Gallbladder stones are not commonly seen in children and young adults. In individuals over the age of twenty, gallstones are observed in approximately 17% of women and 8% of men. The incidence significantly increases after the age of 40. Due to dietary and genetic factors, they are more prevalent in men compared to women. Gallstones are found in 10-20% of the population, with 80% being asymptomatic.
The gallbladder is a pear-shaped structure, 7.5-10 cm long, located on the front surface of the liver, connected to the liver by loose connective tissue. It connects to the common bile duct via the cystic duct. The main function of the gallbladder, an important part of the digestive system, is to store bile produced in the liver. The stored bile plays a role in the digestion of food. The most common gallbladder disease is cholelithiasis, or gallstone formation. These structures, formed by the precipitation and crystallization of cholesterol and calcium salts within the gallbladder, can vary in size, shape, and structure. If larger than 3mm, it is called a gallstone; if smaller, it is referred to as bile sludge.
What are the Symptoms of Gallbladder Stones?
Gallstones can be asymptomatic or may present with mild gastrointestinal symptoms. Such stones may be incidentally discovered during surgical interventions or evaluations for other issues.
Symptoms of gallbladder stones can arise from the disease itself and from the blockage of bile ducts by a gallstone. Symptoms can be acute or chronic. Feelings of bloating, fullness, and indigestion may occur.
Pain and Biliary Colic
Biliary colic is a severe pain typically felt in the upper right quadrant of the abdomen, developing due to a gallbladder stone. This pain often radiates to the back and right shoulder and is usually accompanied by gastrointestinal symptoms such as nausea and vomiting. The most frequently encountered symptom of gallstones occurs after consuming fatty foods like fried items. The person moves restlessly and cannot find a comfortable position. Such a biliary colic attack is caused by the contraction of the gallbladder. When the inner part of the gallbladder swells, it contacts the abdominal wall in the area of the ninth and tenth rib cartilage. This condition leads to a specific sensitivity when taking a deep breath and prevents full inhalation. The pain can be severe enough to require analgesics.
Cholecystitis
Cholecystitis is the acute or chronic inflammation of the gallbladder. If the bile ducts are blocked by a stone, the gallbladder swells, becomes inflamed, and inflammation occurs here. The patient may also experience high fever and severe abdominal pain. In addition to these symptoms, chills, shivering, and nausea-vomiting may also be observed. More than 90% of acute cholecystitis cases have been found to be due to stone-related cholecystitis and require urgent intervention.
Jaundice
Jaundice occurs when gallstones cause a blockage in the common bile duct, leading to bile not reaching the small intestine and being absorbed into the skin and mucosa, giving a yellow color. Jaundice occurs when serum bilirubin levels exceed 5 mg/dL. This is usually accompanied by skin itching.
Changes in Urine and Stool Color
The excretion of bile pigments through the kidneys can give urine a darker color than normal. When bile does not reach the intestines sufficiently, stool is described as grayish, pasty, and usually clay-colored. Gas and indigestion accompany these symptoms.
Vitamin Deficiency
The obstruction of bile flow by stones in the gallbladder also prevents the absorption of fat-soluble vitamins A, D, E, and K. Therefore, if the blockage is prolonged, bleeding due to vitamin K deficiency may occur.
What Causes Gallbladder Stones?
Gallbladder stones form as a result of the disruption of the physical and chemical balances of the substances that make up bile. There are two types of gallstones, composed of pigment and cholesterol, with the majority being cholesterol stones. These solid crystal structures known as pigment stones cannot dissolve, so they are removed through gallbladder surgery. Patients with cirrhosis and bile duct infections have a higher risk of developing pigment stones. Additionally, bile contains calcium, bilirubin, and lecithin.
In individuals prone to gallstones, bile acid synthesis decreases while cholesterol synthesis in the liver increases. Cholesterol is a factor that leads to inflammatory changes in the gallbladder. Excess saturated cholesterol precipitates in the form of stones. Precipitated cholesterol crystals combine with substances secreted from the wall of the gallbladder, causing bile to take on a sludge form. Prolonged fasting can increase the formation of bile sludge.
Dysfunction of the gallbladder’s contraction and relaxation function and secretion function also prepares the ground for stone formation. Over time, a harder structure forms and becomes a gallstone. Increased cholesterol secretion and decreased bile during pregnancy can facilitate the formation of gallstones. It is more commonly seen in overweight women who have had multiple births and are over 40 years old.
How is Gallbladder Stone Diagnosed?
