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Prevent gallstone formation

Tuesday, May 08, 2018

Eating low-fat foods, more fibre and several small meals can go a long way towards preventing stone formation in your gallbladder, says Dr Biswanath Gouda

An anxious young 28-year-old unmarried woman came for consultation last Saturday. Two weeks earlier, she had an acute onset of abdominal pain on the right side going to the back, which lasted for a few hours and was relieved with injectable pain killers. Her doctor had advised her to get a USG done and it showed multiple small stones in her gallbladder. At present, she is pain-free and asymptomatic but is worried about what needs to be done for the stones!

What is a gallbladder?
It is a small organ lying under the liver in the upper right abdomen, that stores bile- a green-yellow liquid that helps with digestion.

Why are stones formed inside the gallbladder?
High cholesterol in your bile High cholesterol in your bile can lead to yellow cholesterol stones, which are hard. It develops if your liver makes more cholesterol than your bile can dissolve.

High bilirubin in your bile Bilirubin is produced when your liver destroys old red blood cells. Some conditions, such as liver damage and blood disorders, cause your liver to produce more bilirubin than it should. Pigment gallstones form when your gallbladder can’t break down the excess bilirubin.

Concentrated bile due to a full gallbladder The gallbladder needs to empty its bile from time to time to be healthy and to function properly. If it fails to empty its bile content, the bile becomes overly concentrated, which causes stones to form, as seen in a  non-contractile gall bladder. According to Harvard Health Publications, 80 per cent of gallstones are made of cholesterol.

What are the symptoms?
It can present itself with pain in the right upper abdomen. You may experience typical pain from time to time when you eat foods that are high in fat, such as fried foods, cheese and pizza.You may also experience nausea, vomiting, dark-coloured urine, clay-coloured stools, jaundice with fever, burping, indigestion and diarrhea.

What are asymptomatic gallstones?
Gallstones themselves don’t cause pain unless they are infected. Rather, pain occurs when the gallstones block the movement of bile from the gallbladder. According to the American College of Gastroenterology, 80 per cent of people have “silent gallstones”. In these cases, your doctor may discover the gallstones from routine health checks, X-rays or during abdomen surgery. Diabetic patients with gallstones usually don’t have pain, which makes its detection a challenge.

What are the complications of gallstones?
Acute Cholecystitis When a gallstone blocks the duct where bile moves from the gallbladder, it can cause infection in the gallbladder  known as acute cholecystitis. It is a surgical emergency, the patient needs to be hospitalised and treated accordingly. The risk of developing acute cholecystitis from symptomatic gallstones is 1-3 per cent.

Jaundice This is a yellowish tint to your skin or eyes due to blockage of bile ducts with gallstones.

Cholangitis A bile duct infection due to stones.

Sepsis Severe blood infection from gallstones.

Pancreatitis Pancreas inflammation of pancreas due to gallstones blocking the pancreatic duct.

Gallbladder Cancer This is seen mostly in the Northern part of India along the basin of the Ganga river.

What are the risk factors for gallstones?
Lifestyle Factors Being overweight/ obese, a diet high in fat/low in fibres, rapid weight loss through diet/ weight loss surgery.
Medical Factors Having liver cirrhosis, diabetes mellitus, being pregnant,taking medicines to lower cholesterol or taking drugs with high estrogen content.
Uncontrollable Factors Being female, having a family history of gallstones, age more than 60 years.

What tests are done for detection of gallstones?
Physical examination Your doctor does a complete physical examination that includes checking your eyes and skin and may involve using diagnostic tests including complete blood count and liver function tests.

Ultrasound To see the gall bladder and number of stones inside, status of liver, any blockages in bile duct, presence of any pancreas infection.

CT scan/ MRI scan (MRCP)  These are special tests done only after a doctor’s recommendation. Usually it is done when the liver function tests are abnormal, the patient has jaundice or pancreatitis.

HIDA Gallbladder scan A nuclear medicine specialist injects a radioactive substance into your veins that travels through your blood to the liver and gallbladder. On a scan, it can reveal evidence to suggest infection, blockage of the bile ducts from stones or non-contracting gallbladder.

Endoscopic retrograde cholangiopancreatography (ERCP) It is a procedure that uses a camera and X-rays to look at problems in the bile and pancreatic ducts. It helps your doctor look for gallstones stuck in your bile duct that can be removed at the same time and also place a stent/tube across to prevent future blockages.

How are gallstones treated?
Most of the time, you won’t need treatment for gallstones unless they cause you pain. If you’re in pain, your doctor will likely recommend surgery. Laparoscopic removal of gallbladder is the right way to do it. Only if you’re at high risk for surgery complications or not fit for general anesthesia, a drainage tube may be placed into the gallbladder through the skin. Your surgery may be postponed until your risk is lowered by treating your other medical conditions.

What is Laparoscopic Cholecystectomy?  
It’s a procedure done by a laparoscopic surgeon  who will usually make three or four  small incisions in your abdomen and with help of camera inserted inside, the gallbladder is removed. You usually go home on the day of the procedure or the day after if you have no complications.

After answering all the patient’s queries related to gallbladder and its stone-related health implications, I have posted her for elective laparoscopic cholecystectomy after two weeks. She will be undergoing a battery of tests and investigations prior to surgery.

Dr Biswanath Gouda is a Laparoscopic Gastro-Intestinal Surgeon in Mumbai. He is attached to Somaiya Superspeciality, Global Hospital, Nanavati Superspeciality and Holy Family Hospital.

How to prevent formation of gallstones

  • Reduce your intake of fats, avoid high-fat, greasy, and fried foods and reduce refined carbohydrates like sugar and white flour.
  • Add natural fibre to your diet to make your bowel movements more solid.
  • Eat several small meals per day and eat slowly.
  • Drink about 8-10 glasses of water per day.
  • Lose weight slowly. Aim to lose no more than 500 gms per two weeks.

Fact file
The gallbladder is a small organ under the liver in the upper right abdomen, which stores bile, a green-yellow liquid that helps with digestion.

The gallbladder needs to empty its bile from time to time to be healthy.

If it fails to empty the bile, this becomes overly concentrated, which causes stones to form.

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