What are gallstones and how do they form. Where are gallstones typically located in the body. What are the main types of gallstones. What symptoms can gallstone disease cause. How is gallstone disease diagnosed. What treatment options are available for gallstone disease.

Understanding Gallstone Disease: An Overview

Gallstone disease is a common condition affecting the biliary system, which is responsible for transporting bile in the body. Gallstones are solid, pebble-like masses that form in the gallbladder or biliary tract when bile hardens due to an excess of cholesterol, bile salts, or bilirubin. These stones can cause various symptoms and complications, making it essential to understand their nature, causes, and treatment options.

Types of Gallstones: Cholesterol vs. Pigment Stones

There are two primary types of gallstones:

• Cholesterol stones: Yellow-green in color, these account for 80% of gallstones in the United States. They are predominantly found in women and obese individuals.
• Pigment stones: These can be black or brown and typically develop in patients with other liver conditions, such as cirrhosis or biliary tract infections.

Understanding the type of gallstone can help healthcare providers determine the most appropriate treatment approach.

Factors Contributing to Gallstone Formation

Several factors can increase the likelihood of developing gallstones:

• High cholesterol levels in the bile
• Increased bilirubin concentration
• Impaired gallbladder emptying
• Obesity
• Rapid weight loss
• Hormonal changes (e.g., pregnancy, hormone replacement therapy)
• Certain medications
• Family history of gallstones

By addressing these risk factors, individuals may be able to reduce their chances of developing gallstone disease.

Recognizing the Symptoms of Gallstone Disease

Many people with gallstones remain asymptomatic, only experiencing symptoms when complications arise. The primary symptom of gallstone disease is biliary colic, which presents as sudden, intense abdominal pain, typically in the right upper quadrant. This pain can last from 15 minutes to several hours and is often exacerbated by meals, particularly those high in fat.

Other symptoms associated with gallstone disease include:

• Fatty food intolerance
• Vomiting
• Right shoulder pain
• Flatulence
• Sweating
• Jaundice (yellowing of the skin or eyes)
• Clay-colored stools

Can gallstone symptoms be mistaken for other conditions? Yes, gallstone symptoms can sometimes be confused with other gastrointestinal issues, such as acid reflux, irritable bowel syndrome, or even heart problems. This is why proper diagnosis by a healthcare professional is crucial.

Diagnostic Approaches for Gallstone Disease

Diagnosing gallstone disease involves a comprehensive approach, including a physical examination, patient history, and various diagnostic tests. The diagnostic process typically includes:

Laboratory Tests

Blood tests are conducted to assess liver function. Abnormal results may indicate complications from gallstones.

Imaging Scans

Several imaging techniques can be used to detect and locate gallstones:

• Ultrasound: The most common and non-invasive method for detecting gallstones in the gallbladder.
• CT scan: Useful for identifying complications such as inflammation or infection.
• MRI and MRCP: Provide detailed images of the gallbladder and bile ducts.
• Cholecystingraphy: Uses a radioactive substance to evaluate gallbladder function and detect inflammation.

Endoscopic Diagnosis

In some cases, endoscopic procedures may be necessary for a more detailed evaluation:

• Endoscopic Retrograde Cholangiopancreatography (ERCP): The preferred method for detecting and removing gallstones in the common bile duct.
• Endoscopic Ultrasound (EUS): Combines endoscopy and ultrasound to produce detailed images of the bile duct and gallbladder.

How accurate are these diagnostic methods? While each method has its strengths, ultrasound is generally considered the most accurate non-invasive technique for detecting gallstones, with a sensitivity of up to 95%.

Treatment Options for Gallstone Disease

The treatment approach for gallstone disease depends on the severity of symptoms, the location of the stones, and the patient’s overall health. Options include:

Watchful Waiting

For asymptomatic gallstones, a “wait and see” approach may be recommended, as many people with gallstones never develop symptoms.

Medication

In some cases, oral medications like ursodeoxycholic acid may be prescribed to dissolve small cholesterol stones over time. However, this approach is not effective for all types of gallstones and may take months or years to show results.

Surgical Intervention

For symptomatic gallstones or complications, surgical removal of the gallbladder (cholecystectomy) is often the recommended treatment. This can be done through:

• Laparoscopic cholecystectomy: A minimally invasive procedure using small incisions and a camera.
• Open cholecystectomy: A traditional surgery involving a larger incision, typically reserved for more complex cases.

Is it possible to live without a gallbladder? Yes, the body can function without a gallbladder. After removal, bile flows directly from the liver to the small intestine, allowing for normal digestion.

Preventing Gallstone Formation: Lifestyle Modifications

While not all gallstones can be prevented, certain lifestyle changes may help reduce the risk of developing them:

• Maintaining a healthy weight
• Eating a balanced diet rich in fiber and low in saturated fats
• Regular exercise
• Staying hydrated
• Avoiding rapid weight loss

Can dietary changes alone prevent gallstones? While a healthy diet can help reduce the risk of gallstone formation, it’s important to note that genetic factors and other medical conditions also play a role. A comprehensive approach to health is most effective in prevention.

