Gallstone

What Is Gallstone?

  • Gallstones are known as “cholelithiasis” in medical terminology.
  • The gallbladder is used to store bile. Bile is a natural substance, released by the gallbladder to help with digestion of fatty foods. Bile causes emulsification of fats so that they can easily be broken down and absorbed by the gastrointestinal system.
  • Gallstones occur when “stones” are formed from the bile in the gallbladder. This may either be because of excess cholesterol or excess bile pigments called bilirubin in the bile. The stones can vary in size and number.
  • Gallstones may cause inflammation of the gallbladder; they may move into bile ducts and cause obstruction of bile ducts, leading to a build up of bile products such as bilirubin, which leads to jaundice. They can also move further down the bile ducts causing inflammation of the pancreas (pancreatitis).    

What Is Gallstone?

  • Gallstones are known as “cholelithiasis” in medical terminology.
  • The gallbladder is used to store bile. Bile is a natural substance, released by the gallbladder to help with digestion of fatty foods. Bile causes emulsification of fats so that they can easily be broken down and absorbed by the gastrointestinal system.
  • Gallstones occur when “stones” are formed from the bile in the gallbladder. This may either be because of excess cholesterol or excess bile pigments called bilirubin in the bile. The stones can vary in size and number.
  • Gallstones may cause inflammation of the gallbladder; they may move into bile ducts and cause obstruction of bile ducts, leading to a build up of bile products such as bilirubin, which leads to jaundice. They can also move further down the bile ducts causing inflammation of the pancreas (pancreatitis).    

What Are The Symptoms Of Gallstone?

  • Gallstones may be symptomatic or asymptomatic.
  • Symptomatic gallstones may be complicated or uncomplicated.
  • Some patients may experience persistent dull upper abdominal pain or discomfort. Other symptoms such as indigestion, biliary colic, bloating and flatulence may be present.
  • Biliary colic is usually dull, nonspecific pain localised to the upper abdomen, that may move to the back. The pain may follow 10-30minutes after ingestion of a fatty meal and can come and go in intensity.
  • Complicated symptomatic gallstones may present as cholecystitis (infection of the gallbladder), colic (pain due to movement of stone though bile ducts), jaundice or pancreatitis.
  • Patients with cholecystitis usually present with severe, localised pain in the upper right are of the abdomen. They may be acutely ill with fever. Clinical examination will show signs of localised peritonitis (inflammation of the abdominal cavity's wall due to infection), with severe tenderness and guarding of abdominal muscles when palpating the gallbladder (known as a positive Murphy's sign).
  • Pancreatitis may present with similar symptoms as cholecystitis, and often special investigations need to be done to determine the cause of symptoms.
  • Special investigations most commonly performed are an abdominal ultrasound (first line investigation in uncomplicated cholelithiasis). A contrasted CT scan of the abdomen is usually performed if complications are suspected. If gallstones and infection of the bile ducts are suspect a special type of MRI (Magnetic Resonance Imaging) called a MRCP might be performed.
  • Blood tests carried out include infective markers, liver function tests, pancreatic enzymes, electrolytes and kidney function.    

What Are The Causes Of Gallstone?

  • Risk factors for gallstones are numerous:
  1. Diet plays an important role, especially a diet high in unsaturated fats
  2. Middle-aged men and women are more often affected.
  3. Females are affected more than males, and more often during their years of fertility. Pregnancy and oral contraceptives are known risk factors.
  4. Being overweight or obese is a predisposing factor
  5. Abnormal cholesterol and blood lipid profile
  6. Metabolic syndrome (a syndrome characterised by three factors present of either dyslipidemia, obesity, high blood pressure or diabetes)
  7. Gallstones are seen more commonly in patients with fair skin complexions. Caucasians and Asians are more at risk than people of African descent.
  8. Liver disease such as cirrhosis
  9. Genetics may increase your risk of gallstone formation up to five times compared to the standard population    

What Are The Things One Should Do To Manage Gallstone?

  • Follow the recommended diet for people with gallstones (see below)
  • Regular exercise has proven to be beneficial in preventing gallstones
  • If you are overweight, weight loss can help prevent gallstones, but it should be slow and controlled, as rapid weight loss has been noted as a risk factor to develop gallstones.
  • Have smaller meals more often, rather than consuming large amounts of food at a time    

What Are The Things One Should Avoid To Manage Gallstone?

  • Do not smoke. Smoking has not been linked to gallstones directly. However, it does increase the general underlying inflammation in the body, and affects your health overall.
  • Do not eat foods high in fat, as they may precipitate episodes of biliary colic.    

What Are The Best Foods For Gallstone?

  • A healthy balanced diet, with a particular focus on low-fat foods
  • Use healthy fat alternatives for cooking such as coconut oil or virgin olive oils
  • Use low-fat spreads, butter, cheese and yogurts
  • Plentiful intake of fresh fruits and vegetables (at least five portions per day)
  • Drink a minimum of two liters of water per day
  • A high fibre diet with low glycemic index foods such as whole wheat bread, pasta, and brown rice

What Are The Worst Foods For Gallstone?

  • High-fat foods need to be avoided.
  • These include fried foods, high-fat dairy products, meats high in fat, especially red meat.    

What Are The Medicines For Gallstone?

