Gallstones are a disease that is more common in women than in men and can be quite painful. Approximately 1 liter of bile is secreted from the liver per day and performs various functions such as digestion of fats and absorption of some vitamins from the intestines.
As the bile flows from the liver to the duodenum, which is the continuation of the stomach, it passes through the gallbladder on its way and accumulates here. By absorbing the water, its density increases even more. After consuming some foods, especially fatty foods, the gallbladder contracts and sends the concentrated bile into the duodenum. Under normal conditions, bile maintains its fluidity thanks to the mixture of various substances in its composition in certain amounts. However, any increase or decrease in these components in the bile can lead to deterioration in the fluidity of the bile and to a “sediment-leaving” state.
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Both these deposits and bile sediments called biliary sludge, which are fed only intravenously for a long time or in cases of long-term fasting, may also play a role in the formation of gallstones.
What is the gallbladder, where is the gallbladder located?
The gallbladder is a pear-shaped organ located just below the liver in the upper right region of the abdomen. It contributes significantly to the digestive functions of the body with the yellow-green bile that it secretes into the intestines.
What is a gallbladder stone?
Stone formation in the gallbladder, defined as cholelithiasis, is a problem that usually occurs in developed countries but can be detected in all parts of the world. The incidence increases with age.
What are the causes of gallstones?
Among the causes of gallstones, 3 types of formation paths come to the fore:
PRESENCE OF EXCESS CHOLESTEROL IN BILE
Under normal conditions, the chemical content of bile in the gallbladder is sufficient to dissolve the cholesterol thrown here from the liver. Sometimes, cholesterol in excess of the level that can be dissolved in bile can be excreted from the liver and this excess cholesterol can crystallize and cause stone formation over time.
EXCESS BILIRUBIN PRESENCE
Red blood cells, which take part in the transport of respiratory gases, perform these tasks with the hemoglobin molecule. Hemoglobin undergoes various biochemical processes and bilirubin is formed in cells that have completed their lifespan and disintegrated in order to produce new cells.
In the presence of liver cirrhosis, bile duct infections and various blood diseases, excessive bilirubin occurs in the body and this excess bilirubin can accumulate in the gallbladder and cause stone formation.
INCOMPLETE EMPTYING OF THE GALLBLADDER
What are the symptoms of gallstones?
While the number and size of the stones increase after gallstone formation begins, they usually do not produce any gallbladder symptoms at first. Gallstones, the majority of which are silent, are discovered by chance during some examinations or in some surgeries, except in emergencies.
Stones in the gallbladder, which move with the effect of gravity, start to form various symptoms when they block the outlet of the gallbladder and prevent its normal discharge. If the stone falls into the main bile duct during the course of gallstone disease, a much more problematic process is entered. In this process, which is called obstructive jaundice, the patient may experience symptoms such as abdominal pain, jaundice, red or brown urine color, nausea, vomiting and sometimes fever.
After the stone blocks the bile duct for several hours, inflammatory changes occur in this area and this is called cholecystitis. If infection is added to this table, care should be taken as it can cause very serious problems that will threaten life. This disease is called cholangitis. Apart from cholangitis, a gallstone falling into the common bile duct can also cause acute pancreatitis, an inflammatory disease of the pancreas. This disease can seriously endanger life.
The symptoms of gallbladder disease, which occurs when the stone blocks the bile duct, can be summarized as follows:
- Pain in the upper right region of the abdomen that suddenly and rapidly becomes heavy
- Back pain
- pain in right shoulder
- nausea, vomiting
- darkening of urine color
- light colored stool
- Excessive gas and other digestive problems
Can gallstones cause other diseases?
Gallstones; It can cause many serious diseases such as inflammation of the gallbladder, obstructive jaundice that develops due to the falling of stones in the bile duct, inflammation of all bile ducts and pancreas.
The complaints that occur in the patients are usually pain in the right-upper part of the abdomen, this pain spreads to the right and is felt on the right side of the back, nausea and sometimes vomiting attacks.
If there is inflammation, fever is also added to the table. These painful attacks usually begin after a heavy, fatty meal and can last for a period of 1-5 hours.
