Gall Bladder Stone

Gall Bladder Stone

Courtesy -Dr.Kumar Parth (MBBS; MNAMS; FMAS; FAIS; FACRSI (Colo-Rectal Surgery) DNB; FSGE (Surgical Gastroenterology)

(Consultant Surgical Gastroenterologist), drkparth9@gmail.com, www.drparthgastro.com

Definition:   Presence of stones in the gallbladder is referred to as cholelithiasis.               

PredisposingFactors:

• Genetics , Gender (more in women)
• Body weight (Obesity), or rapid loss in weight , Fasting
• Decreased motility (movement) of the gallbladder
• Diet
• Drugs : Cholesterol / Lipid lowering drugs , Estrogen
• Diseases: Diabetes, blood disorder (Hemolytic anemia etc.)

Composition of Gall Bladder Stone:

Cholesterol Stone: Found in western world, causes accounted to diet rich in cholesterol.

Pigmented stone: generally found in diseases related to blood disorder

Mixed stone: Contains Calcium, magnesium, sodium phosphate ( most common type found in Asian population (India).

Symptoms :

• (70–85%) are asymptomatic or "Silent Gall Stone"
• Pain in right upper and central part of abdomen (may radiate to inter-scapular region) mostly after half an hour of food (seen more symptomatic after a fatty diet.)
• post meal fullness, belching, upper abdominal discomfort
• Jaundice (yellowing of the skin or eyes)
• Clay colored stools or dark urine

Investigations required:

• Blood - Liver Function test , Complete Blood Count,
• Imaging -Ultrasound Of abdomen and if required MRI (MRCP) abdomen.
• Complications of Gall Stone
• Infection of gall bladder {Empyema(pus) / Mucocele of Gall bladder}
• Perforation of gall bladder
• Stone slipped in Common Bile Duct resulting in obstruction in the passage of bile leading to Jaundice
• Stone from gall bladder slipped to common bile duct and entering into pancreatic duct through common channel of opening in Duodenum (small bowel) leading to Pancreatitis.

Indications for Surgery:

• Symptomatic Gall stone with typical history of pain as mentioned above and proven with Imaging (ultrasound)
• Asymptomatic or Silent gall stone (Found Incidentally during Ultrasound abdomen) - "DOES NOT REQUIRE SURGERY".

Asymptomatic or Silent gall stone requiring surgery in special circumstances are:

• Pregnant lady diagnosed with gall stone during first trimester (incidental finding)
• Any blood disorder and patient is going for any abdominal surgery for any reason.
• Diabetes mellitus - as chances of infection are high on by ground of diabetes
• Gall bladder polyp (a soft tissue growth in lumen of gall bladder) size > 1 cm or single stone measuring > 3 cms, as risk of Gall Bladder cancer increase by 10 fold in these cases.

Treatment: Surgery - Laparoscopic Cholecystectomy (Key Hole Surgery) is Gold standard worldwide.

• Safe surgery, there are no side effects of removing of gall bladder as one has to weigh the complication arising from a "symptomatic" gall stone disease.
• Can be done as a day care surgery
• Post surgery patients are advised to refrain from fatty meal for a week so as to acclimatize the body to a diluted bile. Normal activity is allowed from day 1 of post surgery.