General Surgery and Advanced Robotic Surgery

Why You Shouldn’t Ignore These Warning Signs of Gallstones: Lakeland Surgical Clinic, PLLC: General Surgery and Advanced Robotic Surgery

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Your gallbladder rests just between the liver and pancreas. Its job is to store bile that, when released into the intestines, helps digest fats.

The bile is made up of cholesterol, bile salts, and water. These substances can sometimes pack together and form gallstones, which can be as small as a grain of sand or as large as a golf ball. 

Gallstones affect almost 25 million people but don’t always cause symptoms or problems. 

Our surgical team at Lakeland Surgical Clinic, PLLC, located in Jackson, Mississippi, sees a lot of patients experiencing severe pain due to gallstones. While you can’t halt a gallstone attack mid-event, we can help ease symptoms with medications.  

Recurrent attacks require surgery to remove the gallbladder and prevent complications.

Pain of a gallstone attack

Gallstones can clog the duct, or tube, that allows bile to flow out of the stomach. Your gallbladder then spasms, causing significant pain. Some people describe it like you’re being cut by a knife right under the rib cage on the upper right side or center of the abdomen. You might even mistake the pain for a heart attack — so it’s best to seek immediate care.

You may notice the pain comes on suddenly or appears after a meal. The pain may last several minutes or a few hours. Don’t ignore it; call our office right away for an appointment. 

Nausea and vomiting

If you experience sudden nausea and vomiting after a full meal, contact our office. That is an indication that the gallstone has gotten stuck in a duct that keeps your digestive enzymes flowing. 

Heartburn

Heartburn-like symptoms are another sign of gallstones. You may experience acid reflux and cramping, too, but mistake it for simple indigestion. If it’s recurring or accompanied by other symptoms of gallstones, contact us to get an accurate diagnosis.

Light-colored stools and brownish urine

The compound known as bilirubin breaks down during the digestive process. It makes your urine yellow and stool brown. If your urine is brownish despite being hydrated or stools pale in color, it’s an indication that the bile duct is blocked. Contact us immediately for diagnosis and gallstone treatment. 

Fever and chills

If you have heartburn, nausea and vomiting, and abdominal pain along with fever and chills, it’s a sign that your gallbladder is completely blocked by a stone. The blockage has led to an infection, which could be fatal if not treated. 

Prevention and treatment of gallstones

If we detect gallstones, but you aren’t ready for surgery, some dietary changes could help your gallbladder health. Avoid foods high in saturated and trans fats. You’ll also need to skip processed foods and simple carbohydrates like white sugar and bread. 

Fresh fruits and vegetables, low-fat dairy, healthy fats from nuts and fish, and plant-based proteins should make up the bulk of your diet. 

If you have symptomatic gallstones, surgery is usually required. We may remove your entire gallbladder in a minimally invasive procedure called cholecystectomy. If we find gallstones in the bile ducts, we will also recommend they be removed — even if you’re not yet experiencing symptoms.

If you suspect you have gallstones, make a call to Lakeland Surgical Clinic, PLLC, in Jackson, Mississippi. You may also request an appointment using the online scheduler.  

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Gallstones – Symptoms & Causes

Symptoms & Causes
Diagnosis & Treatment
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FAQ

What are gallstones?

Gallstones are small stone-like deposits found in the gallbladder, which is a small sac-like organ that contains bile. Bile is the digestive fluid produced by the liver to break down and digest fats and is made up of cholesterol, water, fats, bile salts and bilirubin.

Gallstones are made of hardened bile, and if the bile contains high levels of cholesterol, bilirubin or bile salts, it becomes less watery and hardens into stones.

Gallstones can be present as one large gallstone that is the size of a golf ball, little stones, or a combination.

Types of gallstones

There are a few main types of gallstones:

• Cholesterol stones – This is the most common type, mainly comprised of cholesterol, lecithin and bile salts, and appears yellow-green in colour. In high concentrations, it will form cholesterol monohydrate crystals.
• Pigment stones – These are formed when there is a high level of bilirubin in the system. When combined with calcium, the stones may appear black or brown.
• Mixed stones – Over time, cholesterol or pigment stones may accumulate a proportion of calcium, producing mixed gallstones. In Asia, cholesterol or mixed stones are common.

It is possible to have a mix of cholesterol stones, pigment stones and mixed stones.

What are the symptoms of gallstones?

The symptoms of gallstones depend on how, if, and where the gallstones get blocked or lodged in. However, it is important to note that the size or number of gallstones per se is not as important as its presence, as it only takes a single stone to cause symptoms or problems.

Pain is a common symptom, which manifests in different ways. For some, it occurs in the upper right part of the abdomen or in the centre of the abdomen just below the breastbone. Others may experience it in the right shoulder or as back pain between the shoulder blades.

