Gallbladder Stone- Know More

Gallstones, a very prevalent issue has arisen in modern society as a result of lifestyle changes, the intake of junk food, and irregular eating patterns. The development of these stones usually starts in the gall bladder and sometimes these stones start coming upwards towards the common bile duct along with the secretion of bile during the digestion process. Usually, there is no onset of symptoms and these issues are sometimes mistaken for indigestion, which is a transient condition but if the size of the gallstones increases in number and size for an extended period, then this leads to the severity and might worsen the condition of the patient is not detected early.

What are Gall bladder and Gallstones?

The gall bladder is a little, pear-shaped structure situated beneath the liver on the upper right side of the belly. It holds the bile that the liver produces for digestion and releases it into the duodenum through the bile duct. Water, cholesterol, bile salts, and pigments like bilirubin and others make up this bile. The breakdown of lipids in our bodies is aided by bile.

          Gallstones or Cholelithiasis which originate in the gallbladder or bile ducts is solid masses resembling pebbles made of bile precipitates. They range in size from the size of golf balls to small sand grains. Gallstones are usually of two different types:

  1.  Cholesterol stones- 80% of the gallstones are of this type and these are usually yellowish-green in color.
  2. Pigment stones- these gallstones are usually smaller and darker in color. The color of these gallstones is determined by the excess production of the bile pigment bilirubin produced by the liver.

What are the causes? – There is no exact cause for the occurrence of gallstones, still, some of the causes which lead to the formation of gallstones are listed below:

  1. Due to a bad lifestyle such as extreme junk food consumption rich in cholesterol regularly, skipping meals or eating irregularly, severe consumption of alcohol and smoking, etc.
  2. Excess production of the bile pigment bilirubin by the liver in cases of cirrhosis, other liver disorders, and blood infections.
  3. Self-medication like regular intake of NSAIDs to relieve chronic pain.
  4. Bile reflux- It is a reflowing action when the bile bypasses the small intestine and instead rushes back into the stomach. This condition usually leads to ascending the gallstones towards the common bile duct from the gall bladder and finally results in obstructive jaundice due to the blockage at the bile duct.
  5. People over the age of 40 years, obese or overweight, and diabetic people are at higher risks for cholelithiasis.

What are the common symptoms observed?-

  1. Sudden intense abdominal pain usually at the upper right portion usually right after the consumption of meals.
  2. Vomiting
  3. Indigestion, gas formation, and heartburn.
  4. Pain in the right shoulder, between the shoulder blades, or towards the back.
  5. Jaundice-like symptoms like yellowing of the skin and white portion of the eye.
  6. Dark-colored red urine and pale stool.
  7. Fever and chills
  8. Loss of appetite
  9. Severe complicated causes include inflammation of the gall bladder (Cholecystitis), Pancreatitis, and inflammation of the bile ducts (Cholangitis).

What are the Diagnostic tests and Treatments available?-

  1. Pathological examinations such as Blood tests and urine culture.
  2. Upper abdomen ultrasonography- it is a non-invasive test to check the location of the gallstones. However, only large-sized gallstones and the stones present in the gall bladder are visible in this diagnostic test. Smaller-sized gallstones like pigment stones and the gallstones present in the bile ducts are undetected, thus it is not an accurate test.
  3. An MRI technique called Magnetic Resonance cholangiopancreatography (MRCP) especially visualizes the bile ducts. It produces highly detailed images of our biliary system including the common bile duct and is non-invasive. MRCP provides a clear picture and also rules out the possibility of tumors or cancer. Depending upon the number, size, and location of the gallstones, the doctor finally decides which surgical procedure needs to be performed on the patient for the removal of the gallstones.
  4. Endoscopic retrograde cholangiopancreatography (ERCP) is a more advanced and more non-invasive procedure that is effective in locating gallstones if any of them are lodged in the ducts and can also be removed using this technique. It is very useful in the detection of smaller-sized pigment gallstones. It employs a combination of X-rays and endoscopy which entails inserting a small camera into the upper gastrointestinal (GI) system through the mouth.
  5. What is ERCP?

ERCP is both diagnostic as well as a therapeutic technique for gallstones which consists of an endoscope inserted through the mouth with an attached camera that passes through the food pipe and reaches the top of the small intestine, then the technician inserts another smaller tube into the first one to reach further down into the bile ducts. They will inject a special dye through the tube and then the video X-rays (fluoroscopy) are taken as the dye travels through the ducts. Through ERCP, a clamp-like tool is inserted through the tube to remove the stones which are present in the duct. The large-sized gallstones are removed by lithotripsy in which the gallstones are first crushed or broken down into smaller pieces and then each piece is taken out through the scope. The 190 series ERCP (Endoscopic Retrograde Cholangiopancreatography) is cutting-edge technology in the earliest identification of biliary tract neoplasm, cholangiocarcinoma, and pancreatic ductal adenocarcinoma.

  • Endoscopic Ultrasound- this combines both ultrasound and ERCP for the detection of gallstones.

Cholecystectomy- is laparoscopic keyhole surgery for the removal of the gall bladder when the gallstones are accumulated in this sac. It is an ICG Enhanced Fluorescence Guided procedure that requires a small incision, high resolution, minimal blood loss, and a very low risk of infection.

  • Medications as prescribed by the medical practitioner.

Prevention and Control-

  1. Avoid consumption of oily, fried, and spicy foods.
  2. Intake of a healthy diet rich in high- fiber such as fruits, vegetables, and whole grains.
  3. Consuming several little meals throughout the day.
  4. Reduction of alcohol consumption and caffeine.
  5. Management of stress.
  6. Maintaining a healthy weight, exercising, etc.

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