Gallstones are small stones that form in the gallbladder. Gallstones are a common disorder of the digestive system, and affect around 15 per cent of people aged 40 years and over.
The gall bladder is a small sac that holds bile, a digestive juice produced by the liver which helps in digestion of fat. The bile is stored in the gallbladder and, over time, it becomes more concentrated. The gallbladder is able to release bile into the digestive system when it is required. Gall stones are either cholesterol stones or pigment stones. Some times they mixed type.
What are the causes of Gall stones?
Gender. Women are twice as likely as men to develop gallstones. Excess female hormones from pregnancy, hormone replacement therapy, and birth control pills appear to lead to gallstone formation.
Family history. Gallstones often run in families, pointing to a possible genetic link.
Weight. Moderately overweight increases the risk for developing gallstones. Obesity is a major risk factor for gallstones, especially in women.
Diet. Diets high in fat and cholesterol and low in fiber increase the risk of gallstones due to increased cholesterol in the bile and reduced gallbladder emptying.
Rapid weight loss. As the body metabolizes fat during prolonged fasting and rapid weight loss—such as “crash diets”—the liver secretes extra cholesterol into bile, which can cause gallstones. In addition, the gallbladder does not empty properly.
Age. Gall stone occur in young adults and become more common with advancing age.
Ethnicity. They are more common in Asian population.
Medicines: Cholesterol-lowering drugs. Drugs that lower cholesterol levels in the blood actually increase the amount of cholesterol secreted into bile. In turn, the risk of gallstones increases.
Diabetes. People with diabetes generally have high levels of fatty acids called triglycerides. These fatty acids may increase the risk of gallstones.
Who are at risk for Gall stones?
You are more at risk of developing gallstones if you are:
Overweight
Female – women are 2-3 times more likely to be affected by gallstone disease than men
40 or over – most cases of gallstone disease first develop in people aged 40 or above
A mother – women who have had multiple pregnancies have an increased risk of getting gallstone disease. It is thought that the hormonal changes that occur during pregnancy can increase cholesterol levels
What are symptoms of Gall stones?
Many people with gallstones have no symptoms; these gallstones are called “silent stones.” As gallstones move into the bile ducts and create blockage, pressure increases in the gallbladder and one or more symptoms may occur. Symptoms of blocked bile ducts are often called a gallbladder “attack” because they occur suddenly. Gallbladder attacks often follow fatty meals, and they may occur during the night. A typical attack can cause steady pain in the right upper abdomen that increases rapidly and lasts from 30 minutes to several hours.
What are the risks if of Gall stones are not removed?
Gall stones can cause infections in gall bladder and in the surrounding area leading to fever with chills. Most commonly, stones move from gall bladder to bile channels causing yellow discoloration of eyes and can also lead to swelling in pancreas. The more the gall stones stay in gall bladder the more are chances of complications. There is also a small risk for cancer developing in gall bladder after many years of gall stones
How are Gallstones diagnosed?
You may decide to go to the doctor because of pain in your belly. In this case, your doctor will ask you questions about when the pain started, where it is, and if it comes and goes or is always there. Your doctor may order imaging tests. They take pictures of the inside of your body. An ultrasound of the belly is the best test to find gallstones. Additional blood tests may be done to see for your liver and pancreatic functions and also to rule out infection.
What is the treatment of Gallstones?
The treatment of symptomatic Gall stones is surgery. The most widely used treatment is keyhole surgery (laparoscopic Cholecystectomy to remove the gallbladder. But your doctor may decide to do open surgery if there is any contraindication to key- hole surgery In key Hole surgery, doctor makes 4 small cuts in the abdomen to remove the Gall bladder. You can go home next day after the surgery. This type of surgery is generally safe with a low risk of complications.
Do people need their gallbladder?
Fortunately, the gallbladder is an organ people can live without. Your liver produces enough bile to digest a normal diet. Once the gallbladder is removed, bile flows out of the liver directly into the small intestine, instead of being stored in the gallbladder. The organ can be useful but it is not essential. Your liver will still produce bile to digest food.
Dr Athar Khan MS, MRCS (UK) FMAS, is Senior Specialist and Head, Department of General and Laparoscopic Surgery at Al Sharq Hospital, Fujairah, and UAE.
