Adam Bartlett
Adam Bartlett : 09 6234 789
Adam Bartlett FRACS PhD - HPB, Laparoscopic and General Surgeon

Patient Info

Gall Stones

A gallstone, is a lump of hard material usually range in size from a grain of sand to 3-4 cms. They are formed inside the gall bladder formed as a result of precipitation of cholesterol and bile salts from the bile.

Types and causes of gallstones

  • Cholesterol stones
  • Pigment stones
  • Mixed stones - the most common type. They are comprised of cholesterol and salts

Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason.

Pigment stones are small, dark stones made of bilirubin. The exact cause is not known. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anaemia in which too much bilirubin is formed.

Other causes are related to excess excretion of cholesterol by liver through bile. They include the following

  • Gender. Women between 20 and 60 years of age are twice as likely to develop gallstones as me
  • Obesity. Obesity is a major risk factor for gallstones, especially in women
  • Oestrogen. Excess oestrogen from pregnancy, hormone replacement therapy, or birth control pills
  • Cholesterol-lowering drugs
  • Diabetes. People with diabetes generally have high levels of fatty acids called triglycerides
  • Rapid weight loss. As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones

Symptoms

Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called "silent stones." Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis. So accurate diagnosis is important.

Symptoms may vary and often follow fatty meals, and they may occur during the night.

  • Abdominal bloating
  • Recurring intolerance of fatty foods
  • Steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours
  • Pain in the back between the shoulder blades
  • Pain under the right shoulder
  • Nausea or vomiting
  • Indigestion & belching

Diagnoses

Ultrasound is the most sensitive and specific test for gallstones.

Other diagnostic tests may include

  • Computed tomography (CT) or Magnetic Resonance Imaging (MRI) may show the gallstones or complications

  • Endoscopic retrograde cholangiopancreatography (ERCP). The patient swallows an endoscope--a long, flexible, lighted tube connected to a computer and TV monitor. The doctor guides the endoscope through the stomach and into the small intestine. The doctor then injects a special dye that temporarily stains the ducts in the biliary system. ERCP is used to locate and remove stones in the ducts

  • Endoscopic ultrasound (EUS). A endoscope attached to a TV monitor and ultrasound machine is passed into the stomach and first part of the small bowel. The ultrasound probe is very sensitive at looking for abnormalities in the upper GI track, in particular the pancreas and biliary tree
  • Blood tests. Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice

Complications

Acute cholecystits is a severe infection of the gallbladder. It usually begins like biliary colic, but the pain becomes constant, and is associated with fever. Acute cholecystitis usually requires hospital admission for intravenous antibiotics and can be managed surgically by the acute removal of the gallbladder. Surgery can usually be safely deferred until the infection/inflammation has all settled (around 6 weeks), making the surgery easier and safer.

Cholangitis: If stones pass from the gallbladder into the bile duct, they may cause partial or complete blockage of bile flow. This will lead to stasis of bile within the liver, causing an abnormality in the liver function blood tests. If severe you may become jaundiced (yellow), and pass dark urine. When associated with fever and pain, it indicates infection of the bile – termed cholangitis. This is a medical emergency, and requires urgent decompression of the blockage either at the time that the gallbladder is removed (operative exploration) or endoscopically prior to the removal of the gallbladder.

Pancreatitis: The pancreas is a digestive organ intimately related to the bile ducts. Occasionally gallstones can pass out of the gallbladder and into the bile ducts, causing obstruction to the pancreatic duct, leading to inflammation of the pancreas, a condition called pancreatitis. Pancreatitis can range from minor back pain through to a severe life threatening illness. The gallbladder is usually removed as soon as possible following an episode of pancreatitis to lessen the chance of a further attack.

Gallbladder Cancer is a rare tumor condition that usually affects older people with a long history of gallstones. Gallstones predispose to the cancer, but fear of cancer in itself is not an indication for surgery because it is so rare. Gallbladder cancer may be discovered incidentally during the removal of a gallbladder, and is usually cured in these circumstances. More advanced cancers may require much larger operations (liver resection), or even be incurable.

Treatment

Surgery

Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones. The most common operation is called laparoscopic cholecystectomy. For this operation, the surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close up view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures.

If gallstones are in the bile ducts, the physician (usually a gastroenterologist) may use endoscopic retrograde cholangiopancreatography (ERCP) to locate and remove them before or during the gallbladder surgery.

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