Complications of Untreated Gallstone Disease

If left untreated, gallstone disease can lead to serious complications, including:

• Cholecystitis: Inflammation of the gallbladder
• Choledocholithiasis: Stones lodged in the common bile duct
• Pancreatitis: Inflammation of the pancreas due to blockage of the pancreatic duct
• Cholangitis: Infection of the bile ducts
• Gallbladder cancer: A rare but serious potential complication of long-term gallstone disease

How quickly can complications develop? The timeline for complications varies widely among individuals. Some may develop acute symptoms rapidly, while others may have gallstones for years without issues. Regular check-ups and prompt attention to symptoms are crucial for preventing serious complications.

Living with Gallstone Disease: Management and Lifestyle Adjustments

For those diagnosed with gallstone disease, managing the condition often involves a combination of medical care and lifestyle adjustments. Here are some strategies for living with gallstone disease:

Dietary Modifications

Adjusting your diet can help manage symptoms and reduce the risk of gallstone-related complications:

• Reduce intake of high-fat foods
• Increase consumption of fiber-rich foods
• Eat smaller, more frequent meals
• Stay hydrated with water and other non-caffeinated beverages

Are there specific foods to avoid with gallstone disease? While individual tolerances may vary, it’s generally advisable to limit foods high in saturated fats, such as fried foods, fatty meats, and full-fat dairy products.

Pain Management

For those experiencing gallstone-related pain, several strategies can help:

• Over-the-counter pain relievers (as recommended by a healthcare provider)
• Applying a heating pad to the affected area
• Relaxation techniques, such as deep breathing or meditation

Regular Medical Check-ups

Maintaining regular appointments with your healthcare provider is crucial for monitoring the progression of gallstone disease and adjusting treatment plans as needed.

Exercise and Weight Management

Regular physical activity and maintaining a healthy weight can help reduce the risk of gallstone-related complications:

• Aim for at least 150 minutes of moderate-intensity exercise per week
• Engage in activities that promote core strength and flexibility
• If overweight, work with a healthcare provider to develop a safe weight loss plan

How does exercise benefit those with gallstone disease? Regular physical activity can help improve gallbladder function, aid in weight management, and reduce inflammation throughout the body, all of which can contribute to better management of gallstone disease.

Emerging Research and Future Treatments for Gallstone Disease

The field of gallstone disease management is continuously evolving, with ongoing research aimed at improving diagnosis, treatment, and prevention strategies. Some areas of current interest include:

Novel Imaging Techniques

Researchers are exploring advanced imaging technologies to improve the detection and characterization of gallstones, potentially leading to more targeted treatment approaches.

Minimally Invasive Treatments

New minimally invasive techniques are being developed to treat gallstones without the need for traditional surgery, potentially reducing recovery times and complications.

Genetic Research

Studies into the genetic factors contributing to gallstone formation may lead to personalized prevention strategies and treatments based on an individual’s genetic profile.

Microbiome Investigations

Research into the role of gut bacteria in gallstone formation and prevention is ongoing, with potential implications for probiotic-based treatments.

What impact might these research areas have on gallstone disease management? As these areas of research progress, we may see more personalized treatment plans, improved non-surgical options, and more effective prevention strategies for gallstone disease in the future.

Gallstone Disease in Special Populations

While gallstone disease can affect anyone, certain populations may require special considerations in diagnosis, treatment, and management:

Pregnant Women

Pregnancy increases the risk of gallstone formation due to hormonal changes. Management during pregnancy often focuses on conservative treatments, with surgery considered only if absolutely necessary.

Elderly Patients

Older adults may have a higher risk of complications from gallstone disease and may require careful consideration of treatment options based on their overall health status.

Patients with Other Liver Conditions

Individuals with pre-existing liver conditions may be at higher risk for pigment stones and may require specialized management approaches.

Pediatric Patients

While less common, gallstones can occur in children and adolescents. Diagnosis and treatment in this population may differ from approaches used in adults.

How does the management of gallstone disease differ in these populations? Treatment approaches for these special populations often require a more individualized strategy, taking into account factors such as age, overall health status, and potential risks associated with various treatment options.

The Economic Impact of Gallstone Disease

Gallstone disease not only affects individual health but also has significant economic implications:

Healthcare Costs

The treatment of gallstone disease, particularly surgical interventions, contributes substantially to healthcare expenditures worldwide.

Productivity Loss

Individuals with symptomatic gallstone disease may experience reduced work productivity and increased absenteeism, impacting both personal and societal economics.

Long-term Economic Effects

Complications from untreated gallstone disease can lead to more severe health issues, potentially resulting in higher long-term healthcare costs and reduced quality of life.

