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Gall bladder filled with stones? Such an organ cannot function properly. Gallstone disease, one of the most common diseases of the digestive system, can then manifest itself with acute bouts of pain, i.e. colic. Then it becomes necessary to remove the stones. Fortunately, there are more and more modern methods, such as laparoscopy or lithotripsy, thanks to which such procedures can be easily performed.
The gallbladder is an essential storehouse of bile, i.e. a solution of bile acids, electrolytes, bilirubin, cholesterol and phospholipids produced by the liver. When he gets sick, the entire digestive system becomes sick. One of the most common diseases is cholelithiasis – it occurs in about 20 percent. of the entire population, and in the group of people over 65, it affects up to 30 percent.
The little ones are more dangerous
Stones can build up in the gallbladder and (less commonly) in the bile ducts. Small, 1-2 mm or even several centimeters high.
The stones are composed of various proportions of bile pigments, cholesterol, proteins and inorganic ions. Some are made of only (homogeneous) cholesterol and these reach very large sizes. On the other hand, small and rough stones, called pigmented stones, are composed of calcium and cholesterol bilirubates (up to 25%). The most common type are mixed cholesterol and pigment stones.
The smaller the stones are, the more likely they are to get into the bile ducts and cause problems.
Where is it coming from?
Some of us are genetically prone to form cholesterol crystals. Their formation is also influenced by obesity and some diseases, such as malabsorption syndrome or diabetes, as well as hyperlipidemia (a significant increase in the level of lipids in the blood). An energy-rich diet, high in cholesterol or carbohydrates and low in fiber, also contributes to the formation of stones.
Women are particularly at risk of gallstone disease. It is up to eight times more common in them than in men, because female hormones (estrogens) that control the function of the bile ducts increase the tendency to build up deposits. The risk is even higher in women taking oral contraceptives or other estrogen preparations and in those expecting a baby, which is associated with a hormonal imbalance during this period.
There are no symptoms
Gall bladder stones can be completely asymptomatic for many years and are sometimes detected only during examinations, eg ultrasound of the abdominal cavity. This is called silent urolithiasis, occurring in nearly 1/3 people.
In many cases, it does not need to be operated on, conservative treatment is sufficient, consisting in introducing an appropriate diet, avoiding fatty, hard-to-digest, fried foods and the use of choleretic, antispasmodic and disinfectant drugs.
Hip attack
In some patients, urolithiasis manifests itself with unpleasant symptoms, the most common of which is biliary colic, usually appearing after eating a large, fatty meal, especially if it contains egg yolks, meat, butter, cream, oil or mayonnaise. Colic attacks occur as a result of excessive contractions of the gallbladder, stimulated to secrete bile while it is inflamed, or due to partial or complete obstruction of the bile ducts by a stone. The symptom of colic is sudden pain in the right hypochondrium that radiates to the right side and right scapula. It is often accompanied by nausea, bile vomiting, and abdominal distension.
If the colic is not very intense, it may go away on its own, but it usually requires the use of antispasmodics and painkillers, and the symptoms last from a few to several hours. Even with the use of these measures, an acute seizure does not go away. There is a rapidly increasing jaundice caused by obstruction of the bile ducts. The patient then requires quick hospitalization.
During acute inflammation of the gallbladder, its wall may become perforated, changed as a result of ailments, and it may become peritonitis. The patient’s condition deteriorates rapidly, the pains cover the entire abdomen and are very strong (the abdomen is hard, the patient does not allow him to touch it). The surgeon must then perform an operation (laparotomy), excise the follicle, remove pus and bile, and rinse the abdominal cavity. Peritonitis can also occur without tearing the bladder wall, where bile seeps through the bladder wall. Symptoms of the condition are slightly milder and the complication is known as biliary peritonitis.
Efficient diagnosis
Such unpleasant health complications can be avoided if the disease is detected early. The diagnosis of typical urolithiasis is relatively easy – the basis is a thorough interview and medical examination, laboratory tests and ultrasound of the abdominal cavity. The advantage of technically improved ultrasound from year to year is its non-invasiveness. However, the assessment of this study can be significantly hampered by obesity.
In doubtful cases, it may be necessary to perform other examinations, such as an X-ray of the abdominal cavity (especially a scan of the right hypochondrium) or of the chest, gastroscopy, computed tomography, ECG.
There are indications for intravenous cholangiography. It facilitates obtaining a good image of the bladder and bile ducts (radiological method consisting in imaging the bile duct system after intravenous administration of a contrast agent), but it is burdened with side effects, including collapse.
Among other modern methods, endosonography (EUS) should be mentioned – it is a combined ultrasound examination with endoscopy performed from the inside of the gastrointestinal tract with the use of an ultrasound head placed at the end of the endoscope.
Remove, crush or dissolve?
If it is necessary to remove stones, doctors have several methods at their disposal. The most common procedure is to excise the entire gallbladder. It can be a traditional method or a laparoscopic cholecystectomy.
Lithotripsy can also be used to remove stones, which consists in crushing them by an ultrasound wave directed at the gallbladder under ultrasound guidance.
See also: What does nutrition in gallstone disease look like?
Stone dissolution is also used. The patient is given appropriate drugs that work only on stones of cholesterol origin. It is worth knowing that the treatment is long (it takes from one to two years) and expensive, and the stones may reappear (this happens in 50% of patients after discontinuation of drugs). In addition, because of the side effects, dissolution of the stones, like lithotripsy, is only recommended for some patients.
Traditional or laparoscopic method?
In Poland, most gallbladder surgeries are still performed using the classic method. It requires cutting the rectus abdominis muscle, which extends the recovery time (about a month). After the follicle excision using the traditional method, there is also a mark in the form of a large scar below the rib line, which is difficult to accept for many women.
Extensive incision of the abdominal wall can be avoided by the laparoscopic method, which involves performing surgical procedures with the use of a microcamera and a set of microtools. Patients can leave the hospital 2-3 days after the surgery, and return to work two weeks later. The advantages of laparoscopy also include the fact that elderly and obese patients suffer from fewer complications as a result, pneumonia or so-called pneumonia are much less common. postoperative wound dehiscence, which requires re-stitching and a longer stay in the hospital. Laparoscopic surgery also allows you to avoid extensive surgery in the case of urolithiasis. It requires the removal of plaque before or after the procedure, which is performed using a special gastroscope.
However, laparoscopic surgery is not always a better option – in some patients the risk of complications is higher than in the case of classic surgery. It happens that the patient is qualified for laparoscopic surgery, and during the procedure he goes to classic surgery, because, for example, the bile ducts cannot be identified. In laparoscopic operations, damage to the bile ducts occurs more often than in the classical method. The choice of the operating method depends on many factors, and the doctor decides about the type of surgery.
Text: Anna Romaszkan
Consultation: Ewa Cierpisz, MD, PhD, internal medicine specialist, DEMETER Dental and Medical Clinic; Source: Let’s live longer