The other disease caused by gallstones is less frequently, when a large stone in the gallbladder pierces the wall of the bladder for a long time, passes into the intestine and may cause mechanical obstruction in a narrow part of the small intestine. Gallstones, which grow and increase in number during their natural course, constantly irritate the inner wall of the gallbladder and may increase the risk of a chronic inflammation that may progress into cancer. This risk is considered high, especially in cases of stones exceeding 2–3 cm in size.
These conditions due to gallstones are defined as complications. The most common complications are 4:
GALLBLADDER INFLAMMATION (CHOLECYSTITIS)
It is the condition that the stones formed in the pouch settle in the neck region of the canal and cause inflammation (inflammation) there. With the development of cholecystitis, the person complains of severe pain and fever.
The risk of developing acute (sudden onset) cholecystitis in symptomatic gallstones varies between 1-3%. In addition to the complaints of pain and fever, symptoms such as chills-chills, loss of appetite and nausea-vomiting may also occur. Cholecystitis is a condition that needs urgent intervention.
OBSTRUCTION OF THE COMMON BILE DUCT
Gallstones can cause obstruction in the biliary tract, which is produced in the liver and transferred to the small intestine through the gallbladder. After the blockage of the common canal, conditions such as intense pain, jaundice and canal inflammation may occur in the person.
OBSTRUCTION OF THE PANCREATIC DUCT
The pancreatic duct, starting from this organ, merges with the common duct and opens into the small intestine. The function of the duct is to ensure that the digestive enzymes produced in the pancreas are delivered to the duodenum. Gallstones may pass into the pancreatic duct and cause obstruction there. This can result in inflammation of the pancreas, referred to as pancreatitis.
After the development of pancreatitis, a sudden and intense abdominal pain occurs in the person. People who develop pancreatitis are usually treated by being hospitalized.
People with a history of gallstones due to prolonged irritation have an increased risk of developing gallbladder cancer. Although the risk is high, gallbladder cancer is a rare complication because it is a rare type of cancer.
What are the risk factors for gallstones?
Gallstones are more common in women than men. There are many different conditions that are considered as risk factors for the formation of stones:
- be 40 years or older
- Overweight or obesity
- Sedentary (sedentary) life
- Nutrition with products rich in fat
- Consuming high cholesterol foods
- low fiber diet
- Having a family history of gallstones
- Blood diseases such as sickle cell anemia and leukemia
- rapid weight loss
- Using estrogen-containing oral contraceptives (birth control drugs) or being on hormone therapy
- Liver diseases
The reason for the increased susceptibility to gallstone formation during pregnancy is due to the high level of secreted progesterone hormone during pregnancy. Progesterone hormone slows down the contractions of the gallbladder and causes the flow rate to be interrupted.
Apart from these factors, there may be an increased risk of gallstone formation in conditions such as prolonged fasting, bariatric surgery and Crohn’s disease.
Gallstones tend to form when the flow of bile and the emptying of the bladder are slowed down. The most common cause of stone formation is the concentration of cholesterol in bile with high cholesterol content. The second most common stone form is pigmented stones.
Cholesterol stones are usually yellow in color and consist of undissolved cholesterol. Pigment stones are dark brown or black in color and are caused by excess bilirubin in the bile.
Sometimes, mixed type stones, which are formed as a result of the combination of various substances, can be detected. Mixed type stones are in the 3rd rank in the frequency of detection. These stones may contain calcium carbonate, calcium phosphate, cholesterol and bile.
The 4th type of gallstones are calcium stones. It occurs in people who have high levels of calcium in their bloodstream, and in these people, the presence of kidney stones can often be detected in addition to gallstones.
How is the diagnosis of gallstones made?
Diagnosis of the disease; It is diagnosed by blood, urine, stool tests and ultrasonography (USG), along with typical examination findings. With these examinations, nearly 100% definitive diagnosis can be reached. Rarely, other imaging modalities such as computed tomography and MRI are used. In addition, for stones in the bile duct, endoscopic interventions, which we call ERCP, apart from ultrasound, can be used both in diagnosis and treatment.
Gallstone patients typically present to healthcare facilities with abdominal pain in the upper right region that occurs following a fatty and spicy meal. Nausea and vomiting may accompany these complaints.
During the physical examination performed by the physicians, deep palpation (pressing the fingers on that area) to the right upper abdomen during the patient’s breathing and typical gallbladder pain in the person has diagnostic importance. The presence of jaundice findings in the person may indicate obstruction of the common bile duct due to stone.
