In my
gastroenterology practice, on an everyday basis, I come across at least one patient asking whether I need to have my
gall bladder removed or not since gallstones were detected on ultrasonography
done as a routine test. Well, this blog should answer this query with
certainty.
Gallstones
are crystal-like deposits made from cholesterol and other
substances found in the bile. They can be smaller than a grain of sand or as
large as a golf ball and are stored in gall bladder a small, pear-shaped organ
that stores bile, a digestive fluid produced by the liver. Stones form quite
commonly in the gallbladder.
Of every
100 adults in India, stones will show up in the gallbladder in at least 5 of them if they are subjected to an
ultrasound test. This figure goes up to around 15 in Western Europe and
America. The highest prevalence of gallstones has been reported in a tribe of
Pima Indians (Native Americans), 75% of whom are affected by the age of
35.
6F’s define
the risk of formation of gallstones:
1.
Female,
2.
Forty,
3.
Fat,
4.
Fair,
5.
Fertile,
6. Family
history of gallstones.
Diabetics,
pregnancy, sudden weight loss, oral contraceptive pill usage are some other
risk factors for developing gallbladder stones.
There are
2 types of stones, the ones which cause pain and the silent ones which come to
notice incidentally. The typical symptom is a severe upper abdominal pain
occasionally accompanied by nausea, indigestion, or fever.
The painful stones if left untreated, cause repeated pain
episodes and can lead on to major complications like jaundice, swelling of the
gall bladder(Cholecystitis) and swelling of the pancreas(pancreatitis) and gall
bladder cancer.
Silent ones are best left alone as only 20% of them ever
require removal of gall bladder in their lifetime. A simple guide is to undergo
treatment/removal only when the presence of gallstones start to cause symptoms
in a patient either in the form of pain or jaundice/pancreatitis/cholecystitis.
Otherwise, you can comfortably choose to avoid surgery as in the majority of
people they stay silent.
Silent
gallstones of >2cm require removal of the gall bladder to
prevent gall bladder cancer occurrence. The only way to detect whether a person
has gallstones or not is by sonography of abdomen. At least one consultation
with a gastroenterologist needs to be sought for a patient
with gallstones to know if it requires removal of the gallbladder or not.
The only
treatment available to get rid of gallstones is to undergo removal of gall
bladder in toto (completely). This is done either by Laparoscopic cholecystectomy or by open cholecystectomy.
Both the
surgeries are by far simple, safe surgeries which don't require prolonged
hospitalization and are
mostly uncomplicated and tolerated well by most patients.Currently, there is no
medical treatment available for gall stones.
The
answer to the question which is raised in the discussion is that gall bladder
removal as the treatment for gallstones is recommended only if the patient has
symptoms due to stones It's not a vestigial organ and it does have some
function in the digestion of nutrients. So, an unnecessary removal of gall bladder is best avoided.
To
conclude, you should consult a
doctor if you
have any of the following symptoms that worry you:-
• Upper
abdominal pain so intense that you can't sit still or find a comfortable
position
•
Yellowing of your skin and the whites of your eyes
• High
fever with gall stones
Blog by Dr C. Vasudev. Gastroenterologist and Liver Diseases
Specialist (Hepatologist), Interventional Endoscopist at SevenHills
Hospital, Mumbai.
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