What strategies can help mitigate the economic impact of gallstone disease? Preventive measures, early detection, and timely treatment can all contribute to reducing the overall economic burden of gallstone disease on individuals and healthcare systems.

In conclusion, gallstone disease is a complex condition that requires a comprehensive understanding for effective management. From recognizing symptoms and risk factors to exploring treatment options and lifestyle modifications, individuals affected by gallstone disease have various strategies available to them. As research continues to advance our understanding of this condition, we can expect to see improvements in prevention, diagnosis, and treatment approaches in the coming years. By staying informed and working closely with healthcare providers, those affected by gallstone disease can effectively manage their condition and maintain a good quality of life.

Gallstone Disease | Johns Hopkins Medicine

Gallstone disease is the most common disorder affecting the biliary system, the body’s system of transporting bile. Gallstones are solid, pebble-like masses that form in the gallbladder or the biliary tract (the ducts leading from the liver to the small intestine). They form when the bile hardens and are caused by an excess of cholesterol, bile salts or bilirubin.

Types of Gallstones

There are two types of gallstones:

• Cholesterol stones: These are yellow-green stones, predominately found in women and obese people. Cholesterol stones account for 80 percent of gallstones. This is the most common type in the United States.
• Pigment stones: These may be black or brown and tend to develop in patients who have other liver conditions, such as cirrhosis or biliary tract infections.

Gallstone Disease Symptoms

Many people with gallstones do not experience any symptoms. Often, symptoms only appear when there are complications. The complications may be caused by inflammation, infection or obstruction.

The main symptom of gallstone disease is biliary colic. Biliary colic appears suddenly and builds quickly to a peak. It is a constant abdominal pain, usually in the right upper side of the abdomen, lasting anywhere from 15 minutes to several hours. This pain is usually aggravated by meals, especially fatty food.

Biliary colic may also include:

• Fatty food intolerance
• Vomiting
• Right shoulder pain
• Flatulence
• Sweating
• Yellowing of the skin or eyes
• Clay-colored stool

Gallstone Disease Diagnosis

A diagnosis of gallstone disease begins with a comprehensive physical exam during which you describe your symptoms and medical history. Often, the physical exam will be completely normal. Sometimes, your doctor can feel the gallbladder, and there may be some abdominal tenderness. Other diagnostic procedures include:

• Laboratory tests
• Imaging scans
• Endoscopic diagnosis

Laboratory Tests

Blood tests will check your liver function. If there are complications from gallstones, the tests will be abnormal.

Imaging Scans

Gallstones, especially those that are asymptomatic, are often discovered accidentally during an imaging scan for another problem. If you need an imaging scan based on your history and physical exam, there are a number of procedures available. Imaging scans use different technologies to determine the presence and location of gallstones.

• Ultrasound: An abdominal ultrasound is the best noninvasive test for detecting gallstones in the gallbladder. An ultrasound uses sound waves to create images of your organs. It is a simple, safe and painless procedure that provides accurate information about the presence of gallstones.
• CT scan: A CT scan is a powerful X-ray. It can detect complications of gallstone disease, such as excess fluid, gas in the gallbladder wall, gallbladder perforations and abscesses (collections of pus in the body). A CT scan may help determine if you need urgent surgical intervention.
• MRI and magnetic resonance cholangiopancreatography (MRCP): An MRI uses strong magnetic waves to create a detailed picture. An MRCP uses MRI imaging with special software to help detect gallstones and bile duct stones and evaluate the gallbladder for presence of cholecystitis (inflammation).
• Cholecystingraphy: You receive an intravenous radioactive substance, which your liver absorbs and then is secreted into the gallbladder and bile ducts. Scans are then taken that can accurately detect acute inflammation of the gallbladder.

Endoscopic Diagnosis

An endoscope is a thin, flexible, lighted tube inserted into your mouth. It reaches your esophagus, stomach and small intestine. Using the endoscope, you doctor can visualize your biliary system.

Endoscopic Retrograde Cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred method for detecting gallstones in the common bile duct. Because the endoscope is in position, stones can be removed during an ERCP. During this procedure:

• A special side-viewing endoscope called a duodenoscope is used.
• This scope is specially designed to allow the placement of necessary accessories into the bile and pancreatic duct and remove bile duct stones.
• A catheter is used to inject dye into the ducts.
• An X-ray is taken to obtain images of your pancreatic and biliary ducts.

Endoscopic Ultrasound

Endoscopic ultrasound (EUS) uses both an endoscopy and an ultrasound to evaluate and diagnose digestive tract disorders, and together they produce detailed images of your bile duct and gallbladder. Unlike an ERCP, an EUS cannot be used to remove gallstones. However, it is an accurate diagnostic tool and presents a lower risk of complications than ERCP.

Symptoms, Causes, Treatment, and More

Gallstones are deposits of digestive fluid made of solidified substances found in bile, like cholesterol. They are common and may or may not produce symptoms. People with symptoms usually need to have their gallbladders taken out.

