Gall Stone
what is gall stone?
The gallbladder is an organ located in the right upper quadrant of the abdomen, below the liver. It is responsible for the concentration, storage and release of bile in the gastrointestinal tract to facilitate the absorption of lipids and certain vitamins.
Cholelithiasis, the presence of gallstones or more commonly known as “gallstones” is the most common gallbladder condition.
The formation of gallstones is related to the relative concentrations and solubility of bile contents, mainly cholesterol.
A large stone or several small stones can become lodged in the cystic duct and block the flow of bile to the bile ducts and small intestine. This creates a sort of plug that prevents the bile from draining. when there is a risk that the chemicals contained in the bile and some possible bacterial infections can cause acute cholecystitis, an inflammation of the gallbladder, which when created by the presence of stones in the gallbladder or in the bile duct is called lithic cholecystitis – there is also alithic cholecystitis which is not caused by stones and is an even more serious disease.
Gall Stone
The video belongs to the channel ISFGS
Causes of gallstone formation
The formation of gallstones is related to the relative concentrations and solubility of bile contents, mainly cholesterol.
The incidence of gallstones depends on several factors such as ethnicity, race, age, gender, obesity, family history, associated diseases. The precursor to stones is biliary sludge, which basically consists of mucus, cholesterol and a polymer of bilirubin called calcium bilirubin.
There are several types of stones, different in shape and composition, but cholesterol stones account for more than 85%. Cholesterol gallstones vary in color from light yellow to dark brown and account for 4 out of 5 cases of gallstones.
Gall stones more often afflict the female gender. However, men are the ones with the most serious complications.
Gall stones – Size
Gallstones can vary in size from small to large ones that can reach several centimeters. This size significantly affects the symptoms and the way of treatment.
Small stones can pass unnoticed through the biliary system, causing little or no pain. Conversely, larger stones can cause severe pain and obstruction of bile flow, sometimes requiring surgery to remove them.
The size of the stones also affects the effectiveness of treatment methods. Smaller stones may be treated with drug therapy or metabolic changes in diet, while larger stones may require surgery to remove.
How is it related to nutrition?
Diet is closely related to gallstone formation and the health of the biliary system in general. Gallstones usually develop from poor diet and other factors. Some main connection elements include:
- Obesity is associated with an increased risk of gallstones. Maintaining a healthy weight through a balanced diet and physical activity can reduce this risk.
- Drinking enough water is important for maintaining a healthy biliary system. Water helps dissolve bile acids and reduces the risk of gallstones.
- Eating too much saturated fat can increase the risk of gallstones. Limiting saturated fat and choosing healthy fats such as fatty fish, avocados and olive oil are important factors.
Gall stone: Symptoms
Gallstones can have symptoms or be asymptomatic.
In asymptomatic patients the presence of gallstones is often detected incidentally during the performance of other tests. Of asymptomatic patients, only 20% will develop symptoms within 15 years, particularly colic pain.
Symptomatic patients, on the other hand, have the characteristic pain associated with gallstones, known as biliary colic. Biliary colic is actually characterized by a very sharp and sudden pain that occurs in the upper abdomen, in the center or more often to the right under the ribs. The pain may extend backwards until it reaches the lower edge of the shoulder blade.
This pain can last from twenty to thirty minutes to six or even twelve hours. Often, precisely because of its intensity, the pain is associated with nausea, profuse sweating and vomiting.
Symptomatic patients also have an increased risk of developing complications of the disease, such as acute cholecystitis, gangrene, empyema, dropsy, jaundice, choledocholithiasis (the passage of stones in the main bile duct), cholangitis, and acute pancreatitis.
Gallstone: Diagnosis
Ultrasound of the upper abdomen made it possible to assess the true spread of this previously underestimated pathology. Today, according to statistics, about 15% of the population have gallstones.
Ultrasound of the upper abdomen is the simplest and most reliable way of diagnostic approach. In fact, it allows the doctor to see the stones, the condition of the gallbladder wall, and any stones in the common bile duct (duct that carries bile directly from the liver to the intestine). In addition, this examination, unlike the old cholecystography, the patient is not exposed to radiation.
