet (high in fat) or an Oriental one, or for that matter, any other – and your risk for developing gall stones would be approximately the same.
No particular dietary pattern has been studied to be the cause of gall stone disease.
If I have a gall stone, are there any kinds of food I should not take?
A person harboring gall stones can develop symptoms related to them – such as abdominal pain, bloating and feeling of gas– especially after intake of heavy oily, fatty and spicy foods – these stimulate the gall bladder to contract and may increase pain and other symptoms. When infection sets in, the abdominal pain becomes more intense and can be associated with vomiting and fever. For more information on this, you can read here.
How will I know if I have a gall stone?
The symptoms of gall stones which lead the sufferer to the doctor are usually severe colicky abdominal pain, especially in the upper right part of the abdomen; this may be associated with vomiting. They may develop jaundice as well.
When these symptoms occur, a Surgeon is the right person to see; the patient then has to differentiate between gall bladder problems like gall stones from other conditions such as gastritis or ulcer (Acid-Peptic disease).
An ultrasonogram (USG) of the upper abdomen would show most gall stones and settle the issue.
If you have no symptoms, but are worried you may have gall stones – then an USG of the abdomen is the screening method to find out. Silent gall stones have a probability of becoming symptomatic by 2% every year.
Why does a gall stone cause any problem?
A gall stone is an abnormality; it is not supposed to be there. Whenever the human body has such a problem, it tries to get rid of the problem. For example, say you have a boil; the body, being a perfect self-healing machine, will initiate the process of isolating the infected part, collect all the infecting organism in a fluid there, then bring it all to the surface, from where it will burst out of the skin to expel the contents outside.
In the same way, when a gall stone forms, the GB tries to expel the stone into the gut whence it can be expelled into the world outside through the stools. But in this process, it has to cross some narrow channels, such as the bile duct and the cystic duct. If there are multiple small stones, then there is a high chance of a stone slipping through and getting blocked in one of these narrow passages. This kind of blockage is the reason for the severe abdominal pain associated with vomiting and jaundice and calls for emergency management.
Is there any medical treatment for gall stones?
No, there is no medical treatment for gall stones. The only way to solve the issue permanently is to remove the gall bladder itself. If the gall stones have not caused any symptoms, then there may not be a reason to remove it urgently; but even asymptomatic gall stones are preferably taken out while the sufferer is still stable and healthy enough to undergo the procedure. This decision is to be taken judiciously after consulting the expert – a general & laparoscopic surgeon. Asymptomatic stones when they are more than 2cm in size are an indication for surgery.
Can gall stones be removed endoscopically? What surgical procedure is required?
The treatment or cure for gall bladder stones is removal of gall bladder – called Cholecystectomy.
Is it safe to remove the Gall Bladder? Won’t I be unable to digest fatty food items?
The gall bladder is not essential as an organ; digestion can continue unhampered even after removal of the gall bladder.
Is removal of the gall bladder a major surgery? How soon can I recover? How soon can I get back to work?
Surgery to remove a gall bladder should be considered a major one, since it involves anesthesia and prolonged surgery – for around 1- 2 hours. However, by the laparoscopic technique, the “wound of entry” i.e., the surgical incision is much smaller than in open surgery. This means that the recovery & healing is much faster after the procedure.
In fact, depending on the general health of a surgical candidate, the patient can be sent home on the same day; they can start going out in 2 – 3 days, and can even drive if they feel confident enough. Diet is resumed within hours of performing the procedure.
What are the risks of not getting this surgery done?
Gall stones which are moving and producing symptoms should definitely be removed, otherwise the attacks increase in frequency and cause lot of discomfort and disturbance in life. A gall stone that gets stuck in the common bile duct can lead to obstructive jaundice and even cholangitis, which is a potentially dangerous condition. Very long-standing stones can predispose to gall bladder cancer. And even more dangerously, the gall bladder can get infected, and sometimes lead to the formation of empyema. Diabetic patients with gall stones are especially prone to a particular variety of this complication – called emphysematous cholecystitis & gangrene of the gall bladder, which is very dangerous and can be fatal as well. [/sociallocker]
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