Other symptoms include:

• Abdominal bloating
• Burping
• Fever and chills
• Indigestion
• Jaundice
• Nausea and vomiting

The symptoms of gallstones usually occur after having a fatty and/or oily meal, and commonly at night.

Some people with gallstones do not show any symptoms, and in such cases, these are referred to as silent stones. These stones do not affect the gallbladder, liver or pancreas function.

Occasionally, gallstones may present without significant prior symptoms, with a gallstones-related complications as its first symptoms.

What are the causes of gallstones?

Gallstones are the result of an imbalance in bile and an unhealthy gallbladder. When an imbalance occurs, the high cholesterol content in bile crystalises and sticks to the walls of the gallbladder. Over time, they form gallstones which can start from grains of sand and grow to as large as a golf ball. These gallstones irritate the gallbladder and may block the gallbladder, bile ducts, liver or pancreas.

Cholesterol gallstones are caused by increased levels of cholesterol and bilirubin in the bile, as well as reduced levels of bile salts.

Pigment stones tend to occur in people who suffer from liver cirrhosis, infection of the biliary tract, and genetic blood disorders.

What are the risk factors for gallstones?

Risk factors that may increase the likelihood of gallstones include:

• Diabetes
• Cholesterol-reducing drugs
• Excess oestrogen levels
• Women (20 – 60 years old)
• Older age (above 60 years old)
• Rapid weight loss or prolonged fasting
• Family history of gallstones
• Obesity

Gallstones can cause complications such as:

• Inflammation and infection of the gallbladder, when a gallstone is lodged in the neck of the gallbladder. Also known as cholecystitis, it can cause severe pain and fever. If severe, the gallbladder can burst (perforation) and cause widespread infection (peritonitis or sepsis), or it can die (gangrenous).
• Blockage of the common bile duct, obstructing the flow of bile from the liver to the small intestine. It can result in severe pain, jaundice or infection of the bile duct resulting in fever, chills and rigors. If severe, this can lead to potentially serious infections (sepsis).
• Blockage of the pancreatic duct, through which pancreatic juices flow. This can result in inflammation of the pancreas (known as pancreatitis) leading to intense and lasting abdominal pain that may require hospitalisation. If severe, pancreatitis can lead to serious widespread inflammation and potentially life-threatening complications including multi-organ failure, requiring admission into the intensive care unit for management.
• Gallbladder cancer, while rare, is associated with a history of gallstone formation and chronic gallbladder inflammation (known as chronic cholecystitis).

Diagnosis & Treatment

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GSD (Cholelithiasis) – description, symptoms and treatment / Gastrocenter EXPERT

Cholelithiasis (GSD) is a pathology of the hepatobiliary system, in which cholesterol and / or bilirubin metabolism is disturbed, and gallstones are formed in the gallbladder or in bile ducts.

Risk factors for the development of gallstone disease

The likelihood of developing cholelithiasis of the gallbladder is high if the following factors are present:

• female
• pregnancy and childbirth
• age over 40
• hormonal imbalance
• genetic predisposition
• obesity
• overeating and excessive consumption of fatty foods
• nutrition
• disorders of fat metabolism
• therapy with certain drugs, in particular – hormonal
• chronic intestinal diseases and pathologies of the pancreas
• disorders of the anatomy of the biliary system
• chronic inflammatory pathologies of the bile ducts
• biliary functional disorders
• diseases of the endocrine system.

The typical patient with cholelithiasis is a woman over 40 years old, with a fair skin type and blond or red hair, who has given birth or pregnant, who is overweight.

Stages of cholelithiasis

Stage 1 cholelithiasis (prestone): characterized by thickening of bile in the gallbladder and the appearance of salts and crystals in this organ

Stage 2 gallstone disease: Formation of one or more gallstones, usually without any symptoms 0003 4 cholelithiasis stage: complications develop.

Only early diagnosis will cure gallstone disease without surgery.

Symptoms of cholelithiasis

Often this disease is detected already in the later stages, since at the beginning of its development the symptoms characteristic of cholelithiasis are absent in most patients. You should consult a gastroenterologist in the following conditions:

• feeling of heaviness under the right rib
• belching
• bloating
• constipation
• nausea.

Dangerous signs of gallstone disease:

• severe pain in the upper abdomen, accompanied by nausea and vomiting, after which there is no relief
• yellowness of the skin
• pruritus
• dark urine 9001 2
• light stool (result of blockage of the common bile duct stone).

If these complications occur, the patient needs surgical treatment, as they are life-threatening.

Unfortunately, even after the highest quality treatment, some of the consequences of gallstone disease remain forever. After excision of the gallbladder, 50% of patients have pain and other symptoms (postcholecystectomy syndrome).

