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Gallstones

Gallstone disease or cholelithiasis is a health disorder where there are stones in the bile or bile duct. In some cases, stones can be found in both organs. This stone is the result of bile which solidifies into hard particles resembling pieces of rock - like gravel.

Bile itself is the only pathway that works to remove excess cholesterol from the body - both as free cholesterol and as bile salt. While the gallbladder is a sac that serves to store bile before it is released into the intestine. The location of the gallbladder is under the liver.

If gallstones enter the bile duct, blockages and infections of the bile duct (cholangitis) can occur. This blockage that occurs in the bile duct will make the bacteria grow and develop. As a result an infection occurs in the channel. These bacteria can also spread through the bloodstream and cause infections in other parts of the body.

Gallstones can be divided into three types, namely cholesterol gallstones, pigment gallstones, and mixed gallstones. As the name suggests, cholesterol gallstones are formed from cholesterol. These gallstones are usually yellow or green.

Next pigment / bilirubin gallstones, formed from too much calcium bilirubinat in bile. This one gallstone is usually dark, like black or brown. Finally, mixed gallstones are a mixture of cholesterol and bilirubin.

Diagnosis

In diagnosing gallstones, the doctor will collect information and an accurate physical examination of the patient. More than half of sufferers of gallstones usually do not feel any symptoms. Complaints that may arise are bloating, which sometimes accompanied by unpleasant taste in the body when eating fatty foods.

In addition to gathering information, the doctor will also advise you to undergo investigations. Investigations that can be done include ultrasound or ultrasound examination. This is a standard examination to strengthen the diagnosis of gallstones. Ultrasound examination has a very high level of accuracy, which reaches 95%.




Besides ultrasound, another examination that can also be done is a CT scan. A CT scan is performed if the stone is in the bile duct. In addition there is also an MRI (Magnetic Resonance Imaging) examination. This examination is needed if there are complications of jaundice.

Symptoms

Gallstones generally do not cause complaints to patients - as long as the stones do not enter the bile duct. But if the stone enters the end of the bile duct, you can feel a certain complaint.

If it is small, it is possible for stones to easily pass through the bile duct and into the duodenum. The gallstones may not cause symptoms for decades.

Symptoms that are quite striking in gallstones are pain that tends to be severe and settles in the bile duct. The pain arises if the bile duct is blocked by stones. It can also trigger severe abdominal pain that radiates to the back or shoulders. Nausea and vomiting are often associated with attacks of this pain.

Other symptoms that can also appear are fever, pain in the entire surface of the abdomen, stomach feels twisted, and the stomach feels bloated. Great pain can last more than 15 minutes and only disappear a few hours later.

The onset of pain often takes place slowly. But 30% of cases, the pain arises suddenly. Pain due to bile duct stones usually settles and gets worse when deep breathing.

Treatment

Treatment of gallstones must be adjusted to the development of the stone and its impact on you. Because, basically gallstones give different effects and effects between people.

There are several steps to treating gallstones:

1. Early stage

As explained earlier, gallstones do not always cause symptoms. If gallstones do not cause any symptoms, doctors usually will not take special medical measures. However, the doctor will make sure that there are no possible complications. But if there is a possibility of complications or other diseases that are at risk of increasing complications, further treatment is needed.

2. Advanced Stage

At this stage, it is necessary to look at the severity that occurs. If the pain symptoms that you feel are still relatively mild and rarely appear, then drug consumption is sufficient. Usually the medication needed is a type of pain medication. In addition, you should also change your diet to be healthier.

But if the pain that arises - especially in the area of the abdomen - feels very great, then further medical action is needed. Especially if the pain appears quite often. Possible operative action is needed.

3. Operative Action

This medical procedure is needed only if the symptoms you feel are very severe and severe. The worst possibility is that your gallbladder must be removed. There are several operative actions that can be taken to deal with the problem of gallstones.

  • Laparoscopic cholecystectomy

This is the most commonly recommended operative procedure because it produces very minimal incisions. This action is also known as keyhole surgery because of the very small size of the incision - the keyhole similar. The recovery period you need lasts 1-2 weeks.

  • Open cholecystectomy

This action is needed if the size of the gallstones is large enough so that it cannot be removed through keyhole surgery. Or it can be done if your condition is not possible to undergo laparoscopic cholecystectomy. The causes can vary - such as the location of the gallbladder that is strung together or in the case of obese people. The recovery period is quite long, which is 1-1.5 months.

  • ERCP (Endoscopic Retrograde Cholangiopancreatography)

To deal with the problem of blockage of the bile duct due to the presence of gallstones, it can also be done through the ERCP procedure. This procedure is done without removing the gallbladder.

  • ESWL (Extracorporeal Shock Wave Lithotripsy)

This is a procedure for breaking stones using sound waves. Several years ago, the use of the ESWL procedure was very popular. However, this procedure is only limited to patients who have actually been considered for this therapy

Cause

Previously it was explained that there are three types of gallstones. Each is formed and has different contents. Cholesterol stones contain at least 70% cholesterol and the rest are calcium carbonate, palmitite calcium, and calcium bilirubinat. The shape is more varied than the pigment stone form.

These gallstones are almost always formed in the gallbladder. The surface is slippery, round, spiny, and sometimes it looks like a mulberry. Cholesterol stones occur because of the high cholesterol concentration in bile. This happened as a result of high cholesterol in the blood.

High cholesterol in the gallbladder can trigger sedimentation which eventually turns to stone. Another cause is emptying of bile in the gallbladder that is less than perfect. The remaining bile in the bag after the bile pumping process can also cause precipitation.

Unlike pigment gallstones. The appearance of calcium bilirubinat stones, also called mud stones or pigment stones, does not vary much. Often found irregularly shaped, small in size, with color variations between brown, reddish, to black, and sometimes many in number.

It looks like mud or fragile soil. Pigment stones occur because bilirubin is difficult to dissolve in water. In addition it is also due to the deposition of calcium bilirubin salt or due to infectious diseases.

Next mixed gallstones. This is the most common type of gallstone - even reaching 80%. This gallstone is formed from cholesterol, bile pigments, and various calcium salts. Usually multiple and contains little calcium.



References

References

Lee, et al. (2015). Diagnosis and Treatment of Gallstone Disease.

Sanders, G. Kingsnorth, AN. (2007). Gallstones.

Mayo Clinic (2018). Diseases and Conditions. Gallstones.


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Is a health and wellness enthusiast. In him free time, she loves to travel and taste different types of teas.

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