The gall bladder is a small bag, roughly the shape and size of a pear that sits underneath the liver, on the right side of the abdomen. Its main purpose is to store and concentrate bile produced by the liver. Bile is released from the gallbladder after eating, aiding digestion. Bile travels through common bile ducts (CBD) into the small intestine. Gallstones are pieces of solid material that form in the gallbladder. These stones develop because cholesterol and pigments in bile sometimes form hard particles.
What Are Gall Bladder Stones?
Gall bladder stones or gallstones are crystalline masses formed abnormally in the gall bladder or bile ducts from bile pigments, cholesterol, and calcium salts. Gallstones can cause severe pain and blockage of the bile duct. When the wall of the gallbladder is diseased then it produces the stone and polyps etc.
What is Cholecystitis?
Cholecystitis is defined as inflammation of the gall bladder. Most commonly this happens when the flow of bile is stopped or interrupted due to stone (90%) or if infection of biliary tract occurs.
The usual symptoms of cholecystitis are:
- Severe abdominal pain
- The attack may follow a large fatty meal.
Types of Gallstones
- Cholesterolstones: Usually yellow-green in color, approximately 80% of gallstones are cholesterol stones.
- Pigment stones: These stones are smaller and darker and are made up of bilirubin.
Why do Gallstones Form?
- People who are overweight are more likely to form gallstones.
- Excess estrogen from numerous pregnancies, hormone replacement therapy, or birth control pills may increase cholesterol levels in bile, slow down gallbladder emptying, and lead to gallstones.
- People who have biliary infections can develop gallstones.
- Individuals with hereditary blood disorders such as sickle cell anaemia are more likely to form pigment stones.
- Excessive dieting and consuming certain cholesterol-reducing drugs can also increase the risk of gallstone formation.
Symptoms of Gallstones
Symptoms of gallstones are severe abdominal pain often called as gallstone 'attack' (colic) because they occur suddenly. Gallstone attacks often follow fatty meals, and they may occur during the night. Though many patients with gallstones have no symptoms and they are to be asymptomatic and the stones are called ‘Silent stones’. However, a typical attack can cause the following:
- Severe pain in the right upper abdomen that increases rapidly and lasts from few minutes to several hours
- Pain in the back between the shoulder blades
- Pain under the right shoulder
- Nausea or vomiting
Other insignificant symptoms of gallstones include:
- Abdominal bloating (gas formation)
- Recurring intolerance to fatty foods
Who is At Risk For Gallstones?
- Women are more prone than men
- People in their 30's and 40's
- Overweight men and women
- People with rapid/ sudden weight loss
- Pregnant women, women on hormone therapy and those who use birth control pills for a prolonged period
What Are Complications Caused by Stones?
- Recurrent severe abdominal pain or vomiting.
- Jaundice due to blockage of the common bile duct due to stones.
- Acute pancreatitis (swelling of pancreas) which can have catastrophic sequel of multi-organ failure and other serious complications. It may be fatal if severe.
- Pus formation in the gallbladder (Empyema).
- Gangrene and perforation of the gallbladder.
- Cholangitis (life threatening infection of biliary system).
- Associated with Cancer of gallbladder in the long term.
How Are Gallstones Diagnosed?
- Blood tests
- Complete blood count
- Liver function test
- Coagulation profile
- Abdominal ultrasound
- Cholescintigraphy (HIDA scan)
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Magnetic resonance cholangiopancreatography (MRCP)
What Are the Treatment options for Gallstones or Cholecystitis?
The symptomatic stones and diseased gallbladder should be removed by a surgical procedure called Laparoscopic Cholecystectomy. In this procedure, the gall bladder is removed using long narrow instruments through small incisions in the abdomen.
- Treatment of symptoms of pain with injectable or oral painkillers.
- No medical therapy is available for gallstones as such which can cure the disease. Injectable or oral antibiotics and supportive medications are available for treating the infection and overcoming the acute attack.
Surgery to remove the gallbladder (cholecystectomy) is the only way to cure gallstones. This can be done by conventional (open) method or a well-established endoscopic (laparoscopic) method which is now the 'Gold Standard'. The surgery is called "Laparoscopic Cholecystectomy" (Lap. Chole). The surgeon makes few tiny punctures in the abdomen and inserts surgical instruments and a miniature telescope with amounted 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 vessels. The gallbladder is then removed through one of the small incisions. Recovery usually occurs within few hours in most of the cases in the hospital, followed by few days of rest at home. As there is no damage to the muscle (muscles are not cut) during laparoscopic surgery, patients have less pain and negligible wound complications.
If the surgeon finds any difficulty in the laparoscopic procedure, the operating team may decide to switch over to open surgery. It is called open surgery because the surgeon has to make a 5 to 8 inch incision in the abdomen to remove the gallbladder. Open surgery has faded into the background with the laparoscopic technique providing significant advantages and ease for the patient.
Non-surgical approaches are used only in special situations such as when a patient's condition is not fit for anaesthesia and surgery. This does not cure the patients as it only provides symptomatic relief.
Advantages of Laparoscopic Cholecystectomy
- Patients usually have minimal post-operative pain.
- Patients experience faster recovery than patients undergoing open gallbladder surgery.
- Excellent cosmetic outcomes
- Minimal discomfort and early recovery
- Early resumption of normal and routine activities
What Are Pre-Surgery and Post-Surgery Instructions?
Pre surgery instructions
- Some preoperative investigations like blood tests, X-ray or ECG and ultrasound of the gallbladder are required before surgery.
- Follow your surgeon instructions for any prescribed medications.
Post surgery instructions
- The patient is kept under observation for few hours and then shifted to the room.
- Patient is allowed to drink oral liquids on the same day of surgery.
- The patient is allowed to move on its own as soon as possible after the surgery.
- Generally the patient is discharged on the same or next day of the surgery depending on the clinical condition.
- Waterproof dressings are applied on the port sites and the patient may bathe when comfortable.
- The patient is advised to visit again after 5 days when the dressings are removed. On discharge, a discharge summary with the advised medication is handed over to the patient along with the date of the first follow up appointment.
- Round the clock helpline is available for any query or any other emergency.
Diet after surgery
The patient is generally allowed to sip water immediately after the operation and liquids on day of operation. The liquids may include water/ clear soups/ tea/ coffee/ salted lassi as advised by the dieticians.
Next day onwards, normal diet is given and there are no specific restrictions in diet.
- As soon as the patient is out of anesthesia and is shifted to the room, patient is can start moving on his/her own and attend to toilet needs. In fact movements are encouraged in most patients because this causes a dramatic reduction in pain and increase the sense of wellbeing. The patient is allowed to walk as soon as he/she recovers from sleep. There is no restriction on climbing stairs, lifting weight.
- The patient can resume his/her daily routine/ activities as he/she feels comfortable as there are no specific restrictions.
- Medication chart is provided to the patient to ensure proper compliance of prescribed medications. Ensure compliance of pain and other medications prescribed by your doctor.
- Regular follow up is advised