Gall Bladder Stones Treatment

What are Gall Bladder Stones?

Gall bladder stones or Cholelithiasis (gallstones) are hardened deposits of digestive fluids (stones or lumps) that form in the gallbladder or bile duct.

Gallbladder contains chemicals such as cholesterol, calcium bilirubinate, and calcium carbonate, which solidifies into

either one large stone or several small ones.       

Gallstones can vary in their size from as small as a sand grain to as big as a golf ball. Theses stones can develop into single large gallstone, hundreds of tiny stones, or both small and large stones. Gallbladder attack or Biliary Colic: Gallstones causes sudden pain in the upper right abdomen which occurs when gallstones block the ducts of the biliary tract. This sudden pain is called as gallbladder attack or biliary colic.

Overview of Gall Bladder

Gallbladder is a small, pear-shaped organ located in the upper right abdomen—the area between the chest and hips—below the liver. Liver produces gall (bile), a greenish-brown liquid which gets stored and concentrated in the gallbladder. Gall then goes into the small intestine via the bile ducts to facilitate the digestion, mainly of fats. Whenever we eat something, gall is released into the intestines. The bile duct is a narrow tube.  

Types of Gall Bladder Stones

When there is an imbalance of the chemicals in the gallbladder, cholesterol, calcium bilirubinate, and calcium carbonate, gallstones can form. Gall stones are of three types:

• Cholesterol stones: These are the most common ones (representing about 75%-80%).They are usually yellow-green in color & are formed by hardened cholesterol.

• Pigmented stones:They are formed from the crystallization of calcium, when there is excess of bilirubin.They are of black &brown color.
• Mixed stones: They are the combination of both cholesterol & pigmented stones.

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What are the Causes of Gall Bladder Stones?

Mostly gallstones are made up of cholesterol, a type of fat which is made in the liver and obtained from some foods. Apart from that, there are many different factors which can cause gall bladder stones. They may form when:

• Liver releases excess of cholesterol, which can cause a supersaturation of cholesterol into the bile

• Cholesterol remains undissolved in the bile due to lack of bile salts

• Other substances present in the bile can cause crystallization of the cholesterol

• Bile gets concentrated due to incomplete or improper emptying of the gallbladder

Who are at Risk?

They are few people who are at higher risk of getting gall stones, these include:

Symptoms of Gall Stones

Most of the patients with gall bladder stones have no symptoms. They experience pain only if a gallstone blocks one of the bile ducts. In this case they will experience a sudden, mild or severe abdominal pain, which is called as biliary colic.
 

Pain is mostly felt in the area between shoulder blades, back, side part of the body, or upper-right or middle abdomen. Patient experiences pain mostly during night. Other serious symptoms may develop if the blockage is severe, or for a longer duration or develops in another other part of the digestive system (such as the small bowel or pancreas). These include:

Diagnosis

• Transabdominal ultrasound

• X-rays

• Blood & urine test

• Imaging test which can be used to diagnose gall bladder stones are:

• Computed tomography (CT) scan

• Endoscopic retrograde cholangiopancreatography (ERCP) 

• Cholescintigraphy (also called DISIDA, HIDA scan, or gallbladder radionuclide scan)

Gall Bladder Stone Treatment

Usually, no treatment is not required if the patient is symptomless. If a patient suffers from biliary colic or has any other symptom, then only a treatment is required. Commonly used treatment option for gallstones is the surgical removal of gallbladder. If a person cannot undergo surgery, nonsurgical treatments may be used to dissolve cholesterol gallstones. There are three main treatment options available for symptomatic cases:

• Wait & watch

• Non-surgical removal

• Surgical removal

Wait & watch

There are several cases in which the stone dissolves or gets dislodged and thereby, continues its "silence." As the problem may be resolved on its own, without any intervention, many doctors go for wait-and-watch approach following the initial episode.
 

Non-surgical treatment

If a patient has mild & infrequent episodes of abdominal pain (biliary colic), painkillers will be prescribed to control any further episodes. Patient will be advised to go for healthy a diet, which will help to control pain. Gallstones can also be treated with medicine in few cases.

Oral bile acid pills: Are the medicines which are able to dissolve the gallstones by thinning the bile. They contain chemicals ursodeoxycholic or chenodiol, which help in dissolving gallstones.

