About one & half litters of bile come from the liver to gallbladder daily, gallbladder stores bile when we eat food, its job is to deliver this bile to the small intestine through the bile duct. Through this bile, our food is broken into small pieces.
This makes fatty meals to digest. This is the way gallbladder should work. If the gallbladder stops working, so it can cause hepatitis or any other viral infections
Gallstones are classified according to their predominant chemical composition as cholesterol or calcium bilirubin stones. Cholecystitis occurs when a stone becomes impacted in the cystic duct and inflammation develops behind the obstruction.
There are two types of gallstones,1.Cholesterol 2. Pigment.
1.Cholesterol: Cholesterol stones are made from undissolved cholesterol particles, its colours are green or yellow.
2.Pigment: The stones of bile are very dark in colour mostly brown and black because they contain high calcium bilirubin which is present in bile.
Causes of gallstones
Gallstones are caused by the accumulation of different substances in the gallbladder and these take the form of crystal and become small stones.
Obesity is a risk factor for gallstones, especially in women. Rapid weight loss, as occurs after bariatric surgery, also increases the risk of symptomatic gallstone formation.
Diabetes mellitus, glucose intolerance, and insulin resistance are risk factors for gallstones, and a high intake of carbohydrate and high dietary glycemic load increases the risk of cholecystectomy in women.
Drugs such as clofibrate, octreotide, and ceftriaxone can cause gallstones. The order of these causes is as follows.
- Age factor
- Genetic
- Diabetes mellitus
- Obesity
- Weight loss quickly
- Low-calorie diet
- Medications eg, Estrogen oral contraceptives
Signs and symptoms
In many patients, gallstones remain silent and there is a chance of finding by routine ultrasound examination. Gallstones have no specific signs and symptoms or are rather asymptomatic until the stones block the bile duct. Such blockage also leads to severe pain in the upper right side of the abdomen.
Episodic gallbladder pain starts where there is sometimes epigastric pain occurs, the pain extends to the back and shoulder as well.
Sometimes the gallstones pain is accompanied by,
- Low-grade fever
- Vomiting
- Nausea
- Indigestion
- Dark urine & light coloured stools
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Laboratory investigations
Remember the white blood cell count is usually high (12,000-15,000/mcL 12-15 x 10L). Total serum bilirubin values of 1-4 mg/dL (17.1-68.4 mc mol / L) may be seen even in the absence of bile duct obstruction.
Imaging.
Plain films of the abdomen may show gallstones in 15% of cases. Ultrasound is the best imaging test for finding gallstones. It takes only a few minutes, virtually no risk and as well tolerated.
Serum Analysis
Serum aminotransferase and alkaline phosphates levels are often elevated.
HIDA Scan (Hepatobiliary iminodiacetic Acid Scan)
we can also use the HIDA method to diagnose gallbladder stones, In it, we find out the production and flow of bile from the liver to the small intestine. This method of nuclear medicines scan is very safe and effective.
Treatment
It is difficult to cure gallstones without surgery. Nonsteroidal anti-inflammatory drugs, for example, diclofenac 50-75 mg IM (intramuscularly) can be used to relieve gallbladder pain.
Aspirin and other nonsteroidal anti-inflammatory drugs may protect against gallstones Prolonged fasting (over 5-10 days) can lead to the formation of biliary "sludge" (microlithiasis), which usually resolves with refeeding but can lead to gallstones or biliary symptoms.
Laparoscopic cholecystectomy is not very long, it takes 10 to 20 minutes, three small holes are made in it. In which the camera is inserted into the abdomen through the 5mm hole, the laparoscopic surgeon holds the gallbladder in 2 mm hole, and through 10 mm hole, the gallbladder is expelled along with the stones.
laparoscopic surgery doesn't cause any pain to the patients and they are discharged from the hospital quickly. Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallbladder disease. In this procedure, patients can go home within 1 day and return to work within days.
Pain relief after cholecystectomy is most likely in patients with episodic pain (generally once a month or less), pain lasting 30 minutes to 24 hours, pain in the evening or at night, and the onset of symptoms 1 year or less before the presentation.
Preventions
Hypertriglyceridemia may promote gallstone formation by impairing gallbladder motility. A low-carbohydrate diet, physical activity may help prevent gallstones. It is important to eat a high -fibre diet to avoid gallstones.
Consumption of coffee appears to protect against gallstones in women, and a high intake of magnesium and of polyunsaturated and monounsaturated fats reduces the risk of gallstones in men. A diet rich in fruits and vegetables, and statin use reduce the risk of cholecystectomy, particularly in women.
Removal of the gallbladder doesn't result in any disability as a gallbladder with stones is already non - functional. If someone has frequent indigestion and also has pain in the front, especially they eat a high-fat diet, so must consult a doctor. Sometimes the doctor can easily diagnose by physical examination.
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