Gallstones:

Gallstones are hardened deposits of bile fluid that can form in your gallbladder. The bile is produced by the liver and it travels through small tubes in the liver to reach the gallbladder where it is stored until required for digestion. The Gallbladder acts only as a storage organ and does not produce any substances, unlike the liver.

Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. It is connected to the intestines by a tube called common bile duct.

Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time. The symptoms can develop irrespective of the size or number of gallstones. People who experience symptoms from their gallstones require gallbladder removal surgery, which is the gold standard treatment for gallstone disease.

Causes

It's not clear what causes gallstones to form. Doctors think gallstones may result when:

• Your bile contains too much cholesterol. Normally, your bile contains enough chemicals to dissolve the cholesterol excreted by your liver. But if your liver excretes more cholesterol than your bile can dissolve, the excess cholesterol may form into crystals and eventually into stones.
• Your bile contains too much bilirubin. Bilirubin is a chemical that's produced when your body breaks down red blood cells. Certain conditions cause your liver to make too much bilirubin, including liver cirrhosis, biliary tract infections and certain blood disorders. The excess bilirubin contributes to gallstone formation.
• Your gallbladder doesn't empty correctly. If your gallbladder doesn't empty completely or often enough, bile may become very concentrated, contributing to the formation of gallstones.

Types of gallstones

Types of gallstones that can form in the gallbladder include:

• Cholesterol gallstones. The most common type of gallstone, called a cholesterol gallstone, often appears yellow in color. These gallstones are composed mainly of undissolved cholesterol, but may contain other components.
• Pigment gallstones. These dark brown or black stones form when your bile contains too much bilirubin.
• Mixed stones. Majority of stones are of mixed type.

Symptoms

If a gallstone lodges in a duct and causes a blockage, the resulting signs and symptoms may include:

• Sudden and rapidly intensifying pain in the upper right portion of your abdomen
• Sudden and rapidly intensifying pain in the center of your abdomen, just below your breastbone
• Back pain below your right shoulder blade
• Pain in your right shoulder
• Nausea or vomiting

Gallstone pain may last several minutes to a few hours. Repeated attacks main gain in severity and may necessitate an emergency surgery. Also a severe first attack not responding to medical management would necessitate an emergency surgery.

Complications

Complications of gallstones may include:

• Inflammation of the gallbladder. A gallstone that becomes lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain and fever.
• Blockage of the common bile duct. Gallstones can block the tubes (ducts) through which bile flows from your gallbladder or liver to your small intestine. Severe pain, jaundice and bile duct infection can result.
• Blockage of the pancreatic duct. The pancreatic duct is a tube that runs from the pancreas and connects to the common bile duct just before entering the duodenum. Pancreatic juices, which aid in digestion, flow through the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and requires immediate hospitalization. This may also necessitate an additional endoscopic procedure to removal the stone within common bile duct.
• Gallbladder cancer. People with a history of gallstones have an increased risk of gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of cancer is elevated, the likelihood of gallbladder cancer is still very small.

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Risk factors

Factors that may increase your risk of gallstones include:

• Being female
• Being age 40 or older
• Being overweight or obese
• Being sedentary
• Being pregnant
• Eating a high-fat / high-cholesterol diet
• Eating a low-fiber diet
• Having a family history of gallstones
• Having diabetes
• Having certain blood disorders, such as sickle cell anemia or leukemia
• Losing weight very quickly
• Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugs
• Having liver disease

TREATMENT

The symptomatic stones and diseased gallbladder should be removed by a surgical procedure. 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. Patient is allowed to ambulate 2-3 hours after the surgery and is usually discharged the same day or after overnight stay in some patients.

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.

• 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

How does removing Gall Bladder affect my future life?

Gall bladder is a storage organ and removing it doesn’t affect quality of life in any way. There is no long term restrictions on diet or activity after surgery. The bile produced in the liver finds its way through the common bile duct into the intestine where it helps in digestion of food.

Patient goes back on a normal diet from the next day after surgery. They also return back to normal routine activity from second day of surgery. Driving can be resumed after 3-4 days once pain has settled down.