Unbearable Stomach Pain Beware of Gallstones

Cholelithiasis, or gallstones, are hardened deposits of digestive juices that can form in the gallbladder. The gallbladder is a small organ located just below the liver. The gallbladder functions to store a digestive fluid called bile to be excreted into the intestine. In the United States, 6% of men and 9% of women have gallstones, mostly asymptomatic. In patients with asymptomatic gallstones discovered incidentally, the percentage chance of developing symptoms or complications is 1% to 2% per year. Asymptomatic gallstones found in the gallbladder usually do not require treatment unless symptoms develop. However, research says about 20% of these asymptomatic gallstones will not show symptoms for 15 years.

Causes of Gallstone Disease

1. Saturated Cholesterol: Normally, bile can dissolve the amount of cholesterol excreted by the liver. However, if the liver secretes large amounts of cholesterol beyond the capacity of bile to dissolve it, the excess cholesterol can precipitate and form crystals. The crystals will then be trapped in the mucus of the gallbladder. Over time, the crystals can grow to form stones and block the ducts, eventually leading to gallstone disease.
2. Excess bilirubin: Bilirubin, a yellow pigment that comes from the breakdown of red blood cells, will enter the bile after being processed in the liver. Certain conditions, such as certain blood disorders, cause the liver to produce a lot of bilirubin through the process of breaking down hemoglobin or red blood cells, which then accumulates so that they can form gallstones.
3. Gallbladder hypomotility or impaired gallbladder contractility: If the gallbladder does not empty effectively, bile can become concentrated and form gallstones.

Symptoms of Gallstone Disease

Patients with gallstone disease usually present with symptoms of biliary colic (remitting episodes of pain in the right upper abdomen that are constant and sharp, often followed by nausea and vomiting). The pain appears when the stone blocks the gallbladder duct when it contracts. When the gallbladder relaxes, the stones fall back into the gallbladder, and the pain subsides within 30 to 90 minutes. Contraction of the gallbladder appears when there is certain stimulation, such as when we are consuming fatty foods, which may only appear after +/- 1 hour of eating. The frequency of pain varies; it doesn't always appear every day, and some people don't complain of pain after eating fatty foods.

Diagnosis of gallstones

Ultrasound is the first line of choice for the enforcement of gallstones, with a sensitivity of 84% and a specificity of 99% compared to other radiological enforcement methods.

Gallstone Treatment

Sometimes patients can pass gallstones without knowing it. However, if the sufferer is in pain, the doctor will likely recommend gallstone treatment in the form of surgery. In rare cases, a doctor may also recommend medication. The following is an explanation of the treatment of gallstones that you can live with. Based on non-surgical and surgical procedures:

1. Non-Surgical Treatment

If surgery does not suit the individual condition, such as if the patient is a much older individual, there are several other ways doctors can try to get rid of gallstones, including: Oral dissolving therapy This procedure usually involves using the drugs ursodiol and chenodiol to break up gallstones. These medicines contain bile acids, which work to break up stones. This treatment is most suitable for breaking up cholesterol stones and can take months or years to fully work. Shock wave lithotripsy. This procedure involves a lithotripter, a machine that generates shock waves that pass through a person. These shock waves can break gallstones into smaller pieces. Percutaneous drainage of the gallbladder This procedure involves placing a sterile needle into the gallbladder to aspirate (extract) bile. Then, the doctor will insert a tool in the form of a tube to help with additional drainage.

        2. Surgery

Cholecystectomy, which is surgery to remove the gallbladder. Since the gallbladder is not an essential organ, you can live a healthy life without it.

There are two types of cholecystectomy:

• Laparoscopic Cholecystectomy. In the procedure, the surgeon will usually make three or four incisions in the abdomen. Then the doctor will insert a small, lighted device into one of the incisions, examine the stones, and carefully remove the gallbladder.
• Open Cholecystectomy. Doctors usually do this operation when the gallbladder is inflamed, infected, or injured. This surgery may also occur if the problem occurs during a laparoscopic cholecystectomy.

Complications of Gallstone Disease

• Inflammation of the gallbladder

Gallstones that get stuck in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain and fever.

• Bile duct blockage

Gallstones can block the tubes (ducts) through which bile flows from the gallbladder or liver to the small intestine. Severe pain, jaundice, and bile duct infections can occur due to this condition.

• Blockage of the pancreatic duct

The pancreatic duct is a tube that runs from the pancreas and connects to the bile duct just before entering the duodenum. Fluid from the pancreas, which aids in digestion, flows through the pancreatic duct. Gallstones can cause a blockage in the ducts of the pancreas, which can cause 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. Even so, this cancer is very rare.

If you experience these signs and symptoms and suspect the cause is gallstones, immediately consult a doctor to confirm the diagnosis of the condition you are experiencing so that treatment can be carried out immediately.

 

Source:

Tanaja J, Lopez RA, Meer JM. Cholelithiasis. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470440/