GALLSTONES :

As the name suggests gallstones are stones in the gall bladder. Nowadays the cases of gallstones are increasing and it is more common in the Asian population.

 

 

RISK FACTOR :

1) Old age due to decrease in mobility of gall bladder.

2) Obese population due to increase in cholesterol in the body.

3) Women especially those who are pregnant are at extra risk of gallstones due to extra secretion of estrogen and progesterone which can lead to increase production of cholesterol in the body.

4) Excessive weight loss in less amount of time can lead to gallstone formation.

5) Medicines like ceftriaxone, oral contraceptive medicines, clofibrate, somatostatin.

6) Genetic materials like Apo A-1, Apo B, Apo E have shown to have links in gallstone formation.

7) Diabetics patients also have low motility of bile in the gall bladder and leads to gallstones.

8) Alcoholic liver cirrhosis

9) chronic hemolysis and pernicious anemia.

10) parasitic infection. 

TYPES OF GALLSTONES:

1) CHOLESTEROL GALLSTONES

2) PIGMENT GALLSTONES

3) MIXED GALLSTONES

 PATHOPHYSIOLOGY-

1) CHOLESTEROL GALLSTONES:

The food which we eat gets metabolized and converted into many forms. One of these forms is cholesterol. It is insoluble in water and needs bile to become soluble. The bile containing biliary salt and phospholipid helps in making the cholesterol soluble. However, if the quantity of cholesterol is more than what can be metabolized in the body or if the bile salt and phospholipid are less compared to a normal level, so they are not able to metabolize the cholesterol. This increases the chance of cholesterol gall stones.

2) PIGMENT STONES:

These stones are of two types: black pigment stones and brown pigment stones. The color in the stones comes from the extra unconjugated bilirubin in the bile.

CLINICAL FEATURE:

Gallstones start to produce symptoms when they move either into the cystic duct or in the common bile duct.

If the gallstones get impacted into the cystic duct then it can cause biliary colic or cholecystitis which can be acute or chronic in nature. If the gallstones enter into the neck of the gall bladder then it can lead to obstructive jaundice, pancreatitis, or Cholangitis.

Biliary colic:

Pain arising due to gallbladder is known as biliary colic. When gallstones get impacted into the neck of the gall bladder then it gives rise to biliary colic because the neck of the gall bladder is covered with stones so bile movement is hampered and this increases the pressure in the gall bladder and causes pain.

Pain due to gallstones is generally felt at the right lower part of the ribs. Sometimes pain can be felt at epigastric reason too.

Pain can be severe after eating a heavy meal or fatty meal. It can be associated with vomiting too. Biliary pain can persist for half-hour to two hours but in some cases can be up to 6 hours.

ACUTE CHOLECYSTITIS :

It is a condition in which the gallstones get stuck at the neck of the gall bladder and due to this wall of the gallbladder neck gets damage and also the bile inside the bladder causes damage too which leads to inflammation. As the bile gets accumulated, it leads to the growth of bacteria which further aggravates the problem.

Pain in acute cholecystitis can continue to more than twelve hours as compared to biliary colic. Pain due to acute cholecystitis generally radiates upward towards the shoulder (acromion). Pain is mostly at the night after lying down in the bed.

Due to the growth of bacteria, the patient can have symptoms like fever, nausea, vomiting, loss of appetite.

A mass can be felt over the gall bladder location which is in the right upper quadrant of the stomach.

CHRONIC CHOLECYSTITIS:

In most cases, gallstones don’t produce any symptoms, and only after long time symptoms like mild stomach pain, nausea or vomiting, and loss of appetite can be seen.

INVESTIGATIONS :

1) Complete blood count- It is done to check for anemia and also if any infection is present in the body.

2) Lipid profile test – It is done to check if cholesterol levels are high as they can lead to cholesterol gallstone.

3) Liver function test- This test is also important to check if liver cells are getting damaged because of gallstones.

4) Blood sugar test – Diabetics are more prone to develop gallstones due to a decrease in motility of the gall bladder.

5) Ultrasound abdomen- It is the most widely used test to diagnose gallstones as it is more accurate.

6)  MRCP AND EUS – MRCP (magnetic resonance cholangiopancreatography) and EUS (Endoscopic ultrasound) can also be used in diagnosis.

7) CT Scan: These tests can also be used for more detailed study.

 TREATMENT-

Depending on the patient’s condition two types of treatment options are available which are Medical treatment and surgical treatment.

Medical treatment-

If the cystic duct of the gall bladder is open and the size of gallstones is less than 1.5 cm and also the patient has no serious complication due to gall stones then UDCA can be prescribed by the doctors and the patient is scanned again after few months to check for the status of the gallstones.

If an infection is suspected due to symptoms and blood check-up, then the doctor prescribes the appropriate antibiotics.

Anemic patients are treated appropriately.

Patients with high cholesterol and sugar level are treated to bring the cholesterol and blood sugar levels under control.

Anti-parasitic medication can be prescribed if the parasitic infection is suspected.

SURGICAL TREATMENT:

Laparoscopic cholecystectomy- It is a laparoscopic procedure of removal of the gall bladder. It is mostly used treatment options as it has shown better results compared to other options and also eliminates chances of gallstone reformation and gall bladder carcinoma.

Compared to open cholecystectomy, in laparoscopic surgery patients can start normal activities more quickly as recovery is much better and also very minimal surgical scar mark.

Other treatment options include ERCP ( Endoscopic retrograde cholangiopancreatography), open surgical removal of the gall bladder when laparoscopic surgery is not possible.

COMPLICATIONS OF GALLSTONES:

1) Gallstone pancreatitis: It occurs when the stone presses over the pancreatic duct and hampers the flow of pancreatic enzyme which leads to reflux of pancreatic enzyme and causes pancreatitis.

2) Cholecystoduodenal fistula: It is a serious condition when the gallstones in the gall bladder cause erosion in the duodenum due to constant friction produced by rubbing of gallstones against the duodenum.

3) Gallstone ileus.

STAY SAFE AND HEALTHY.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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