GALLSTONES

What Is the Gallbladder?

 

The gallbladder is a small pear-shaped sac that can be found under your liver. Your liver produces bile, which is then stored in the gallbladder. The gallbladder’s function is to excrete bile into the small intestine to help digest fats, allowing easier absorption of fat-soluble vitamins and nutrients into the bloodstream.

 

“The main function of the gallbladder is to store bile, which is a fluid made by your liver to break down fats that you eat. After a meal, bile is secreted by the gallbladder when the small intestine secretes the hormone cholecystokinin. The bile flows into the small intestine and helps to digest fats that the foods contain. The gallbladder also acts as a reservoir for the bile that is not being used by the body.”

– Dr Ganesh Ramalingam

 

What Happens When You Experience Gallbladder Disease?

 

One of the primary causes of gallbladder diseases is inflammation due to irritation of the gallbladder walls. This is because gallstones block the ducts that lead to the small intestine, causing bile to accumulate and resulting in inflammation.

 

As a result of gallbladder disease, you might experience the following symptoms:

  • Pain – usually occurs in the mid-to upper-right section of your abdomen)
  • Nausea and vomiting
  • Chronic Diarrhoea
  • Jaundice – Yellowing of the skin or whites of the eyes, caused by the excess of the pigment bilirubin
  • Discoloured stools or urine – Light coloured stools or dark coloured urine may be observed

If you think that these symptoms look similar to other gastric diseases or typical stomach discomfort, you may be right.

 

“Most patients who experience pain in their abdomen may not be able to identify the conditions of gallbladder disease immediately. As a result, it is important to look for signs of gallbladder disease or inflammation as they may eventually damage the gallbladder, making it lose its ability to function correctly.”

– Dr Ganesh Ramalingam

 

Most people can go about their lives without even realising they have a gallbladder disease, which in this case, was one relating to gallstones. In 2015, a 70-year-old man removed a gallstone the size of a melon. The condition went unnoticed for decades before it finally detected and removed. By the time of removal, it weighed 1.2kg and was 14cm wide, making it one of the largest gallstones to be removed from a person.

 

What Are Gallstones?

 

Gallstones, Gallbladder Disease

Gallstones are small solid pieces of material usually made of cholesterol, which form in the gallbladder. In many cases, they do not cause symptoms and do not require immediate removal.

 

However, if the gallstones are trapped in the bile duct of the gallbladder, you will suddenly feel intense pain and need to be treated immediately.

 

What Causes Gallstones?

 

When cholesterol levels in the blood are too high, this excess cholesterol hardens and turns into stone. This is how the stones develop in 80% of gallstone cases. In the remaining 20% of gallstone cases, gallstones result from the hardening of unusually high levels of a waste product called bilirubin in the gallbladder.

 

What Are the Symptoms of Gallstones?

 

Most people with gallstones may not even experience symptoms or know they have it unless the doctor diagnoses them. But if you do, symptoms of gallstones include:

 

  • Sudden, intense abdominal pain that is felt in the middle of your abdomen or your right-hand side that may last for several hours
  • This pain often spreads to your back or right shoulder or shoulder blade
  • Nausea or vomiting
  • Yellowing of your skin or eyes, which is called jaundice
  • Fever or chills

 

Dr Ganesh says, “Gallstones themselves don’t cause pain, but the pain which most patients experience occurs when the gallstones block the movement of bile from the gallbladder.”

 

When that happens, gallstones can lead to pain in the upper right abdomen. Patients may start to have gallbladder pain from time to time when consuming foods that are high in fat, such as fried foods. The pain does not usually last more than a few hours.

 

How Are Gallstones Diagnosed?

 

Gallstones, Gallbladder Disease

 

To diagnose the presence of gallstones, your doctor will assess you in a physical examination. You may be scheduled to undergo diagnostic imaging tests such as blood tests, ultrasound scan, CT scan, cholangiography, and MRI scan to check for abnormalities in your gallbladder.

 

Blood tests can test for infection or other conditions such as pancreatitis and jaundice, which is caused by gallstones. An ultrasound scan or CT scan provides images of your gallbladder. The doctor analyses the images for signs of gallstones.

 

Cholangiography is performed by using a dye that shows up on X-rays. The dye may be injected using an endoscope through your mouth, or into your blood. Alternatively, it may be injected directly into your bile ducts during surgery. After this, X-ray images are taken. If your gallbladder and bile systems are functioning normally, the dye will be absorbed in specific places. 

 

Otherwise, the images will reveal abnormalities in your bile or pancreatic systems. If a blockage has been detected, an endoscopic retrograde cholangial-pancreatography (ERCP) will be carried out. During this procedure, your doctor removes the blockage using an endoscope.

 

MRI scan is carried out to check for gallstones in the bile ducts. This scan uses strong magnetic fields and radio waves to produce detailed images of the organs in the body.

 

What Are the Risk Factors That Cause Gallstones?

 

Dr Ganesh says, “The risk of an individual developing gallstones is mainly related to their diet and lifestyle. For many, they tend to lean towards a high fat and high cholesterol diet, which may lead to other gallbladder diseases as well.”

 

You may be at risk if you:

  • Are overweight or obese
  • Consume a low-fibre, high-fat and high-cholesterol diet
  • Have had rapid weight loss recently

 

Other factors that increase your risk of developing gallstones are:

  • A family history of gallstones
  • Birth control pills or hormones
  • Liver disease
  • Diabetes

 

While gallstones are usually developed later in age, a rare occurrence took place when an otherwise healthy three years and ten-month-old boy was presented to the hospital’s emergency department after multiple visits to other facilities complaining of abdominal pain. 