Contact dissolution therapy: This is also a non-surgical treatment option which involves injecting a solvent known as methyl tertiary-butyl ether (MTBE) into the gallbladder to dissolve the gallstones.

Percutaneous Cholecystectomy: This procedure involves using a needle to withdraw fluid from the gallbladder and after that a catheter is inserted through the skin to drain the fluid. This catheter is then left in place for few weeks, after which surgical removal of gallbladder is done to prevent recurrence. This treatment option is normally performed in seriously ill patients who cannot tolerate surgery right away.

Surgical Removal

If a patient has severe symptoms of gall bladder attack which occur frequently, then gall bladder stone surgey is recommended. This surgical procedure is known as cholecystectomy and is performed by using a laparoscope and a miniature video camera. The process is minimally invasive, and the patient is allowed to go home after the procedure.

A gall bladder is not a very essential organ of the human body, hence, after its removal patient’s quality of life doesn’t gets effected. After the removal of gallbladder, bile flows out of the liver through the hepatic and common bile ducts and directly goes into the duodenum, instead of being stored in the gallbladder.

Two types of cholecystectomy can be performed:

Laparoscopic cholecystectomy or key-hole surgery: In this procedure, several tiny incisions are made in the patient’s abdomen and a laparoscope (which is a thin tube with a tiny video camera attached to it at the end) is inserted inside. After that abdomen is temporarily inflated with carbon dioxide gas (this gas is harmless & makes it easy for the doctor to view the organs).Camera helps in showing a magni­fied image from inside the body to a video monitor, providing a zoomed & clearer view of the organs and tissues. By looking at the monitor and with the help of the instruments, gallbladder is carefully separated from the liver, bile ducts, and other structures. After which the gallbladder is removed through one of the small incisions. After the gallbladder has been removed, the gas in the abdomen is allowed to escape through the laparoscope, cuts are sutured and dressings is done.

This procedure is performed under general anesthesia. It takes around 60-90 minutes to perform the procedure and patient is discharged the same day. Normally complete recovery takes around 10 days.

Benefits

• Faster recovery

• Procedure involves only four small openings in the abdomen, than a five to seven inch incision, which is made in open surgery (Less invasive procedure)

• Minimal post –operative pain

• Duration of hospitalization is less( few hours to overnight)

Open cholecystectomy: In this procedure an incision, which is about 4 to 6 inches long is made just below the ribs on the right side & it extends till the waist. Procedure is performed under general anesthesia. After the procedure mostly a hospitalization of 5-6 days is required. It has a longer recovery period & it takes almost six weeks to recover.

An open cholecystectomy is performed when a laparoscopic cholecystectomy is not recommended, in cases like:

• Patient is in the third trimester (the last three months) of pregnancy

• Person is extremely overweight

• Have an unusual gallbladder or bile duct structure that makes a keyhole procedure difficult and potentially dangerous

• Gall bladder is severely inflamed, infected or scarred from other operations

Complications of Gall Bladder Stone Surgery

Like any other abdominal surgery, Laparoscopic Cholecystectomy also carries some risks. Although the risks are rare, but it still carries the same risks as general surgery. Complications include:

• Temporary changes in the bowel habits.

• Bleeding & infection may occur.

• At times the gallbladder cannot be safely removed by laparoscopy, In that case open abdominal surgery has to be performed immediately.

• Nausea and vomiting may occur after the surgery.

• Injury to the bile ducts, blood vessels, or intestine can occur, requiring corrective surgery

• At times leakage of bile in the abdomen can occur.

• Pneumonia, blood clots, heart problems can also occur.

Diet After Gall Bladder Removal

After the removal of gall bladder a patient has to have a careful watch on their diet. This will help the patient to adjust to the changes in the new digestion, with less discomfort. Following eating habits should be followed:

• Eat small, more frequent meals

• Have low fat food

• High fiber & gas producing food should be started slowly

• Caffeinated beverages and dairy products are difficult to digest , so should be avoided

• Spicy foods should be introduced slowly

References

http://www.webmd.com/digestive-disorders/gallstones

http://www.]edicalnewstoday.com/articles/153981.php

http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/gallstones/Pages/facts.aspx

https://www.gstatic.com/healthricherkp/pdf/gallstones_en_IN.pdf

http://www.everydayhealth.com/gallbladder/non-surgical-treatments-for-gallstones.aspx

http://www.nhs.uk/Conditions/Gallstones/Pages/Treatment.aspx