Read on to learn more about gallstones, the symptoms they can cause, and how to treat them.

Your gallbladder is a small organ in your upper right abdomen, right below your liver. It’s a pouch that stores bile, a green-yellow liquid that helps digestion. Issues with your gallbladder typically occur when something is blocking its bile duct—like a gallstone.

Most gallstones are created when substances found in bile, like cholesterol, harden. Gallstones are very common and routinely asymptomatic.

However, about 10 percent of people who are diagnosed with gallstones will develop noticeable symptoms within 5 years.

Photo: Bruce Blaus | Wikimedia Commons | https://commons.wikimedia.org/wiki/File:Gallstones.png

Gallstones can lead to pain in the upper right abdomen or the center of your stomach. You may experience gallbladder pain from time to time after you eat foods that are high in fat, such as fried foods, but the pain can occur at almost any time.

Pain caused by gallstone issues usually lasts for only a few hours, but it can feel severe.

If gallstones are left untreated or unidentified, the symptoms may increase to include:

• a high temperature
• rapid heartbeat
• yellowing of the skin and whites of the eyes (jaundice)
• itchy skin
• diarrhea
• chills
• confusion
• a loss of appetite

These symptoms can be signs of a gallbladder infection, or inflammation of the gallbladder, liver, or pancreas.

Because gallstone symptoms may mimic the symptoms of other serious issues like appendicitis and pancreatitis, no matter what, if you’re dealing with one or more of these issues — it’s time to see a doctor or get yourself to the ER.

If you need help finding a urologist, then check out our FindCare tool here.

Asymptomatic gallstones

Gallstones themselves don’t cause pain. Rather, pain occurs when gallstones block the movement of bile from the gallbladder.

According to the American College of Gastroenterology, about 80 percent of people who have gallstones have “silent gallstones.” This means they don’t experience pain or have symptoms. In these cases, your doctor may discover the gallstones from X-rays or during abdominal surgery.

The actual cause of gallstones is thought to be due to a chemical imbalance of bile inside of the gallbladder. While researchers still aren’t clear about what exactly causes that imbalance to happen, there are a few possible reasons:

Too much cholesterol in your bile

Having too much cholesterol in your bile can lead to yellow cholesterol stones. These hard stones may develop if your liver makes more cholesterol than your bile can dissolve.

Too much bilirubin in your bile

Bilirubin is a chemical produced during the normal breakdown of red blood cells. After it’s created, it passes through the liver and is eventually excreted out of the body.

Some conditions, such as liver damage and certain blood disorders, cause your liver to produce more bilirubin than it should. Pigment gallstones form when your gallbladder can’t break down the excess bilirubin. These hard stones are often dark brown or black.

Concentrated bile due to a full gallbladder

Your gallbladder needs to be able to empty its bile to function properly. If it fails to empty its bile content, the bile becomes overly concentrated, which can cause stones to form.

Most of the time, you won’t need treatment for gallstones unless they cause you pain. Sometimes you can pass gallstones without even noticing. If you’re in pain, your doctor will likely recommend surgery. In rare cases, medication may be used.

If you’re at high risk for surgery complications, there are a few nonsurgical ways to attempt to treat gallstones. However, if surgery isn’t performed, your gallstones may come back — even with additional treatment. This means you may need to keep an eye on your condition for the majority of your life.

Surgery

Cholecystectomy, which is surgery to remove the gallbladder, is one of the most common operations performed on adults in the United States. Because the gallbladder isn’t an essential organ, it’s possible to live a healthy life without it.

There are two types of cholecystectomy:

• Laparoscopic cholecystectomy. This is a common surgery that requires general anesthesia. The surgeon will usually make three or four incisions in your abdomen. They’ll then insert a small, lighted device into one of the incisions, check for stones, and carefully remove your gallbladder. You can usually go home on the day of the procedure or the day after if you have no complications.
• Open cholecystectomy.This surgery is typically performed when the gallbladder is inflamed, infected, or scarred. This surgery may also happen if problems occur during a laparoscopic cholecystectomy.

You may experience loose or watery stools after gallbladder removal. Removing a gallbladder involves rerouting the bile from the liver to the small intestine. Bile no longer goes through the gallbladder and it becomes less concentrated. The immediate result is a laxative effect that can cause diarrhea, but this issue should resolve on its own for most people.

Nonsurgical treatments

If surgery can’t be performed, such as if the patient is a much older individual, there are a few other ways doctors can try to get rid of your gallstones.

• Oral dissolution therapy typically includes using the medications ursodiol (Actigall) and chenodiol (Chenix) to break up gallstones. These medications contain bile acids, which work to break up the stones. This treatment is best suited for breaking up cholesterol stones and can take many months or years to work completely.
• Shock wave lithotripsy is another option. A lithotripter is 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 involves placing a sterile needle into the gallbladder to aspirate (draw out) bile. A tube is then inserted to help with additional drainage. This procedure isn’t typically a first line of defense and tends to be an option for individuals who may not be suited for other procedures.

