Understanding Gall Stones- Expert disease insight blog by Dr C Vasudev

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.