Diagnosis of cholelithiasis

In our clinic, an examination for cholelithiasis begins with an appointment with a gastroenterologist, who, based on the collected history and initial examination, determines the scope of the upcoming diagnosis, which may include:

• Ultrasound (calculi and thickening of bile can be easily detected using this technique)
• Clinical and biochemical blood tests
• Urinalysis
• Scatological analysis
• FGDS.

Based on the results of the studies, the gastroenterologist will determine the stage of cholelithiasis, the presence of concomitant pathologies, give recommendations on diet and transition to a healthy lifestyle, plan a medication regimen and, if necessary, refer the patient to a surgeon.

Treatment of cholelithiasis

Treatment of cholelithiasis is planned depending on the stage at which the disease was detected.

At the beginning of the pathological process , therapeutic treatment of cholelithiasis is carried out. During this period, the disease can be controlled through diet, proper lifestyle and regular medication.

Late stages of cholelithiasis are dangerous with the appearance of severe complications leading to irreversible health consequences and sometimes death of the patient. Patients with advanced gallstone disease require surgical treatment. The decision to resect the gallbladder is made by a gastroenterologist in a team with a surgeon. During such a consultation, specialists jointly choose the type of upcoming surgical intervention and discuss the features of preparation for the selected operation.

Prognosis of cholelithiasis

The prognosis for this disease may vary depending on the presence of complications.

Some patients have experienced sudden recovery when, during an attack of biliary colic, a small stone passed into the intestinal lumen.

The favorable prognosis of cholelithiasis depends on the timely diagnosis and the quality of medical or surgical treatment.

Prevention of gallstone disease

The following measures will help to avoid the development of cholelithiasis and prevent the progression of an already existing disease: from alcohol

control of diabetes mellitus.

Advanced gallstone disease cannot be controlled by diet and a healthy lifestyle alone. It is possible to stop this disease in the later stages only through a comprehensive treatment prescribed by a team of qualified doctors.

Physicians treating disease

Zinovieva Evgenia Nikolaevna

Chief Physician, Gastroenterologist, Hepatologist, Candidate of Medical Sciences, Associate Professor

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Fadeeva Irina Ilyinichna

Surgeon, oncologist

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9 0006 Clinical cases

Overweight and gallstones

Patient T., 42 years old, applied to the gastro-hepatocenter EXPERT to a gastroenterologist with complaints of loss of appetite, nausea, bitterness in the mouth, heaviness and pain in the right hypochondrium after eating.

From a survey of the patient, the doctor found out that after giving birth 15 years ago, she gained 23 kg in body weight, eats irregularly, loves sweets and fatty foods. She has been taking hormonal contraceptives for the last 3 years. From the anamnesis of life, it was possible to find out that the mother and grandmother of the patient suffer from cholelithiasis (GSD). Both were operated on – the gallbladder was removed.

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Combination of pancreatitis and cholelithiasis

Patient X., 52 years old, came to the EXPERT center with complaints of girdle pain after eating fatty foods and a small amount of alcohol, nausea, loosening of the stool.

From the anamnesis it is known that discomfort in the area above the navel with loosening of the stool was observed for several years with nutritional errors, but after following a strict diet, they disappeared without a trace. On this occasion, the woman was not examined. These symptoms appeared for the first time.

Read more

Itching of the skin in a pregnant woman

Patient E. applied to the EXPERT gastro-hepatocenter at 15-16 weeks of pregnancy, because she noted the appearance of moderate itching of the skin, mainly at night. The woman is 32 years old, the second pregnancy. During the first pregnancy, the nocturnal itching increased, and by the end of the pregnancy it was almost unbearable. The doctors couldn’t do anything about it. This time the woman came with fear that the situation would repeat itself.

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Cholelithiasis

03 December 2018

Cholelithiasis (GSD), or cholelithiasis, is a disease characterized by the formation of calculi (stones) in the gallbladder and/or bile ducts.

This pathology is more typical for women – in females it occurs approximately 3-4 times more often than in men. The risk of developing the disease increases with age.

1. Article content:
2. ● Causes of cholelithiasis (GSD)
3. ● How the disease manifests itself: symptoms of cholelithiasis
4. ● Modern methods of treatment and diagnosis of cholelithiasis
5. ● Treatment of cholelithiasis with surgery
6. ● Treatment of gallstone disease without surgery

• Depending on the composition, several types of stones are distinguished:
• Cholesterol – 70% or more cholesterol. Formed mainly in the gallbladder.
• Black – Composed of calcium bilirubinates and polymerized bilirubin. They also form in the gallbladder.
• Brown – Composed of unconjugated bilirubin and phospholipid hydrolysates. Formed mainly in the bile ducts.

The structure of stones can be different – crystalline, layered, amorphous, fibrous. The sizes also differ – stones can be from 1 mm to several centimeters in diameter.