In the presence of atypical symptoms, however, other pathologies affecting the digestive tract must be excluded (for example, peptic ulcer, gastroesophageal reflux, irritable bowel syndrome, etc.).
Ultrasound does not require any special preparations for the test other than fasting for at least 6/8 hours and possibly a low fiber diet (fruits, whole grains, legumes) for the previous two or three days. In this way we try to prevent intestinal distention, one of the main factors that prevent diagnosis.
If the ultrasound examination is positive, no further tests are needed to confirm the presence of gallstones. If, on the other hand, the ultrasound is negative, further tests can be done:
Upper Abdominal Magnetic Resonance Imaging (MRI) and Magnetic Cholangiopancreatography (MRCP): It is an innovative technique that exploits the potential of magnetic resonance. It allows imaging reconstruction of the intrahepatic and extrahepatic biliary tract, as well as visualization of stenosis and lithiasis.
Endoscopic Reverse Cholangiopancreatography (ERCP): This is an invasive method that allows radiological highlighting of the state of the health of the biliary and pancreatic ducts (biliary system, gallbladder, common hepatic duct, intrahepatic ducts and pancreatic duct system). Contrast medium is injected through a tube that is inserted through the mouth and down into the digestive tract to take x-rays. Through other catheters it is also possible to perform therapeutic maneuvers such as extraction of stones or drainage of bile in case of obstructive jaundice (benign or malignant).
Gallstone: Treatment
If gallstones have already caused biliary colic, the chances of this colic reoccurring are rather high (about 60% in the next two years). For this reason, after the appearance of colic or other complications, the main indication is surgical removal of the gallbladder (cholecystectomy).
Cholecystectomy
Cholecystectomy surgery is the only way to permanently solve the problem.
In recent years, the use of this intervention is increasingly preventive, especially if the gallstones are small and multiple. There is always the risk that these stones will become dislodged, causing the typical complications of lithiasis. Consequently, the preventive approach to the disease is definitely preferable to emergency surgery.
In the absence of symptoms, removal of the gallbladder is indicated, for example, when the patient is young (high risk of long-term complications) and/or when he cannot psychologically bear the existence of the disease. It is also indicated in the presence of diabetes mellitus, when there is immunosuppression and other pathologies/risk factors (such as the presence of a gallbladder polyp >5-6mm) that require an invasive surgical approach.
How it is done:
Thanks to the introduction of laparoscopic surgery, known to most as a “minimally invasive” technique, the treatment of gallstones has been significantly modernized in recent years. Through small incisions made in the patient’s abdomen, special tools are inserted that the surgeon will manipulate with the help of images from a micro camera inserted at the level of the navel. The introduction of gas into the abdominal cavity helps lift the abdominal wall making operations easier.
Advantages of laparoscopic surgery
Laparoscopic surgery is a modern and effective approach to the treatment of gallstones, presenting many advantages over traditional surgical techniques. These advantages include:
- Minimally Invasive: Laparoscopic surgery allows surgical instruments to enter through small incisions in the abdomen, instead of the open surgical approach. This significantly reduces surgical trauma, pain and recovery time.
- Shorter Hospital Time: Patients who undergo laparoscopic surgery to remove gallstones usually recover faster. Thanks to this type of intervention, the postoperative course is faster and the patient can be discharged on the same day of the operation, without the pains and recovery difficulties that characterized the past.
- Minimal Risk of Infections: Smaller intervention on the body reduces the risk of infections. The laparoscopic approach is usually associated with less blood loss, minimizing the risks associated with surgery.
- Conservative Pain Management: The less invasiveness of laparoscopic surgery allows for more effective pain management with minimal impact on the patient, allowing them to return to their daily activities more quickly.
In general, after laparoscopic removal of the gallbladder, life begins as normal from the day after surgery.
What is life like without bile?
Living without bile can signal a number of changes and challenges in one’s health and lifestyle. Bile is an important substance produced by the liver and stored in the gallbladder to aid in the digestion process.
When someone lives without bile, as can happen after a choledectomy, they are likely to experience some side effects such as dietary changes. The choledectomy procedure can affect the digestive process, as bile helps digest fats. Patients may need to adjust their diet by choosing low-fat foods.