 

The pain was described as being cramp-like, and the child’s mother endorsed his aversion to fatty foods and carbonated beverages. Abdominal ultrasound revealed the child had calcified gallstone that developed in the neck of the gallbladder. 

 

While being rare in adults, cholelithiasis (the condition for the presence of one or more gallstones in the gallbladder) must always be on the differential diagnosis with a childhood complaint of postprandial abdominal pain. 

 

Cholecystectomy, the surgical removal of the gallbladder, is the appropriate treatment for symptomatic cholelithiasis. This is especially so in children. A cholecystectomy can safely be performed in the outpatient setting, and the emerging technique of single-incision laparoscopy is likely to play an increasingly important role in its management in carefully selected patients.

 

Do Gallstones Go Away on Their Own?

 

Most of the time, patients with gallstones will not need treatment unless it is causing them pain. Depending on the severity of the condition and presence of gallstones within the gallbladder, dietary changes may be the first step to preventing complications. 

 

In severe cases where patients experience extreme pain, your doctor will likely recommend surgery.  

 

What Should I Avoid Eating With Gallstones?

 

To improve your condition and reduce your risk of gallstones, changing your diet may help. You may consider:

  • Reduce your intake of fats and choose low-fat foods whenever possible. Avoid high-fat, greasy, and fried foods.
  • Adding fibre to your diet helps make your bowel movements more solid. By adding only a serving of fibre at a time, you can prevent gas that can occur from eating excess fibre.
  • Avoiding foods and drinks known to cause diarrhoea, including caffeinated drinks, high-fat dairy products, and high-sugar foods.
  • Eating several small meals per day as smaller meals are easier for the body to digest.
  • Drinking sufficient amounts of water daily (6 to 8 glasses).

 

If you are planning to lose weight, aim to do it slowly. Aim to lose no more than one kilogram per week as rapid weight loss may increase the risk of gallstones and other health problems.

 

How Are Gallstones Treated?

 

For patients with asymptomatic gallstones, lifestyle changes can help prevent complications.

 

Consider making changes in the following:

  • Maintain a healthy weight
  • Consume a diet focusing on anti-inflammatory foods (such as tomatoes, olive oil, green leafy vegetables and berries)
  • Avoid rapid weight loss
  • Lead a healthy active lifestyle

 

For symptomatic gallstones where patients experience pain, surgery may be recommended. 

 

Laparoscopic Cholecystectomy is a common surgery used to treat gallstones. This surgery is recommended if you have pain or other symptoms from gallstones, or your gallbladder is not functioning normally. The stones may block the bile ducts which provide a passageway for bile to flow from the gallbladder or liver to the small intestine. 

 

This condition, known as choledocholithiasis, can cause severe pain, jaundice and infection. It requires immediate medical attention. Gallstones may also block the pancreatic duct, which is a tube between the pancreas and the common bile duct. 

 

This may cause pancreatitis, which is inflammation of the pancreas. It is a severe condition that causes intense and constant abdominal pain.

 

Laparoscopic Cholecystectomy is done under general anaesthesia. With three or four small incisions, your surgeon will be able to remove your gallbladder, allowing you to be discharged in a day or two after the procedure.

 

Do note that you may experience loose or watery stools after gallbladder removal. Since removing a gallbladder involves rerouting the bile from the liver to the small intestine, bile no longer passes through the gallbladder, and it becomes less concentrated. This can result in a laxative effect that causes diarrhoea. Eat a reduced-fat diet so that you release less bile as a means of treating this. 

 

What Happens After I Remove My Gallstones?

 

If surgery is needed to remove your gallbladder or any stones in your gallbladder, the outlook is often positive. In most cases of stone removal, the gallstones do not recur.

 

With that said, you do not require treatment if your gallstones do not cause symptoms. You may, however, want to make lifestyle changes to prevent them from getting bigger and causing problems.

 

Can I Survive Without My Gallbladder?

 

Cholecystectomy, Gallbladder Disease

Sara Meinschein is a busy 21-year-old. While balancing her hectic lifestyle as a student while working as a nurse, Sara started to feel nauseous and experience abdominal pain, but would brush it off as mild indigestion.

 

For four months, Sara suffered from pain and had several instances of gallbladder attacks. This occurs when a gallstone gets stuck in the bile duct of the gallbladder.

 

Further investigation revealed Sara had sludge and gallstones in her gallbladder. Ultimately, Sara decided to have her gallbladder removed, and within a week of recovery, Sara’s appetite returned just in time for Thanksgiving.

 

“I didn’t realise how much pain I was in with the attacks,” Sara says. “I feel so much better now.”

 

“You can lead a perfectly normal life without a gallbladder. Your liver will still make enough bile to digest your food. However, instead of being stored in the gallbladder, it drips continuously into your digestive system.”

– Dr Ganesh Ramalingam

 

With that said, there may be some lifestyle changes required to improve your quality of life while helping you ease digestive symptoms such as:

 

  • Adopt a low-fat diet
  • Avoid fatty foods
  • Eat small and frequent meals
  • Avoid eating a large dinner after fasting

 

Schedule a consult with our doctor Dr Ganesh Ramalingam

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