Further in the article we will tell in more detail about the causes of cholelithiasis, symptoms of pathology, methods of treatment and diagnosis.

Causes of cholelithiasis (GSD)

There is no single cause of gallstone disease. Many experts believe that the main cause of cholelithiasis is the production of pathologically altered bile by the liver, which precipitates and forms stones, while others believe that cholelithiasis occurs due to pathological processes in the gallbladder.

However, as studies show, in addition to these two reasons, a number of other factors are required. So, the causes of gallstone disease may lie in the following:

• Irregular meals, frequent overeating, or fasting.
• The predominance in the diet of fatty, spicy, fried foods, smoked meats, marinades, pickles, etc.
• One reason could be alcohol abuse.
• Taking certain medications (oral contraceptives, non-steroidal anti-inflammatory drugs, etc.).
• Sedentary lifestyle.
• genetic predisposition.
• Pregnancy can also cause gallstone disease.
• Obesity.
• Diabetes mellitus and other diseases of the pancreas.
• Biliary dyskinesia among the causes of cholelithiasis.
• Congenital anomalies of the biliary tract.
• Liver diseases.

Causes of gallstone disease are important when choosing a method of treatment. So, if cholelithiasis occurred against the background of other diseases, therapy should begin with the elimination of primary diseases.

How the disease manifests itself: symptoms of cholelithiasis

How does gallstone disease manifest itself? Symptoms can be of a different nature and, depending on the nature of the pathological process, the stage of the disease and the size of the stones, be more or less pronounced. Cholelithiasis can be asymptomatic for a long time. Usually the first symptoms of cholelithiasis occur 5-10 years after the onset of the disease.

• The main symptoms of gallstone disease include the following:
• Pain in the right hypochondrium, or in the epigastric region, which may radiate to the right shoulder, shoulder blade, interscapular region, lower back.
• Attacks of renal (biliary) colic.
• Bitterness in the mouth and belching.
• Nausea and even vomiting are more common symptoms during or after biliary colic.

Approximately 80% of all patients with gallstone disease have no symptoms and seek medical help only after biliary colic.

Modern methods of treatment and diagnosis of cholelithiasis

Diagnosis of gallstone disease usually does not present any difficulties. Based on the history and complaints of the patient, only a preliminary diagnosis can be established. For clarification, additional diagnostic methods are used.

• Thus, the diagnosis of gallstone disease includes:
• Ultrasound examination of the abdominal organs is the gold standard in the diagnosis of cholelithiasis and allows you to determine the stones in the gallbladder, or ducts, their size, number, and also assess the nature of the inflammatory process.
• General and biochemical analysis of blood.
• Computed tomography with contrast.
• MRI.
• MR cholangiography.
• Endoscopic retrograde cholangiopancreatography.
• EGDS.

All modern methods of treatment of cholelithiasis can be divided into conservative and surgical. Treatment of cholelithiasis without surgery is carried out with small stones. At an early stage of the disease, with minimal stones, only dynamic observation is often recommended. In the presence of calculi of considerable size, as well as in the case of a severe course of the disease, they resort to surgery. Further in the article we will consider what kind of modern methods of treating cholelithiasis are used today.

Treatment of cholelithiasis with surgery

Surgical treatment of cholelithiasis is used when conservative therapy is ineffective and consists in the removal of the gallbladder along with stones. With gallstone disease, the operation is called cholecystectomy and can be performed in several ways. The main indications for cholecystectomy are as follows:

• Stones occupy more than 1/3 of the volume of the gallbladder.
• Gallstone disease occurs with frequent biliary colic.
• Complicated gallstone disease.

• So, with cholelithiasis, the operation can be performed by the following methods:
• Open cholecystectomy – removal of the gallbladder through an incision in the right hypochondrium. After the operation, a significant (about 10-12 cm) scar remains.
• Laparoscopic cholecystectomy – during this operation, 3-4 small (5-10 mm) punctures are formed in the abdominal wall, through which special microinstruments are inserted. Under the control of a video camera, the gallbladder is removed and removed from the abdominal cavity through one of the punctures.

Surgical treatment of cholelithiasis can also be combined with conservative therapies.

Treatment of cholelithiasis without surgery

Is surgery necessary for cholelithiasis (cholelithiasis)? Treatment without surgery is possible only in the early stages of gallstone disease, in the absence of symptoms. But, as practice shows, cholelithiasis without surgery is not amenable to effective treatment. Long-term drug therapy not only does not prevent the development of biliary colic, but can also provoke it with the migration of stones and blockage of the biliary tract. In addition, with a long stay of stones in the gallbladder, the risk of developing an inflammatory process increases.

• GSD (cholelithiasis) can be treated without surgery by the following methods:
• Lipolytic Therapy – taking drugs that can break down gallstones.