Ultrasonography is the first test used in the diagnostic approach to gallstones. With this radiological diagnosis method, even stones as small as 2 mm can be detected. Findings such as the detection of thickening in the wall of the gallbladder and the presence of fluid around it are symptoms that indicate that the person has gallbladder inflammation.
For stones that are very small and cannot be detected by ultrasonography, the diagnosis can be made by endoscopic ultrasonography. In this process, the thin and flexible endoscope is inserted through the mouth and advanced through the digestive system, and small stones are visualized by means of sound waves.
If a stone in the common bile duct is suspected, an imaging method called magnetic resonance cholangiopancreatography (MRCP) can be used. If the stone in the common canal is detected with this procedure, the procedure called endoscopic retrograde cholangiopancreatography (ERCP) is started. Removal of stones can also be performed during the ERCP procedure.
How is gallbladder surgery and stone treatment?
Various methods are used in the treatment of the disease and its complications. The most commonly used method is laparoscopic surgery. Less than 5% of gallbladder surgeries are performed with open surgery. The most important reason for open surgery is previous attacks in the abdomen or adhesions formed due to surgery. ERCP and PTK are other treatment methods used when necessary.
The removal of the gallbladder for the treatment of gallstones is called cholecystectomy. The gold standard cholecystectomy approach is laparoscopic surgeries. If the surgery is not performed laparoscopically for various reasons, the open surgery method may be preferred. Today, it is accepted as a rational approach to leave the sac and remove only the stones during the surgical procedure. The reason for this is the risk of recurrence of stones and complications in approximately 1 year in patients.
In laparoscopic cholecystectomy surgery performed under general anesthesia, the operator makes 3-4 incisions (incisions) in the patient’s abdomen. From these incision areas, small and illuminated surgical instruments are inserted into the patient’s abdominal cavity and the gallbladder is removed. Patients are observed for a while after the operation and can be discharged on the same day or the day after the operation, unless an undesirable situation is encountered.
It is considered normal to develop diarrhea in people who have had laparoscopic cholecystectomy surgery. This is due to the direct passage of bile from the liver to the small intestine after surgery. Bile, which cannot pass into the concentrated form, acts as a laxative in the intestines and causes the stool to become watery. One of the most important steps to be taken in overcoming this situation is to avoid the consumption of high-fat foods with meals.
Apart from surgery, gallbladder stones can be intervened with medical treatment and a method called lithotripsy. Medical treatment is preferred due to the developing operating room and procedure conditions in today’s conditions. In people who cannot be operated on, drugs with ursodiol active ingredient can be applied , especially for stones caused by cholesterol . In the use of these drugs, problems such as taking them in varying doses 2 to 4 times a day, that it may take years for gallstones to pass, and that stone formation can be observed in patients after the treatment is terminated may be encountered.
Lithotripsy is another method that can be used in the treatment of non-surgical gallstones. In this application, shock waves are given to the person to break the stones into smaller pieces.
There are a number of nutritional changes that can be made within the knowledge and recommendation of physicians in order to prevent the development of gallstones and the negative effects associated with the stone:
- Avoiding high-fat foods such as fries and eating low-fat foods
- Adding foods high in fiber to the diet program that facilitate bowel movements
Coffee may have a protective effect against gallstones and other diseases, but it is recommended to stay away from beverages containing high levels of caffeine, high-fat dairy products and sweet foods with high sugar content due to their diarrheal effects.
In order to facilitate digestion, eating smaller meals and consuming at least 6-8 glasses of water daily are among other nutritional practices that can be done.
It is recommended that people who are at risk of developing gallstones or gallstones should choose slow weight loss methods while losing weight. Care should be taken as losing weight quickly can lead to the development of gallstones and other health problems. Patients who have undergone or will undergo bariatric surgery treatments that cause rapid weight loss should choose the most appropriate method for them. When investigating what a gastric balloon is , they can see that less weight is lost in a longer time than the methods in bariatric surgery.
Symptoms of gallstones and other complaints may appear over time and then disappear. It is recommended that you apply to health institutions especially if you complain of abdominal pain that lasts longer than 5 hours, if the symptoms of jaundice are accompanied, if the stool is white in color and if these symptoms are accompanied by other complaints such as sweating, chills, chills and fever.