Gallbladder: Gallstones / Cholelithiasis
Gallstones are stones are formed in the gallbladder. The gallbladder is a small, pear-shaped organ located below the liver in the right upper abdomen.
Gallstones are formed when cholesterol or bile pigments precipitate out of bile as small crystals. As these crystals enlarge, they form gallstones. Gallstones range in size from as small as a grain of sand to as large as an almond seed. The number of stones may also vary from person to person.
- Gallstones are more common in women than men, in particularly the middle-aged females.
- Increasing age
- 3 persons out of every 10 above the age of 60 years old may have gallstones.
- A diet high in fat and cholesterol and low in fibre can increase the risk of gallstones
- Familial risk
- Diabetes mellitus
- Overweight or obese patients
- People taking oestrogen-containing medication,
- People taking certain medications to lower cholesterol levels.
- People who have rapid weight loss.
- As the body metabolizes fat during prolonged fasting and rapid weight loss (e.g. crash diets), the liver secretes extra cholesterol into bile, which can then cause gallstones.
Majority of people with gallstones have no symptoms. Occasionally, the stones may get lodged in the cystic duct. This is when symptoms will arise.
Mild symptoms include:
- Bloatedness or indigestion
- Mild pain felt in the right upper abdomen
The symptoms tend to occur after taking oily or fatty food.
If the blockage of the cystic duct is significant, the patient may experience a gallbladder attack (medically this is known as biliary colic):
- Pain in the right upper abdomen lasting 30 minutes to several hours
- Pain spreading to the back over the right shoulder
- Nausea or vomiting
The attack may stop spontaneously after a few hours should the gallstone fall back and no longer blocks the duct. However, if the blockage persists, the patient may develop acute cholecystitis.
Although gallstones are not usually life-threatening, there are situations where gallstones can cause complications that may lead to severe illness and even death.
You should see your doctor if you develop the mild symptoms and not wait till you develop an acute gallbladder attack. Furthermore, gallstone symptoms may be similar to other conditions such as a heart attack, appendicitis, stomach ulcers, etc. Hence it is important that you see your doctor and obtain an accurate diagnosis.
The doctor will take a detailed history of your complaints and perform a thorough physical examination.
Investigations that may be performed include:
- Abdominal ultrasound
- the most sensitive and specific test for gallstones.
- Computed Tomography (CT) scan
- Magnetic Resonance Imaging (MRI or MRCP) scan
If the gallstones do not cause any symptoms, they can be left alone.
If you are having symptoms, surgery to remove the gallbladder (cholecystectomy) may be recommended. Surgery to remove the gallbladder is one of the most common operations performed on adults in the world.
Nearly all cholecystectomies today are performed by keyhole or laparoscopic technique, known as Laparoscopic Cholecystectomy. Such minimally invasive operations result in less pain and allow the patient to recover faster, and consequently have an earlier discharge from hospital.
Although laparoscopic or keyhole operation to remove the gallbladder is the standard operation nowadays, there may be special circumstances where your surgeon has to perform the traditional Open Cholecystectomy. Such situations include a severely inflamed gallbladder, infection, or scarring from other operations, etc.