The diagnosis procedure begins with a physical examination, where the individual’s complaints are listened to, and after a detailed preliminary assessment, necessary tests (blood, urine, stool) are requested. The diagnosis is then made through an ultrasound (USG) procedure.
For stones that cannot be detected by ultrasound due to their very small size, endoscopic ultrasound may be preferred. This procedure involves entering the digestive system through the mouth with a flexible endoscope, allowing the visualization of small stones using magnetic sound waves.
How is Gallbladder Stone Treated?
Various procedures are applied in the treatment of the disease and its symptoms, primarily to relieve persistent symptoms, eliminate the cause of biliary colic, and treat acute cholecystitis. Surgical intervention may be delayed until the patient’s symptoms disappear or may be performed as an emergency if the patient’s condition requires it. Definitive treatment occurs with the removal of the gallbladder, a procedure known as cholecystectomy.
Laparoscopic Cholecystectomy
The most commonly used method for gallbladder stone surgery is laparoscopic cholecystectomy. Performed under general anesthesia, this procedure is carried out by entering through a small incision with a tube called a laparoscope. The location of the gallbladder is identified using light and a camera in the tube, and the gallbladder is removed from a different incision point. The patient is discharged on the same day as long as no complications develop after the surgical procedure.
It is considered normal for diarrhea to develop after laparoscopic cholecystectomy. This condition arises from the direct passage of bile from the liver to the small intestine. Bile that passes through the intestines without accumulating in the gallbladder can have a laxative effect, leading to watery stools. To control this situation, it is recommended to consume less fatty foods.
An alternative method commonly known in society to laparoscopic cholecystectomy is the laser method for breaking gallstones. However, contrary to popular belief, it is not as effective as cholecystectomy. Although stones can be temporarily fragmented with lasers, stone formation may recur.
Frequently Asked Questions
Who is more likely to have gallbladder stones?
Gallbladder stones are a disease that is common in those with a fatty diet, prone to obesity, and those who lose weight rapidly, mostly seen in women. Genetic predisposition is also an important factor.
How is gallbladder stone detected?
After a fatty and heavy meal, a sudden pain is felt in the upper right quadrant of the abdomen that disturbs the person and does not go away with rest. Nausea, vomiting, and complaints of indigestion may also be present.
Does gallbladder stone cause pain?
Especially stones that block the bile duct manifest with severe pain. During the passage of bile from the gallbladder to the small intestine, which usually occurs rapidly with food intake, nausea and low blood pressure may be observed.
Can gallbladder stones pass on their own?
Very small stones may rarely pass through the bile ducts and be expelled through the intestines. However, this process does not usually progress silently; stones can block the bile duct, causing pain, jaundice, or pancreatitis. Therefore, waiting for the stone to pass is risky.
Can gallstones be broken?
Laser or sound waves can be used as methods for breaking gallstones, but they are not commonly used treatment methods. They are not preferred because the broken fragments can block the bile duct, leading to various complications; surgical methods are prioritized.
Do gallstones recur?
As long as the gallbladder remains in place, stone formation can recur. Dietary adjustments and lifestyle changes can reduce the risk, but it cannot be completely prevented. When the gallbladder is removed surgically, the risk of new stone formation is almost eliminated.
What happens if gallstones are not treated?
Initially, it progresses with recurring pain, but over time can lead to serious complications such as gallbladder inflammation (acute cholecystitis), bile duct infection (cholangitis), and pancreatic inflammation (pancreatitis). Delayed treatment may require hospitalization and emergency surgical intervention.
How is gallbladder stone surgery performed?
Today, the most common method is laparoscopic cholecystectomy. The gallbladder is removed using cameras and surgical instruments through small incisions made in the abdominal wall. Generally, a one-day hospital stay is sufficient, and the recovery process is faster compared to open surgery.
What can be done to pass gallstones?
Medications used to pass or dissolve stones may develop complications depending on the size of the stone and its proximity to the duct. Such interventions can lead to the stone entering the bile duct, causing blockage and inflammation. If a stone is detected, surgical planning is considered a safe and permanent solution.
Which doctor should be consulted for gallstones?
For the initial evaluation, a general surgery specialist should be consulted. After the diagnosis is confirmed through imaging methods, if deemed appropriate, the surgical plan will also be made by the general surgeon.
If you are experiencing symptoms of gallbladder stones, do not delay in consulting a General Surgery Specialist.
It is possible to have a safe gallbladder surgery using modern laparoscopic methods with the experienced surgical team of Hisar Hospital Intercontinental.
To make an appointment, fill out the appointment form or contact us at 444 5 888.
