Gallstones

WHAT ARE GALLSTONES?
Gallstones are formed when bile stored in the gallbladder hardens into pieces of stone-like material. They may vary in number and size. Gallstones can block the normal flow of bile if they get collected in any of the ducts that carry bile from the liver to the small intestine. colonoscopy.

WHAT IS BILE?
Bile is a liquid produced by the liver which helps the body to digest fat. fiile is made in the liver, and then stored in the gallbladder until the body needs to digest fat. During that time, the gallbladder contracts and pushes the bile into a tube called the Common Bile Duct (CBD) that carries it to the smali intestine, where it helps with digestion.

WHAT ARE THE CAUSES OF GALLSTONES?
Although Gallstones are a very common medical problem,, very littl e i s known about why s ome people develop th em a nd some do not. However,there are few people who are at a greater ris k of developing gallston es. »Age: People over 60 years of age are more likely to develop Gallstones than younger people.

» Gender: Women between 20 and 60 years of age are twice as likely to develop galIsto nes as men. »Obesity: Obesity is a major risk factor for Gallstones ,especially in women
» Excess estrogen: Women on birth control pills,, hormone replacement treatment etc.
» Cholesterol-lowering drugs
» Diabetes: People with diabetes generally have high levels of fatty acids called triglycerides. These fatty acids increase the risk of Gallstones.
» Prolonged Fasting
» Rapid weight Loss

WHO IS AT RISK FOR CALL STONES?
Women are more at risk than men. Overweight individuals and people who fast or lose a lot of weight quickly can also develop Gallstones . Also, pregnant women, women on hormone treatment, and birth control pills for prolonged period can be at risk for gallstones

WHAT ARE THE SYMPTOMS?
Other Gallstones symptoms include:
» Gas formation (bioating of abdomen)
» Persistent intolerance to fatty foods ¦ Belching
» Indigestion People who also have the above and any of following symptoms should see a doctor right away:
» Chills
» Low-grade fever
» YelIowish color of the skin o r whites of the eyes
» Clay-colored stools

WHAT ARE "SILENT STONES"?
Many people with Gallstones show no symptoms, These patients are said to be asymptomatic and these stones are called "silent stones." Treatment for these stones is detectable.


WHAT ARE THE COMPLICATIONS OF THESE STONES?
Obstruction of the common bile duct causing jaundice ' Inflammation (swelling and painful condition) or infection of the gallbladder (acute cholecystitis)
» Inflammation or infection of the liver (cholangitis), which can occur when Gallstones enter the common bile duct. Though not common, this can lead to the d eath of tissue
» Inflammation of die pancreas (pancreatitis)
» Severe infection with pus filling the gallbladder (empyema)
» An abnormal connection (fistula) between the gallbladder and small intestine
» Ahole i n the gallbladder (perfo ration) Gallbladder cancer (I in 1,000 per year in people with gallstones

HOW ARE GALLSTONES FOUND AND TREATED?
Ultrasound is most commonly used to find Gallstones . In a few complex cases, other X-ray tests may be used to evaluate gallbladder disease. Gallstones do not go away on their own. Some can be temporarily managed with drugs or by making dietary adjystments, such as reducing fat intake. This treatment has a low. short-term success rate. Symptoms will eventually continue unless the gallbladder is removed Surgical removal of the gallbladder is the safest treatment for gallbladder disease

WHAT IS THE TREATMENT OF GALLSTONES?
Medical Treatment available only for the symptoms like pain and infection is treated with injectable or oral pain killers and antibiotics However, no medical treatment is available which can cure the disease. Surgery Surgery to remove the gallbladder is the most common way to treat symptomatic Gallstones . The surgery is called c holecystectomy. The standard surgery 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, Then the cystic duct is cut and the gallbladder removed through one of the small incisions.

Because the abdominal muscles are not cut during laparoscopic surgery, patients have less pain and fewer complications than they would have had after surgery using a large incision across the abdomen. Recovery usually involves only one night in the hospital, followed by several days of restricted activity at home.

