Gallstones and surgery
Overview
Gallstones are hardened deposits of digestive
fluid that can form in your gallbladder. Your gallbladder is a small,
pear-shaped organ on the right side of your abdomen, just beneath your liver.
The gallbladder holds a digestive fluid called bile that's released into your
small intestine.
Gallstones range in size from as small as a
grain of sand to as large as a golf ball. Some people develop just one
gallstone, while others develop many gallstones at the same time.
People who experience symptoms from their
gallstones usually require gallbladder removal surgery. Gallstones that don't
cause any signs and symptoms typically don't need treatment.
Symptoms
Gallstones may cause no signs or symptoms. If
a gallstone lodges in a duct and causes a blockage, the resulting signs and
symptoms may include:
· Sudden and rapidly intensifying pain in the
upper right portion of your tummy
· Sudden and rapidly intensifying pain in the
center of your tummy, just below your chest
· Back pain between your shoulder blades
· Pain in your right shoulder
· Nausea or vomiting
Gallstone pain may last several minutes to a
few hours.
When to see a doctor
Make an appointment with your doctor if you
have any signs or symptoms that worry you.
Seek immediate care if you develop signs and
symptoms of a serious gallstone complication, such as:
· Abdominal pain so intense that you can't sit
still or find a comfortable position
· Yellowing of your skin and the whites of your
eyes (jaundice)
· High fever with chills
Causes
It's not clear what causes gallstones to form.
Doctors think gallstones may result when:
· Your bile contains too much cholesterol. Normally, your bile contains enough
chemicals to dissolve the cholesterol excreted by your liver. But if your liver
excretes more cholesterol than your bile can dissolve, the excess cholesterol
may form into crystals and eventually into stones.
· Your gallbladder doesn't empty correctly. If your gallbladder doesn't empty
completely or often enough, bile may become very concentrated, contributing to
the formation of gallstones.
Types of gallstones
Types of gallstones that can form in the
gallbladder include:
· Cholesterol gallstones. The most common type of gallstone,
called a cholesterol gallstone, often appears yellow in color. These gallstones
are composed mainly of undissolved cholesterol, but may contain other
components.
· Pigment gallstones. These dark brown or black stones form
when your bile contains too much bilirubin.
Risk factors
Factors that may increase your risk of
gallstones include:
· Being female
· Being age 40 or older
· Being overweight or obese
· Being sedentary
· Eating a high-fat diet
· Eating a high-cholesterol diet
· Eating a low-fiber diet
· Having a family history of gallstones
· Having diabetes
· Losing weight very quickly
· Taking medications that contain estrogen, such
as oral contraceptives or hormone therapy drugs
· Having liver disease
Complications
Complications of gallstones may include:
· Inflammation of the gallbladder. A gallstone that becomes lodged in the
neck of the gallbladder can cause inflammation of the gallbladder
(cholecystitis). Cholecystitis can cause severe pain and fever.
· Blockage of the common bile duct. Gallstones can block the tubes (ducts)
through which bile flows from your gallbladder or liver to your small
intestine. Severe pain, jaundice and bile duct infection can result.
· Blockage of the pancreatic duct. The pancreatic duct is a tube that runs
from the pancreas and connects to the common bile duct just before entering the
duodenum. Pancreatic juices, which aid in digestion, flow through the
pancreatic duct.
A gallstone can cause a blockage in the pancreatic duct, which
can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes
intense, constant abdominal pain and usually requires hospitalization.
· Gallbladder cancer. People with a history of gallstones have
an increased risk of gallbladder cancer. But gallbladder cancer is very rare,
so even though the risk of cancer is elevated, the likelihood of gallbladder
cancer is still very small.
Prevention
You can reduce your risk of gallstones if you:
· Don't skip meals. Try to stick to your usual mealtimes
each day. Skipping meals or fasting can increase the risk of gallstones.
· Lose weight slowly. If you need to lose weight, go slow.
Rapid weight loss can increase the risk of gallstones. Aim to lose 1 or 2
pounds (about 0.5 to 1 kilogram) a week.
· Eat more high-fiber foods. Include more fiber-rich foods in your
diet, such as fruits, vegetables and whole grains.
·
Maintain
a healthy weight. Obesity and
being overweight increase the risk of gallstones. Work to achieve a healthy
weight by reducing the number of calories you eat and increasing the amount of
physical activity you get. Once you achieve a healthy weight, work to maintain
that weight by continuing your healthy diet and continuing to exercise.
Diagnosis
Tests and procedures used to diagnose
gallstones and complications of gallstones include:
· Abdominal ultrasound. This test is the one most commonly used to
look for signs of gallstones. Abdominal ultrasound involves moving a device
(transducer) back and forth across your stomach area. The transducer sends
signals to a computer, which creates images that show the structures in your
abdomen.
· Other imaging tests. Additional tests may include
computerized tomography (CT), magnetic resonance cholangiopancreatography
(MRCP) or endoscopic retrograde cholangiopancreatography (ERCP). Gallstones
discovered using ERCP can be removed during the procedure.
· Blood tests. Blood tests may reveal infection, jaundice, pancreatitis
or other complications caused by gallstones.
Treatment
Most people with gallstones that don't cause
symptoms will never need treatment. Your doctor will determine if treatment for
gallstones is indicated based on your symptoms and the results of diagnostic
testing.
Your doctor may recommend that you be alert
for symptoms of gallstone complications, such as intensifying pain in your
upper right abdomen. If gallstone signs and symptoms occur in the future, you
can have treatment.
Indications for surgery in gallstones
·
Symptomatic gallstones disease
·
Gallstones with jaundice
·
Pancreatitis
·
Family history of gallbladder cancer
Treatment options for gallstones include:
· Surgery to remove the gallbladder
(cholecystectomy). Your doctor may
recommend surgery to remove your gallbladder, since gallstones frequently
recur. Once your gallbladder is removed, bile flows directly from your liver
into your small intestine, rather than being stored in your gallbladder.
You don't need your gallbladder to live, and gallbladder removal
doesn't affect your ability to digest food.
What are the
advantages of laparoscopic gallbladder surgery?
·
Smaller incision –
Several small incisions, each less than one (1) inch long, instead of a 5- to
7-inch incision for open surgery.
·
Less pain than after
open surgery.
·
Quicker recovery than
open surgery – You might go home the same day you have your surgery. You can
also go back to regular activities more quickly.
Is Laparoscopic
Gallbladder Removal for You?
Laparoscopic
gallbladder removal might be the right choice for you because it is the most
common type of gallbladder surgery. It might not be an option if:
·
You have severe
gallbladder problems, or
·
You had earlier
surgery in your upper abdomen.
·
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