Some risk factors for gallstones are related to diet, while other factors are not as controllable. Uncontrollable risk factors are things like age, race, sex, and family history.

Lifestyle risk factors

• living with obesity
• a diet high in fat or cholesterol and low in fiber
• undergoing rapid weight loss
• living with type 2 diabetes

Genetic risk factors

• being born female
• being of Native American or Mexican descent
• having a family history of gallstones
• being 60 years or older

Medical risk factors

• living with cirrhosis
• being pregnant
• taking certain medications to lower cholesterol
• taking medications with a high estrogen content (like certain birth controls)

While some medications may increase your risk of gallstones, don’t stop taking them unless you have discussed it with your doctor and have their approval.

Your doctor will perform a physical examination that includes checking your eyes and skin for visible changes in color. A yellowish tint may be a sign of jaundice, the result of too much bilirubin in your body.

The exam may involve using diagnostic tests that help your doctor see inside your body. These tests include:

• Ultrasound. An ultrasound produces images of your abdomen. It’s the preferred imaging method to confirm that you have gallstone disease. It can also show abnormalities associated with acute cholecystitis.
• Abdominal CT scan. This imaging test takes pictures of your liver and abdominal region.
• Gallbladder radionuclide scan. This important scan takes about one hour to complete. A specialist injects a radioactive substance into your veins. The substance travels through your blood to the liver and gallbladder. On a scan, it can reveal evidence to suggest infection or blockage of the bile ducts from stones.
• Blood tests. Your doctor may order blood tests that measure the amount of bilirubin in your blood. The tests also help determine how well your liver is functioning.

To help improve your condition and reduce your risk of gallstones, try these tips:

• Eat fewer refined carbs (like cookies and white bread) and less sugar.
• Increase your intake of healthy fats, like fish oil and olive oil, which may help your gallbladder contract and empty on a regular basis.
• Eat the proper amount of fiber per day (women need about 25 grams a day, men need about 38 grams a day).
• Get some sort of physical activity every day.
• Keep yourself properly hydrated.

If you plan to lose weight, do it slowly. Rapid weight loss may increase your risk of gallstones and other health problems.

While there is no foolproof way to completely prevent gallstones, cholesterol seems to play a major role in their formation. If you have a family history of gallstones, your doctor may advise you to limit foods with a high saturated fat content. Some of these foods include:

• fatty meat, like sausage and bacon
• cakes and cookies
• lard and cream
• certain cheeses

Because people living with obesity are more predisposed to gallstones, keeping your weight within a moderate range is another way to limit the possibility of their formation.

If your doctor has diagnosed you with gallstones and decides you need surgery to remove them or your gallbladder, the outlook is often positive. In most cases of stone removal, stones don’t return.

If you aren’t able to have surgery and decide to take medication to dissolve the stones, the gallstones can return, so you and your doctor will need to monitor your progress.

If your gallstones aren’t causing symptoms, you will most likely not need to do anything. Still, you may want to make lifestyle changes to prevent them from getting bigger and causing problems.

causes, symptoms and treatment in FSCC FMBA

Gallbladder stones: causes, symptoms and treatment in FSCC FMBA

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Stones in the gallbladder (cholelithiasis) – a disease of the gallbladder, which is accompanied by the formation of stones. Stones in the bladder disrupt the process of digestion, interfere with the normal outflow of bile, and cause acute conditions such as colic.

Gallstones are solid masses of various sizes, shaped like rounded stones. They are formed during the hardening of bile, caused by an excess of cholesterol, bile salts, bilirubin.

The gallbladder is a small sac-like organ located under the liver. The main functions are the accumulation and concentration of bile.

In turn, bile is a fluid that is synthesized in the liver. Bile consists of acids, pigments, enzymes. Bile is involved in the breakdown of fats. The liver, gallbladder, duodenum and pancreas are connected by a duct system.

Types of gallstones

• Cholesterol stones. Yellow-green in color. Predominantly formed in women and obese people. The share of cholesterol stones accounts for up to 80%.
• Pigment stones. Black-brown in color. Formed with concomitant liver diseases, cirrhosis, inflammation of the bile ducts.

Symptoms

Many people with gallstones do not experience symptoms. Complaints arise during the formation of large stones, an increase in their number, as a result, the development of complications. Complications include inflammation, infection, impaired bile flow after duct closure.