If the surgeon discovers any obstacles to the laparoscopic procedure, such as infection or scarring from other operations, the operating team may have to switch to open surgery. In some cases the obstacles are known before surgery, and an open surgery is planned. It is called "open" surgery because the surgeon has to make a 5 to 8 inch incision in the abdomen to remove the gallbladder. This is a major surgery and may require about a 2 to 7 days stay in the hospital and several more weeks at home to recover. Open surgery is required in about 5 percent of gallbladder operations.

WHAT ARE THE COMPLICATIONS OF THE SURGERY!
The most common complication in gallbladder surgery hs injury to the bile ducts. An injured common bile duct can leak bile and cause a painful and potentially dangerous infection. Mild injuries can sometimes be treated nonsurgically. Major injury, however, is more serious and requires additional surgery

WHAT ARE THE ADVANTAGES OF PERFORMING THE PROCEDURES LAPAROSCOPIALLY?
Rather than a five to seven inch incision in conventional surgery , the laparoscopic operation requires only four small openings in the abdomen
» Patients usually have minimal post-operative pain
» Patients experience faster recovery than open gallbladder surgery patients
» It can be performed as a day care procedure. Most patients go home within one day and enjoy a quicker return to normal activities

WHAT IS EXPECTED AFTER GALLBLADDER SURGERY?
Gallbladder removal is a major abdominal operation with a certain amount of post operative pain. Nausea and vomiting are not uncommon. Once liquids or a diet is tolerated, patients leave the hospital the same day or day following the laparoscopic gallbladder surgery. Activity is dependent on how the patient feels. Walking is encouraged. Patients can remove the dressings and take a shower a day after the operation. Patients will probably be able to return to normal activities within a week's time, including driving, walking up stairs, light Iifting and working. IngeneraI, recovery shouId be progressive, once the patient is at home.

WHAT IF THE GALLSTONE IS IN COMMON BILE DUCT (CBD)?
If Gallstones are in the bile ducts, the surgeon may use ERCP-an endoscopic technique for removing Gallstones before or during the gallbladder surgery.

WHAT IS ERCP?
The surgeon may use endoscopy in removing CBD stones before gall bladder surgery. Once the endoscope is in the smalt intestine, the surgeon locates the affected bile duct. An instrument on the endoscope is used to cut the duct, and the stone is Captured in a tiny basket and removed with the endoscope. This two-step procedure is called ER.CP with endoscopic sphincterotomy. Nonsurgical Treatment Nonsurgical approaches are used only in special situations. Half the time stones recur after nonsurgical treatment.

CAN WE LIVE WITHOUT A GALLBLADDER?
heart attack, so accurate diagnosis is important
» Gallstones can cause serious problems if they become trapped in the bile ducts
» Laparoscopic surgery to remove the gallbladder is the most common treatment

WHAT PREPARATION IS REQUIRED AFTER ADMISSION FOR SURGERY?
Preoperative preparation includes blood work, medical evaluation, chest X-ray and an EKG depending on your age and medical condition. The surgeon reviews with you, the potential risks and benefits of the operation. You will have to provide written consent for surgery. The surgeon may request that you completely empty colon and cleanse intestines prior to surgery. You may be requested to drink clear liquids, only, for one or several days prior to surgery. It is recommended that you take a shower the night before or morning of the operation. After midnight the night before the operation, you should not eat or drink anything except medications that the surgeon has permitted to take with a sip of water on the morning of surgery. Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery. Diet medication should not be used for two weeks prior to surgery.

WHAT IS A GALLBLADDER?
Gallbladder is a small pear-shaped organ that is about three to six inches in length. It is found below the liver. Its function is to store and concentrate bile,, a greenish brown fluid which is produced in the liver.

 

Team of Specialists:

• Dr. Deep Goel Consultant- Minimal Invasive, Bariatric & ONCO SurgeryView Profile