Gall Bladder Stone

Courtesy -Dr.Kumar Parth (MBBS; MNAMS; FMAS; FAIS; FACRSI (Colo-Rectal Surgery) DNB; FSGE (Surgical Gastroenterology)

Consultant Surgical Gastroenterologist (Bangalore),,WWW.DRPARTHGASTRO.COM

  Definition :   Presence of stonesin the gallbladder is referred to as "cholelithiasis".                 

                       *Function of gallbladder is to concentrate the bile.

Predisposing Factors :

·      Genetics , Gender (more in women)

·      Body weight (Obesity) , or rapid loss in weight , Fasting

·      Decreased motility (movement) of the gallbladder

·      Diet

·      Drugs : Cholesterol / Lipid lowering drugs ,Estrogen

·      Diseases : Diabetes, blood disorder (Hemolyticanemia etc.)

Composition of Gall Bladder Stone:

CholesterolStone : Found in western world, causesaccounted to diet rich in cholesterol.

Pigmentedstone : generally found in diseasesrelated to blood disorder

Mixedstone : Contains Calcium, magnesium,sodium phosphate ( most common type found in Asian population (India).

Symptoms :

  • (70–85%)are asymptomatic or "Silent Gall Stone"
  • Pain inright upper and central part of abdomen(may radiate to interscapular region)mostly after half an hour of food (seen more symptomatic after a fatty diet.)
  • post mealfullness, belching, upper abdominal discomfort

·      Jaundice (yellowing of the skin or eyes)

·      Clay colored stools or dark urine

  • Imaging -Ultrasound Of abdomen and if required MRI(MRCP) abdomen.

  • Infection of gall bladder {Empyema(pus)/ Mucocele of Gall bladder}
  • Perforation of gall bladder
  • Stone slipped in Common Bile Ductresulting in obstruction in the passage of bile leading to Jaundice
  • Stone from gall bladder slippedto common bile duct and entering into pancreatic duct through common channel ofopening in Duodenum (small bowel) leading to Pancreatitis.

Indication forSurgery :

  • Symptomatic Gall stone with typical history of painas mentioned above and proven with Imaging (ultrasound)
  • Asymptomatic or Silent gall stone (FoundIncidentally during Ultrasound abdomen) - "DOES NOT REQUIRE SURGERY".
  • Asymptomatic orSilent gall stone requiring surgery in special circumstances are:
  • Pregnant lady diagnosed with gall stone duringfirst trimester (incidental finding)
  • Any blood disorder and patient is going for anyabdominal surgery for any reason.
  • Diabetes mellitus - as chances of infection arehigh on by ground of diabetes
  • gall bladder polyp (a soft tissue growth in lumenof gall bladder) size > 1 cm or single stone measuring > 3 cms , as riskof Gall Bladder cancer  increase by 10fold in these cases.

Treatment : Surgery - Laparoscopic Cholecystectomy (Key Hole Surgery) isGold standard worldwide.

  • Safe surgery, there are no side effects of removingof gall bladder as one has to weigh the complication arising from a"symptomatic" gall stone disease.
  • Can be done as a day care surgery
  • Post surgery patients are advised to refrain fromfatty meal for a week so as to acclimatize the body to a diluted bile. Normalactivity is allowed from day 1 of post surgery.