Gallstone colic is a key sign of gallstones. The pain occurs suddenly, quickly reaches a maximum. Colic is characterized by increasing pain in the right hypochondrium. The duration is several hours. Colic is provoked by the intake of fatty foods. Characterized by the following features:

• Sudden, increasing pain in the upper right abdomen
• Severe pain in the center below the sternum
• Right shoulder pain
• Increased pain when eating fatty foods
• Nausea or vomiting
• Fever
• Jaundice
• Discolored chair (clay color)

Causes of cholelithiasis

Responsible for the development of gallstones:

• Increased cholesterol content in bile. High cholesterol levels in the blood lead to high levels of cholesterol in the bile. Excess cholesterol occurs with diabetes, obesity. Lecithin and acids, aimed at dissolving cholesterol, cannot cope with the splitting process. Cholesterol turns into crystals.
• Excess bilirubin. Bilirubin is a breakdown product of red blood cells. An increase in the synthesis of bilirubin is associated with cirrhosis, infection, and blood pathology. Bilirubin as well as cholesterol provokes the formation of stones.
• Impaired contractility of the gallbladder. With incomplete emptying, part of the bile remains in the bladder, concentrates in the form of a precipitate, then crystallizes with the formation of stones

Risk factors:

• Female
• History of cholelithiasis
• Age over 40
• Overweight, obesity
• Metabolic disorders (diabetes mellitus)
• Reduced physical activity
• Unbalanced nutrition
• Pregnancy
• Diseases of the liver

Diagnosis

Diagnosis requires a comprehensive examination. The attending physician conducts a survey, determines the main complaints, the history of the development of symptoms, finds out what provokes the appearance of complaints. Then the doctor conducts an examination, palpates the abdomen in different departments. The examination includes:

• Laboratory tests
• Instrumental diagnostics
• Endoscopic methods

Laboratory tests

If gallstone disease is suspected, a general and biochemical blood test is performed. Assess the performance of the liver and biliary tract.

Instrumental diagnostics

• Ultrasound is a highly effective non-invasive imaging modality. The method is based on the reflection of ultrasonic waves from internal organs and image formation.
• Computed tomography. Allows you to visualize gallstones, as well as complications caused by gallstone disease. The method is based on X-ray radiation.
• Magnetic resonance imaging. Highly informative method in relation to the detailed image of the structures of the liver, gallbladder, biliary tract, as well as inflammation. MRI is based on electromagnetic waves interacting with radio frequency radiation.
• Cholecystography. The patient is injected intravenously with a contrast agent, then an x-ray is taken. The image accurately determines the condition of the biliary tract, the site of obstruction, the presence of inflammation.

Endoscopic methods

• Retrograde cholangiopancreatography is the preferred endoscopic procedure for stone detection. This procedure allows you to remove intraductal stones using a duodenoscope, as well as inject a contrast agent for subsequent x-rays.

Complications

• Cholecystitis is the most common complication. Occurs when a stone enters the cystic duct. Bile, which stagnates in the bladder, causes it to become inflamed. Cholecystitis is accompanied by intense pain, fever.
• Choledocholithiasis is characterized by the movement of a stone into the common bile duct, with an increased risk of damage to both the gallbladder and the liver. Closure of the common bile duct is accompanied by pain, development of obstructive jaundice, infection

Treatment of the gallbladder in the Federal Scientific and Practical Center

Treatment depends on the clinical picture, the intensity of symptoms, concomitant diseases. The goal of treatment is to relieve symptoms, prevent complications and prevent recurrence of the pathology.

Treatment of the gallbladder includes:

• Prescribing drugs
• Surgery
• Extracorporeal lithotripsy
• Endoscopic stenting
• Lifestyle correction (elimination of excess body weight, proper nutrition)

Medical therapy

Prescribing drugs has two goals: preventing the formation of new and dissolving existing stones. Medicines are effective for small, non-calcified cholesterol stones in a normally functioning gallbladder. The duration of the course is 12 months and longer if necessary.

Laparoscopic surgery

In cholelithiasis, which is accompanied by symptoms, frequent colic, removal of the gallbladder (laparoscopic cholecystectomy) is indicated.

Surgeons of the FSCC FMBA of Russia perform the operation through one access – an advanced type of surgical removal of the gallbladder. The technique consists in creating one incision near the navel, while classical laparoscopy involves four incisions-ports.

Minimally invasive ICG fluorescent navigational laparoscopy is the method of choice for surgical treatment at the Federal Research and Clinical Center. It is based on the use of a fluorescent contrast agent, which is administered intravenously to the patient before surgery. Thanks to the contrast agent, the visualization of anatomical structures, blood vessels, and bile ducts improves. The use of ICG technology has been proven to reduce the risk of intraoperative complications, reduce the patient’s stay in the hospital and the recovery period.

Endoscopic retrocholangiopankeratography (ERCP)

ERCP under the control of the SPY GLASS DC imaging system is a modern method for the diagnosis and treatment of cholelithiasis. The SpyGlass DC device is an ultra-thin endoscope with a miniature camera fixed on it, which is passed through the channel of the main endoscope. An advanced device determines the cause of the disease with high accuracy, allows visually controlled crushing of large stones.

ERCP, along with lithotripsy, is the method of choice in the presence of contraindications to surgical treatment.

