Gallstone Disease
What is gallstone disease?
Gallstone disease is a condition whereby the bile in the gallbladder (which is normally in liquid form) becomes too concentrated and turns to stone. This condition affects roughly 10-20% of the general population and the majority of them do not have any symptoms. However, about 20% of them will develop some symptoms in their lifetime and between 1-4% of them have recurrent symptoms every year.
Can you share more about the different types of gallstones (cholesterol stones vs pigment stones)?
There are 2 types of gallstones which are cholesterol stones and pigment stones. Most gallstones that form are due to cholesterol stones while only about 20% of gallstones are pigment stones. The composition or content of the stones differs between the two and so are the causes of the stones. Cholesterol stones are yellow-green stones, that tend to occur in patients with high cholesterol in their bodies and are also related to age, gender, dietary intake and obesity. Pigment stones are black or brown in colour. They are more associated with biliary tract (the ducts connecting the liver to the small bowel) infections such as parasitic or bacterial infection or due to certain diseases such as haemolytic anaemia.
What causes gallstone disease?
Gallstone disease occurs due to several causes. Cholesterol stones are formed when there are imbalances in the components of bile which is mainly due to an increase in cholesterol levels. Pigment stones are formed mainly due to parasitic or bacterial infection, and certain diseases like haemolytic anaemia and can be also due to mechanical reasons such as lack of gallbladder contraction.
What are the signs/symptoms to watch out for?
There are several signs and symptoms that you need to watch out for. The first symptom is abdominal pain especially if the pain occurs on the right upper side of the abdomen. The pain is usually constant and is noticed with the intake of fatty or oily food.
An infection of the gallbladder can cause a patient to run a fever over and above the pain. Besides fever, the patient may feel lethargic with chills. Some may experience nausea and vomiting. If a patient has abdominal pain with a fever, it is advisable that he or she goes to see a doctor to seek treatment.
Another symptom that you need to watch out for is jaundice. Jaundice is a yellowish discoloration of the body, initially beginning with the eyes, but eventually spreading to the rest of the body. The patient may get itchiness of the skin due to jaundice. If jaundice occurs, it is a sign of obstruction of the biliary tract and it needs an urgent admission to the hospital for further treatment.
Who is at risk?
There are several groups of people who are at risk of developing gallstone disease. The first risk factor is hereditary (genetic). Certain people are more prone to gallstone disease if any of their close relatives have had the disease. Other risk factors are age and gender. The older we get, the higher the risk due to the higher amount of cholesterol that is circulating in our body. Women are also more prone to gallstones than men. This may be due to the effect of female hormones. Thus, oral contraceptive pills also is a risk factor. Obesity is also a risk factor. The more obese a person is, the more concentrated the bile and the higher risk of gallstones. People with diabetes mellitus are at risk due to changes in their cholesterol metabolism and gallbladder functions. Other risk factors include the presence of certain diseases like haemolytic anaemia or inflammatory bowel disease and patients on long-term intravenous nutrition.
Is it a serious condition? What are the complications?
Gallstones may cause serious or severe complications. The complications can be due to several reasons such as inflammation, infection, or obstruction of the biliary tract. One of the commonest complications is biliary colic which manifests in constant abdominal pain. Cholecystitis or an infection of the gallbladder can occur and if left untreated, can worsen to become a collection of pus in the gallbladder (empyema). This can lead to gallbladder perforation. If that occurs, the patient will be severely ill and needs urgent medical attention. Other serious complications are jaundice and inflammation of the surrounding organs like the pancreas.
How can we prevent gallstone disease?
You can prevent gallstones by modifying certain risk factors like obesity and cholesterol levels by maintaining a healthy lifestyle and diet. By doing so, you will also lower your risk of developing other contributing diseases such as diabetes mellitus.
How is it treated and managed?
When patients present with symptoms, this will lead to further investigations such as an ultrasound or a computed tomography (CT) scan of the abdomen. Once a patient is diagnosed, the treatment and management of gallstone disease depend on the severity and condition of the patient at that time. A patient who is stable and does not show signs of complications such as fever may be managed with analgesics and an elective appointment to remove the gallbladder. However, the presence of fever necessitates more aggressive management due to an underlying infection. The patient will need hospital admission for the commencement of intravenous antibiotics and an operation to remove the gallbladder once the fever and pain subside. The operation for gallbladder removal is mostly done now via the laparoscopic method with small incisions on the abdomen and insertion of laparoscopic equipment and camera. The wounds are small and the majority of patients recover within the same day or the day after. A small percentage of patients who are more ill will need further care in the hospital for the next few days until full recovery is achieved.
Question and answer with Dr. Ahmad Muhsin Mohammad Nor, Consultant General Surgeon.