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Major risk factors

There are certain risk factors that can increase your vulnerability to developing gallstones. These are:

• Sex - women are more likely to develop the problem as compared to men
• Age - quite prominent in people lying in the age group of 30 to 40 years.
• Obesity and rapid weight loss.
• Hormone therapy
• Pregnancy
• Prolonged use of birth control pills

Symptoms that indicate gallstones

There are certain symptoms that may indicate gallstones. Patients are likely to experience gallstone attack i.e. severe bouts of abdominal pain, especially after consuming fatty meals. These are more likely to be experienced at night and often lead to:

• Unbearable pain in the right upper abdomen that keeps fluctuating.
• Back pain
• Pain in the right shoulder
• Nausea and vomiting

Apart from the above-mentioned symptoms, the patient can also experience abdominal bloating and ingestion. In some cases, the patients do not experience any symptom at all. Such patients are termed as asymptomatic and their gallstones are called silent stones.

Right diagnosis

Right diagnosis of any disease is very important for its proper treatment. As far as gallstones are considered, doctors usually recommend tests like ultrasound (both abdominal and endoscopic), oral cholecystography, a hepatobiliary iminodiacetic acid (HIDA) scan, computerized tomography (CT), magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP). Blood tests may also be required in some cases.

Complications associated with gallstones

The various complications associated with gallstones include the following:

• Persistent abdominal pain and discomfort
• Blockage in the common bile duct which can lead to jaundice
• Swelling in the pancreas which can lead to severe complications
• Empyema i.e. pus formation in the pancreas
• Gangrene
• Cholangitis
• Gall bladder cancer

Gallbladder polyp

Gallbladder polyp refers to the abnormal growths in the gallbladder that protrude out from the lining of its walls. These can be benign as well as cancerous and can be further classified as cholesterol polyps, adenomyomas, inflammatory polyps, adenomas and other miscellaneous polyps. Gallbladder polyps can be removed by a procedure known as a cholecystectomy.

Biliary pancreatitis

Biliary pancreatitis is a chronic and life-threatening complication of gallstones. Both the bile duct as well as the pancreatic duct open into the small intestine via the same opening. The gallstones can block this opening thereby preventing the pancreatic enzymes from reaching the small intestines. The enzymes are forced to return to the pancreas, where they react with the pancreatic cells leading to chronic inflammation and swelling accompanied by unbearable pain. This is known as biliary pancreatitis.

Slipping of stone into the CBD

If the gallstone slips into the common bile duct, it can lead to immense pain, jaundice or both. In such a case, the patient needs to undergo endoscopy (ERCP) for immediate removal of the stones.

ERCP is usually done before the surgery, however, it may be performed afterwards as well. The endoscope is inserted inside the patient’s body via his mouth and directed towards the opening of the bile duct. A small instrument attached on the endoscope is used to break down the stone into smaller fragments which are then collected in a tiny basket and removed with the help of the endoscope. The whole procedure is carried out in two steps i.e. ERCP and EPT.

In some cases, the stone is not visible in the ultrasound however the patient might still experience the symptoms. Such patients may be subjected to magnetic resonance cholangiopancreatography (MRCP - an MRI scan) for a detailed screening.

The relation between gallstones and gall bladder cancer

There is a well-established and medically proven relation between gall bladder stones and gall bladder cancer. In fact, studies have shown that around 85 per cent of people detected with gall bladder cancer were found to have gallstones as well. The latter can lead to increased production of carcinogens which lead to chronic irritation. The size of gallstones is directly proportional to the risks of developing gall bladder cancer.

Apart from this, there are several other factors that may increase your risks of acquiring gall bladder cancer. These are as under:

• In the case of females, multiple childbirths and obesity have been found to be closely associated with gall bladder cancer.
• Environmental factors may also be responsible for it.
• Your genes may also increase your risks of acquiring gallbladder cancer.

Treatment options

Symptomatic management:

Symptomatic management as the name suggests focuses on the management of the symptoms to improve the quality of the patient’s life. This can be done through various ways depending upon the size of gallstones and the adversity of the symptoms.

In the case of chronic pain, the patient may be asked to take oral or injectable painkillers.

Antibiotics and supportive medication can help to deal with the infection and acute attack.

Gall bladder removal may be recommended in case all other treatment options fail to work. This can be either done through conventional surgical approach or laparoscopic Cholecystectomy (Lap Chole).

Surgery

Although medical therapy can temporarily help with the symptoms, Cholecystectomy is important to completely cure the gallstones.
Cholecystectomy can be performed using two different surgical approaches i.e. the conventional (open) method or endoscopic (laparoscopic) method.

Laparoscopic procedure:

As the name suggests, it is a minimally invasive procedure that is carried out via tiny punctures which are made on the patient’s abdomen to introduce the instruments along with a tiny telescope and camera to generate enlarged images of the whole procedure on a large screen. These images help doctors to direct the instruments carefully towards the gallbladder, which is then removed by making a very small incision. The patient is good to go within a few hours but is required to take a few precautionary measures for healthy healing. Since there are no large incisions, the patient experiences minimal pain with discomfort.

Open surgery:

In some cases, doctors may find it quite difficult to remove the gallbladder by laparoscopic technique and have to immediately switch to the open surgery. This is carried out by making a 5 to 8-inch long incision on the abdomen, right above the gallbladder and directly accessing it.