Extracorporeal shock wave lithotripsy

Extracorporeal lithotripsy is an alternative to surgery. Under the influence of high-frequency shock waves, stones in the gallbladder can be crushed and destroyed.

Prophylaxis

Following simple recommendations reduces the risk of developing gallstones:

• Regular physical activity
• Maintenance of optimal weight, if overweight, gradual reduction
• Complete, balanced diet, eating at the same time
• Eating high fiber foods

Information verified by an expert

This article is an informational material and is not intended for self-diagnosis and self-treatment. If signs of discomfort appear, you should contact your doctor.

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Oncosurgery, Surgery, Liver Surgery

Yuri Viktorovich Ivanov

Head of the surgical department. Doctor – surgeon – oncosurgeon

Seniority
over 29 years

Head of the surgical department. Doctor – surgeon – oncosurgeon

• Abdominal surgery (open and laparoscopic operations on the liver, gallbladder, stomach, spleen, pancreas, small intestine, all types of hernias of the abdominal wall and diaphragm, reconstructive and restorative operations on the stomach and small intestine)
• Exclusive operations: for lateral and median cysts of the neck, extravasal compression of the celiac trunk syndrome (Dunbar’s syndrome), esophageal diverticulum (Zenker’s diverticulum), reconstructive operations on the bile ducts, minimally invasive operations on the pancreas
• Any type of operations in emergency surgery: acute appendicitis, strangulated hernia, acute intestinal obstruction, acute pancreatitis, acute cholecystitis, gastrointestinal bleeding, blunt abdominal trauma with damage to internal organs

details

Experience
more than 29 years

for information about the appointment with this specialist, please contact the contact center

4 400 ₽

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Cholelithiasis – Clinic 29

Gallstone disease (GSD) is a disease in which stones form in the gallbladder or bile ducts. Gallstone disease has been known since ancient times. Galen also discovered gallstones during the autopsy of corpses. Mentions of cholelithiasis are found in the writings of doctors of the Renaissance. Currently, every tenth inhabitant of our planet suffers from gallstone disease, and this disease of civilization is becoming a social problem.

Causes of cholelithiasis

Gallstone disease in both adults and children is a multifactorial disease. The main factors are:

• Power failure
• Poor quality drinking water
• Heredity
• Physical inactivity
• Bad habits
• Disturbance of intestinal microflora
• Stress
• Uncontrolled intake of drugs, etc. , that is, all those factors that lead to metabolic disorders, especially cholesterol metabolism.

Leading links in the process of stone formation: stagnation of bile in the gallbladder and an increase in the concentration of salts in bile due to metabolic disorders.

Can cause gallstone disease:

• overeating, starvation, irregular meals;
• sedentary lifestyle, especially sedentary work;
• pregnancy;
• taking hormonal contraceptives;
• obesity;
• biliary dyskinesia;
• diseases of the pancreas.

Clinical picture

There are three variants of the clinical picture of cholelithiasis:

• asymptomatic lithiasis;
• clinical manifestation, manifested by abdominal pain and dyspeptic disorders;
• gallstone colic.

Asymptomatic stone carrying is assumed when there are no complaints, and stones in the gallbladder (ducts) are an incidental diagnostic finding, more often on ultrasound. Unfortunately, the stones do not dissolve by themselves, and the disease will manifest itself in other forms over time.

Abdominal pain and dyspeptic disorders are the main complaints. In adults, pain is usually in the right hypochondrium, more often in the form of a feeling of heaviness and is provoked by a violation of the diet (overeating, fatty, fried foods). The nature of the pain depends on the size of the stones. Dull, drawing, vague pains are characteristic of patients with single stones or large stones. Multiple, small, easily moving stones, as a rule, give acute paroxysmal pain – gallstone colic.

Sometimes a small stone passes from the gallbladder into the bile ducts. In this case, an attack of gallstone disease occurs: there is a sharp pain in the right hypochondrium or in the upper abdomen. It can “give” to the right collarbone, right arm or back under the shoulder blade. In this case, bitterness appears in the mouth, nausea and vomiting, which does not bring relief, the sclera of the eyes may turn yellow. If the stone (with a relatively small size) was able to bypass the ducts and fall into the duodenum, the attack stops on its own, and the stone comes out with feces. Otherwise, there is a blockage of the biliary tract and there is a danger of developing acute cholecystitis and mechanical (subhepatic) jaundice. In this case, in addition to the typical picture of colic, yellowness of the skin, discolored stools, and dark urine appear. Pain can spread to other areas of the upper abdomen, often there are “girdle” pains – a sign of blockage not only of the biliary tract, but also of the pancreatic duct. Obturation (blockage) of the excretory ducts is a very dangerous condition!

