Gallstones, |a condition not to be ignored

The presence of stones in the gallbladder, a condition known as gallstones, is a frequent condition through it often remain silent and rarely leads to serious complications. However, when gallstones lead to pain, surgery is usually required. Today, the surgical removal of the gallbladder is one of the most common interventions performed in western countries. 

The gallbladder is a small organ located beneath the liver on the right side of the abdomen. It stores the bile, a substance permanently secreted by the liver. During meals, the bile is released through a small duct into the intestine to facilitate the digestion process. Gallstones are stone-like deposits, ranging from a few millimetres up to the size of a golf ball, and, in 80 per cent of cases, made of cholesterol crystals. 

Gallstones often do not induce any symptoms and are incidentally discovered during a routine exam or for other medical reasons when an ultrasound of the abdomen is performed. 

They may also lead to various symptoms and, if untreated, to potentially serious complications.

Some patients experience acute, intense and intermittent pain in the right upper quadrant of the abdomen associated with vomiting that often occurs after a meal. This syndrome is called biliary colic and corresponds to movements of a stone in the bile duct or to a temporary blockage of the gallbladder. The pain may subside within a few hours. Between one and four per cent of patients with gallstones develop symptomatic biliary colic annually. 

The stone could also migrate out of the gallbladder to the duct and block the flow of bile. When the obstruction is prolonged over several hours, it may result in an inflammation and/or an infection of the gallbladder called acute cholecystitis. This complication, which includes fever, severe pain and tenderness in the right abdomen, occurs in about 20 per cent of untreated biliary colic. Cholecystitis is a surgical emergency as it could lead to severe complications such as abdominal abscess, an inflammation of inner membrane of the whole abdominal cavity (peritonitis) or even a blood infection (septicaemia). 

Women, the elderly, overweight and obese people, individuals with a family history of gallstones, those who eat a fat-rich or low-fibre diet or are taking some anti-cholesterol or hormonal treatment are more prone to developing gallstones. 

Gallstones that remain “silent” do not need to be treated. Studies have showed that 60 per cent of asymptomatic individuals will not experience any symptoms throughout their lives. 

Conversely, 70 per cent of those who suffer from gallstone pain could experience complications. Such individuals need to be treated when the symptoms are mild and out of an infection context. Ignoring the disease at this stage may lead to more complicated surgery during an acute situation. 

Medical treatment (with medications dissolving the stones) combined with lithotripsy (shock waves to break up stones) is not very effective and rarely proposed these days. The reference treatment is the complete removal of the gallbladder in a procedure known as a cholecystectomy. 

After the intervention, the bile freely flows to the intestine and the digestion is not affected although a few patients may suffer temporary diarrhoea. Depending on the gallbladder characteristics, it can be done through a minimally invasive procedure (laparoscopic surgery) or through the classic approach with abdominal incision (laparotomy). Undertaken by experienced surgeons, such interventions are usually well tolerated with the patient being discharged 2 to 3 days after laparoscopic surgery and 4 to 6 days after classic surgery. No specific diet is needed. 

As being overweight is a risk factor, the prevention of gallstones focuses on maintaining a healthy body weight, which is one of the cornerstones of a healthy lifestyle. However, rapid weight loss also favours the development of gallstones. Thus, for those attempting to lose weight, the loss should be progressive and not exceed about 1 kilogram per week.

 

Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at [email protected].