General Surgery - Gallstones
Gallstones or “cholelithiasis”, is a condition where you have stones in the gallbladder. The gallbladder is a small pouch shaped organ located at the right upper part of your abdomen, attached to the lower surface of the liver. The gallbladder acts as a storage compartment for bile. Bile is a fluid made by the liver that passes through tubes called bile ducts and is released into the intestines when you eat. Bile assists the body in digesting fats and other substances. There are many individuals who have gallbladder stones but don’t know it. Abdominal pain occurs when these gallstones grow larger and blocks the bile ducts.
Cholelithiasis is formed when there are problems with the way bile is made and excreted from the gallbladder. Bile is a balanced mixture of water, cholesterol, bile salts and a substance called bilirubin. Cholesterol stones are formed when the bile has too much cholesterol and not enough bile salts. Gallstones may also be formed when bile does not empty from the gallbladder as fast as it should. Certain diseases that affect the liver and blood, such as hepatitis and anemia, may cause a different type of stones called pigment stones.
Risk factors for developing cholelithasis included (but are not limited to):
· Females
· Being overweight.
· Certain medicines, such as estrogen, antibiotics, and cholesterol-lowering medicines.
· Diabetes or previous surgery of the small intestines.
· Fasting or rapid weight loss.
· Having another family member with cholelithiasis.
· Pregnancy
· Greater than 40 years of age.
The most common symptom of cholelithiasis is pain felt in the right upper part of the abdomen. The pain may develop suddenly in the center of the upper belly and spread to the right upper back or shoulder blade area. Often it feels painful just below the right rib cage. It is usually hard to get comfortable; moving around does not make the pain go away. The pain may prevent you from taking normal or deep breaths. It can last for 15 minutes to 24 hours; 1 to 5 hours of continuous pain is common. The pain from gallstones classically occurs after meals, especially after those high in fat. Feelings of nausea and vomiting are not uncommon. These symptoms may go away, but often the symptoms recur, especially after any meal high in fat. There are many other conditions that cause similar symptoms, including heartburn, pain caused by a heart attack, and liver problems. Stomach flu (gastroenteritis) and food poisoning also can cause symptoms similar to gallstones.
Other signs and symptoms may include:
· Yellowing of the skin or whites of the eyes
· Itching of the skin
· Feeling bloated or having too much gas in the stomach
· Bowel movement that are gray colored or looks like clay
· Urine that looks like tea or cola
There are several methods and tests used to diagnose cholelithiasis.
· You may need blood tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
- An abdominal ultrasound is a test that is done to see inside your abdomen. Sound waves are transmitted through a transducer and displayed on a monitor. The stones can best be seen within the gallbladder using an ultrasound. In addition, if any gallstones are seen in the bile ducts, an ultrasound will see these too.
- A HIDA scan is a functional test that can be used to see if your gallbladder has inflammation from the presence of stones. You are given a small amount of radioactive dye in your IV. Pictures are then taken by a special scanner that can "see" the dye in your body. The radiologist can look at the pictures to see if your liver and gallbladder are working normally.
- An ERCP (endoscopic retrograde cholangiopancreatography) is a test done during an endoscopy to find stones, tumors, or other problems. Dye is put through the endoscope into the bile ducts to visualize your pancreas and bile ducts. If you have stones within the bile ducts, they may be removed during ERCP. Depending on the results of your blood tests and ultrasound, this test is not always necessary.
Most gallstones do not cause problems. But if they block a duct, they usually need treatment. Treatment for cholelithiasis is mainly surgical.
- A laparoscopic cholecystectomy is a procedure uses a laparoscope and thin instruments to take out the gallbladder. A laparoscope is a thin, lighted tube with a camera at the tip. Small incisions are made in the abdomen, where the laparoscope and other surgical instruments are inserted.
- An open cholecystectomyis a technique that is used when it is difficult or dangerous to remove your gallbladder laparoscopically. Open cholecystectomies are usually done after a trial of laparoscopic surgery fails.
After a laparoscopic cholecystectomy, the patient is usually discharged home the same day or the next morning. There are no restrictions on diet or dietary consequences after removal of the gallbladder. The incisions will heal over the next several weeks.
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University Surgical Consultants