  • Asymptomatic gallstones do not need treatment. Elective cholecystectomy (gallbladder removal) may be considered if you doctor thinks that you can later develop complications, or if you have other associated risk factors.
  • Patients with symptomatic gallstones are usually hospitalised, especially if there are complications. Admissions are treated with intravenous antibiotics and analgesia.
  • Surgical procedures done include       
  1. Extracorporeal shockwave lithotripsy. This is a non-invasive procedure where stones are broken down by applying a very specifically directed frequency to the stones.
  2. Laparoscopic cholecystectomy (removal of gallstone via a camera tube through the skin)
  3. Open cholecystectomy- if laparoscopic surgery cannot be performed.    

What Are The Tips To Manage Gallstone?

  • If you have a history of gallstones and still have your gallbladder, you may have an increased risk of developing gallbladder cancer, especially if you had previous episodes of gallbladder infection. Consider discussing elective gallbladder removal with your surgeon.    

What Are The Symptoms Of Gallstone?

  • Gallstones may be symptomatic or asymptomatic.
  • Symptomatic gallstones may be complicated or uncomplicated.
  • Some patients may experience persistent dull upper abdominal pain or discomfort. Other symptoms such as indigestion, biliary colic, bloating and flatulence may be present.
  • Biliary colic is usually dull, nonspecific pain localised to the upper abdomen, that may move to the back. The pain may follow 10-30minutes after ingestion of a fatty meal and can come and go in intensity.
  • Complicated symptomatic gallstones may present as cholecystitis (infection of the gallbladder), colic (pain due to movement of stone though bile ducts), jaundice or pancreatitis.
  • Patients with cholecystitis usually present with severe, localised pain in the upper right are of the abdomen. They may be acutely ill with fever. Clinical examination will show signs of localised peritonitis (inflammation of the abdominal cavity's wall due to infection), with severe tenderness and guarding of abdominal muscles when palpating the gallbladder (known as a positive Murphy's sign).
  • Pancreatitis may present with similar symptoms as cholecystitis, and often special investigations need to be done to determine the cause of symptoms.
  • Special investigations most commonly performed are an abdominal ultrasound (first line investigation in uncomplicated cholelithiasis). A contrasted CT scan of the abdomen is usually performed if complications are suspected. If gallstones and infection of the bile ducts are suspect a special type of MRI (Magnetic Resonance Imaging) called a MRCP might be performed.
  • Blood tests carried out include infective markers, liver function tests, pancreatic enzymes, electrolytes and kidney function.    

What Are The Causes Of Gallstone?

  • Risk factors for gallstones are numerous:
  1. Diet plays an important role, especially a diet high in unsaturated fats
  2. Middle-aged men and women are more often affected.
  3. Females are affected more than males, and more often during their years of fertility. Pregnancy and oral contraceptives are known risk factors.
  4. Being overweight or obese is a predisposing factor
  5. Abnormal cholesterol and blood lipid profile
  6. Metabolic syndrome (a syndrome characterised by three factors present of either dyslipidemia, obesity, high blood pressure or diabetes)
  7. Gallstones are seen more commonly in patients with fair skin complexions. Caucasians and Asians are more at risk than people of African descent.
  8. Liver disease such as cirrhosis
  9. Genetics may increase your risk of gallstone formation up to five times compared to the standard population    

What Are The Things One Should Do To Manage Gallstone?

  • Follow the recommended diet for people with gallstones (see below)
  • Regular exercise has proven to be beneficial in preventing gallstones
  • If you are overweight, weight loss can help prevent gallstones, but it should be slow and controlled, as rapid weight loss has been noted as a risk factor to develop gallstones.
  • Have smaller meals more often, rather than consuming large amounts of food at a time    

What Are The Things One Should Avoid To Manage Gallstone?

  • Do not smoke. Smoking has not been linked to gallstones directly. However, it does increase the general underlying inflammation in the body, and affects your health overall.
  • Do not eat foods high in fat, as they may precipitate episodes of biliary colic.    

What Are The Best Foods For Gallstone?

  • A healthy balanced diet, with a particular focus on low-fat foods
  • Use healthy fat alternatives for cooking such as coconut oil or virgin olive oils
  • Use low-fat spreads, butter, cheese and yogurts
  • Plentiful intake of fresh fruits and vegetables (at least five portions per day)
  • Drink a minimum of two liters of water per day
  • A high fibre diet with low glycemic index foods such as whole wheat bread, pasta, and brown rice

What Are The Worst Foods For Gallstone?

  • High-fat foods need to be avoided.
  • These include fried foods, high-fat dairy products, meats high in fat, especially red meat.    

What Are The Medicines For Gallstone?

  • Asymptomatic gallstones do not need treatment. Elective cholecystectomy (gallbladder removal) may be considered if you doctor thinks that you can later develop complications, or if you have other associated risk factors.
  • Patients with symptomatic gallstones are usually hospitalised, especially if there are complications. Admissions are treated with intravenous antibiotics and analgesia.
  • Surgical procedures done include       
  1. Extracorporeal shockwave lithotripsy. This is a non-invasive procedure where stones are broken down by applying a very specifically directed frequency to the stones.
  2. Laparoscopic cholecystectomy (removal of gallstone via a camera tube through the skin)
  3. Open cholecystectomy- if laparoscopic surgery cannot be performed.    

What Are The Tips To Manage Gallstone?

  • If you have a history of gallstones and still have your gallbladder, you may have an increased risk of developing gallbladder cancer, especially if you had previous episodes of gallbladder infection. Consider discussing elective gallbladder removal with your surgeon.