Gall Bladder stone - MITR

Gall Bladder Stone

Gall bladder

This organ is located under the liver at lower margin of the rib cage. This balloon like organ stores bile formed in the liver. Bile plays an important role in fat digestion.

Origin of Bile and its flow from Liver to Gall bladder & Small Intestine

Bile is a yellow colored fluid formed by the liver cells. From the liver cells, bile flows through many small tubes to emerge from the liver. At this level, it flows through a tube called as the common hepatic duct and enters either into the small intestine or the gallbladder. Thus, all the tubes through which bile flows starting from the liver and ending into the small intestine comprise the biliary tree.

Role of Gallbladder – What does it do to the Bile?

Within the gallbladder, bile gets concentrated and stored. Following a fatty meal, food reaching the stomach initiates gallbladder contraction. This ensures pumping of bile from the bile storage organ into the common bile duct, finally reaching the small intestine. Understanding this bile flow helps one to understand the complications of gallbladder stone. Since gallstone form in the gallbladder, they cause problems at various levels during their travel to reach the duodenum (first part of the small intestine).

Gallstones

Stones which form in the biliary tree in the presence of bile are gallstones. Most gallstones form within the gallbladder, less commonly in the bile ducts. Though the exact mechanism is still not well understood, the precursor is the sedimentation of cholesterol crystals especially when bile acid concentration within the gallbladder is reduced. Inadequate emptying of gallbladder either following increased hormone states as in pregnancy or oral contraceptive use also contribute to stone formation. They could be either sand like, sludge (thick paste of sand) or stone. These can produce symptoms or stay silent without causing any symptoms.

Symptoms

A typical gallstone pain is experienced in the right upper abdomen below the rib cage usually after food. The pain can very intense with vomiting sensation. The pain can increase steadily for 30-45 minutes and last for several hours. This pain can also be experienced at the right shoulder or shoulder blades. Typically, pain is experienced at night after about two hours of a fatty meal. There could be associated bloating sensation, gas and belching. Some patients may not have such typical symptoms. Initial symptoms can be acidity, vague pain on right side, Fullness. Symptoms may be well appreciated in diabetic patients.

Treatment

In the absence of any symptoms, gallstones are labeled as silent. Such stones require no treatment. Occasionally, a mild single episode of pain due to gallstone can also be observed. Gallstones have been known to remain silent for years.

Wait and watch policy for silent gallstones is well accepted. Medications like ursodeoxycholic acid work on the principle of increasing the bile acid pool. Bile acids help to dissolve the cholesterol crystals in the bile thus preventing sedimentation, precipitation and stone formation. The role of UDCA is limited to people where surgery is not an option due to various reasons, mainly unfit for surgery. The main disadvantage of UDCA is its prolonged use (as long as two years) and recurrence of stones following discontinuation of the drug.

Cholecystectomy

An operation to removethe gallbladder prevents new stone formation and thus, is a definitive treatment for symptomatic gallbladder stone. Surgery is necessary for cure only in patients with symptomatic gallstones. Most of the people have no recurrent symptoms or dietary problems after gallbladder removal surgery. 10% people can develop symptoms like abdominal pain, discomfort and diarrhea.

The operation for gallbladder removal can be done either by a cut over the abdomen (open surgery) or multiple small cuts (laparoscopic surgery).

Open surgery: This operation is done through a single cut below the right rib cage.

Laparoscopic surgery: This operation is done through four to five cuts over the abdomen ranging from 5 to 10 mm.

Single incision laparoscopic surgery: This operation is done through a single cut of approximately 2cm at the belly button.