Diagnosis of cholelithiasis

Diagnosis is based on the clinical picture, on examination of the patient – the doctor can determine pain at specific points, on changes in blood and urine tests in the presence of inflammation in the gallbladder and / or impaired bile outflow. Ultrasound reveals formations in the gallbladder, but with symptoms of severe cholecystitis (inflammation), stones may not be visible, ultrasound does not always detect stones that have entered the ducts. Then X-ray methods of research are used: retrograde cholecystopancreatography (RCPG) is the most common method.

Treatment of cholelithiasis

The tactics of treatment of cholelithiasis is determined by the clinical picture, the position of the stones and the timing of the patient’s request for medical help. Non-surgical methods of treatment are rarely used, mainly in children during the period of hormonal instability, in adults in the preoperative period. In case of cholelithiasis, it is prescribed:

• diet with the exception of fatty, fried, smoked, spicy. Food should be fractional, without overeating. Particular importance is attached to the use of vegetables and fruits, wheat bran and other foods containing dietary fiber. They bind bile acids in the intestine, which promotes their synthesis in the liver.
• motor mode: we avoid both hypodynamia and excessive physical exertion. Walking, table tennis, billiards are shown.
• Cholagogue preparations, herbs and tubes are contraindicated!

Surgical treatment

If you have applied for a planned appointment outside the acute phase of gallstone disease, the stones are located only in the gallbladder, and not in the ducts, then you will perform a laparoscopic cholecystectomy (removal of the gallbladder). If stones are localized only in the gallbladder, radical surgery – cholecystectomy in most cases leads to a permanent cure for cholelithiasis. Cholecystectomy is a pathogenetically substantiated operation: the shock organ is removed, i.e. already a defective organ with impaired function and a constant source of infection. All this leads to an acceleration of the circulation of bile acids between the intestines and the liver, a decrease in the stone-forming properties of hepatic bile, and the prevention of the formation of gallstones.

If you delayed the operation for cholelithiasis or tried to “expel” the stones and there was an obstruction of the biliary tract. Such a situation can end with a laparotomy (large abdominal incision), sometimes even with the removal of part of the biliary tract and the imposition of various non-physiological, but vital, connections between organs for the outflow of bile.

Do not be afraid of the operation! The only radical way to treat gallstone disease is to remove the diseased gallbladder. Currently, a special technique has been developed for laparoscopic surgery (the operation is performed using several punctures of the abdominal wall). It is less traumatic, and the patient can get up on the day of the operation. The cosmetic effect is also important – the absence of seams on the body. This issue is especially of concern to girls, because no one wants past illnesses and operations to be read on his body.
After removal of the gallbladder, you can safely return to normal life and practically do not adhere to any diet.

Complications of cholelithiasis

– Infections. The most serious complication of acute cholecystitis caused by gallstones is infection, which develops in about 20% of cases.

– Gangrene and abscess. Severe inflammation can cause abscess and necrosis (destruction) of tissue in the gallbladder, leading to gangrene. At high risk are men over 50 who have a history of cardiovascular disease.

– Perforation (rupture) of the gallbladder. An estimated 10% of cases of acute cholecystitis due to gallstones have gallbladder perforation, a life-threatening condition. In general, it occurs in people who have not sought help for too long, or in people who do not respond to treatment. Gallbladder perforation is most common in people with diabetes. After the wall of the gallbladder has been perforated, the pain may temporarily decrease. This dangerous delusion threatens with the development of peritonitis and the spread of infection into the abdominal cavity.

– Empyema. Pus in the gallbladder (empyema) occurs in 2 to 3% of patients with acute cholecystitis. Patients usually experience abdominal pain for more than 7 days. Physical examination often does not always immediately reveal the cause. Empyema can be life-threatening, especially if the infection spreads to other parts of the body.

– Fistula. In some cases, inflammation of the gallbladder spreads and results in perforation of nearby organs, such as the small intestine. In such cases, a fistula is formed between the organs, which is a channel or opening. Sometimes, in such cases, gallstones may actually pass into the small intestine. This can be very serious and requires immediate surgery.

— Gallstone obstruction. Gallstone blockage of the bowel is known as gallstone ileus. It primarily occurs in patients over 65 years of age and can sometimes be fatal. Depending on where the stone is located, surgery may be required to remove it.

– Infection of the common bile duct (cholangitis). Infection of the common bile duct is a very dangerous serious disease. If antibiotics are given immediately, the infection is cured in 75% of patients. If cholangitis is not stopped, the infection can spread and become life-threatening.

– Pancreatitis. Common bile duct stones are responsible for most cases of pancreatitis (inflammation of the pancreas).

– Cancer of the gallbladder. Gallstones occur in about 80% of people with gallbladder cancer. There is a strong relationship between gallbladder cancer and gallstone disease, chronic cholecystitis, and inflammation. Symptoms of gallbladder cancer usually do not appear until the disease has reached the last stage, and may include weight loss, anemia, recurrent vomiting, and foreign body sensation in the abdomen. However, this cancer is very rare, even among people with gallstones.

– Porcelain gallbladder.