Surgical Conditions – Gall Stones

A gallstone, is a lump of hard material usually range in size from a grain of sand to 3-4 cms. They are formed inside the gall bladder formed as a result of precipitation of cholesterol and bile salts from the bile.

Types of gallstones and causes

• Cholesterol stones
• Pigment stones
• Mixed stones - the most common type. They are comprised of cholesterol and salts

Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason. Low grade infection in the gall bladder is another factor in the development of gall stones.

Pigment stones are small, dark stones made of bilirubin. Bilirubin is the pigment secreted by the liver The exact cause is not known. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anaemia in which too much bilirubin is formed.

Other causes are related to excess excretion of cholesterol by the liver in the bile. They include the following

Gender. Women between 20 and 60 years of age are twice as likely to develop gallstones as men.

Obesity. Obesity is a major risk factor for gallstones, especially in women.

Oestrogen. Excess oestrogen from pregnancy, hormone replacement therapy, or birth control pills

Cholesterol-lowering drugs.

Diabetes. People with diabetes generally have high levels of fatty acids called triglycerides.

Rapid weight loss. As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones.

Symptoms

Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called "silent stones." Gallstone symptoms can be similar to those of many other conditions such as heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis. Accurate diagnosis is, therefore important.

Symptoms may vary and often follow fatty meals, and they may occur during the night

• Abdominal bloating
• Recurring intolerance of fatty foods
• Severe pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours

It may be associated with

• Pain in the back between the shoulder blades
• Pain under the right shoulder
• Nausea or vomiting
• Indigestion & belching

Ultrasound is the most sensitive and specific test for gallstones.

Other diagnostic tests used may include

• Computed tomography (CT) scan may show the gallstones or complications
  
  
• Endoscopic retrograde cholangiopancreatography (ERCP). The patient swallows an endoscope--a long, flexible, lighted tube connected to a computer and TV monitor. The doctor guides the endoscope through the stomach and into the small intestine. The doctor then injects a special dye that temporarily stains the ducts in the biliary system. ERCP is used to locate and remove stones in the bile ducts
  
  
• Isotope scanning. This is a test known as a HIDA scan. Radioactive isotope is administered and fills the gall bladder. A hormone is given which causes the gall bladder to contract and this tells us if the gall bladder is functioning normally
  
  
• Blood tests. Blood tests may be used to look for signs of disturbed liver function tests infection,  pancreatitis, or jaundice due to bile duct blockage. Abnormalities of this type can infer gall bladder disease

Course of illness

The usual course of the illness is for patients to suffer recurring bouts of severe upper abdominal pain a condition known as biliary colic. Patients may suffer episodes of infection (cholecystitis) or inflammation of the pancreas (pancreatitis). Bile-duct blockage and infection caused by stones making their way into the biliary tract can be a life-threatening illness due to blockage of the bile flow and jaundice. With prompt diagnosis and treatment, the outcome is usually very good.

Treatment

Laparoscopic Cholecystectomy and Cholangiogram Click here to find out more.