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GALL BLADDER STONE

Overview

The gallbladder is a small bag, generally the shape and size of a pear that sits underneath the liver, on the right side of the stomach area. Its main purpose is to store and concentrate bile produced by the liver. Bile is released from the gallbladder after eating, aiding digestion. Bile travels through common bile ducts (CBD) into the small intestine. Gallbladder stones are pieces of solid material that form in the gallbladder. These gallbladder stones develop because cholesterol and pigments in bile sometimes form hard particles. 

What are gallbladder stones?

Gall bladder stones or gallstones are crystalline masses shaped usually in the gall bladder or bile ducts from bile pigments, cholesterol, and calcium salts. gall bladder stones can cause severe pain and blockage of the bile duct. At the point when the wall of the gall bladder is diseased then it produces the gall bladder stone and polyps and so forth.

What is cholecystitis?

Cholecystitis is characterized by irritation of the gallbladder. Most usually this happens when the flow of bile is halted or hindered because of gallbladder stone (90%) or if the infection of biliary tract happens.

The casual symptoms of cholecystitis are:

  • Serious stomach pain
  • Fever
  • Disquietude
  • Queasiness
  • Retching
  • The attack may take place after a large fatty meal.
  • Pigment stones: These stones are smaller and darker and are comprised of bilirubin.

Symptoms of gallstones

Side effects of gallbladder stones are extreme stomach torment frequently called as gallbladder stones 'attack' (colic) since they happen all of a sudden. gallbladder stones attacks often take place after fatty meals, and they may happen amid the night. Despite the fact that numerous patients with gallbladder stones have no manifestations and they are to be asymptomatic and the stones are called 'Silent stones'. However, a typical attack can cause the following:

  • Severe pain in the right upper abdomen that increases rapidly and lasts from few minutes to a few hours
  • Pain in the back of the shoulder blades
  • Pain in the right shoulder
  • Nausea or vomiting

Other insignificant symptoms of gallbladder stones include:

  • Stomach swelling (gas formation)
  • Recurring intolerance to fatty foods
  • Burping
  • Acid reflux

Who is at risk for gallstones?

  • Women are more prone than men
  • People in their 30's and 40's
  • Overweight men and women
  • People with rapid/ sudden weight loss
  • Pregnant women, women on hormone therapy and those who use birth control pills for a prolonged period

Complications caused by stones

  • Repetitive extreme stomach pain or vomiting.
  • Jaundice because of blockage of the normal bile duct because of gallbladder stones.
  • Intense pancreatitis (swelling of the pancreas) which can have a catastrophic sequel of multi-organ failure and different serious complications. It might be deadly if serious.
  • Pus formation in the gallbladder (Empyema)
  • Gangrene and perforation of the gallbladder.
  • Cholangitis (a life-threatening infection of biliary system).
  • Related to Cancer of the gallbladder in a long time.

Diagnosis for gall stones

• Blood tests
• Complete blood count
• Liver function test
• Coagulation profile
• Abdominal ultrasound
• Cholescintigraphy (HIDA scan)
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Magnetic resonance cholangiopancreatography (MRCP)

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Treatment options for gallstones or cholecystitis

The ailing gall bladder ought to be evacuated by a surgical methodology called Laparoscopic Cholecystectomy. In this procedure, the gallbladder is removed using long narrow instruments through small incisions in the abdomen.

Gallbladder Surgery

Surgery to remove the gallbladder (cholecystectomy) is the only way to cure gallbladder stones. This should be possible by regular (open) technique or a settled endoscopic (laparoscopic) strategy which is currently the 'Gold Standard'. The surgery is called "Laparoscopic Cholecystectomy" (Lap. Chole). The surgeon makes few tiny punctures in the abdomen and inserts surgical instruments and a miniature telescope with an amounted video camera into the abdomen. The camera sends an amplified picture from inside the body to a video screen, giving the specialist a nearby perspective of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts and vessels. The gallbladder is then removed through one of the small incisions. Recovery usually occurs within few hours in most of the cases in the hospital, followed by few days of rest at home. As there is no damage to the muscle (muscles are not cut) during laparoscopic surgery, patients have less pain and negligible wound complications.

If the surgeon finds any difficulty in the laparoscopic procedure, the operating team may decide to switch over to open surgery. It is called open surgery in light of the fact that the specialist needs to influence a 5 to 8-to inch entry point in the stomach area to expel the gallbladder. Open surgery has blurred out of the spotlight with the laparoscopic method giving critical points of interest and ease to the patient.

Non-surgical treatment

Non-surgical approaches are used only in special situations such as when a patient's condition is not fit for anaesthesia and surgery. This does not cure the patients as it only provides symptomatic relief.

Advantages of laparoscopic cholecystectomy

  • Patients usually have minimal post-operative pain.

  • Patients experience faster recovery than patients undergoing open gallbladder surgery.

  • Excellent cosmetic outcomes

  • Minimal discomfort and early recovery

  • Early resumption of normal and routine activities

What are pre-surgery and post-surgery instructions?

 

Pre-surgery instructions

 

  • Some preoperative investigations like blood tests, X-ray or ECG and ultrasound of the gall bladder are required before surgery.
  • Follow your surgeon instructions for any prescribed medications.

Post surgery instructions

 

  • The patient is kept under observation for few hours and then shifted to the room.
  • The patient is allowed to drink oral liquids on the same day of gall bladder surgery.
  • The patient is allowed to move on its own as soon as possible after the gall bladder surgery.
  • Generally, the patient is discharged on the same or next day of the gall bladder surgery depending on the clinical condition.
  • Waterproof dressings are applied on the port sites and the patient may bathe when comfortable.
  • The patient is advised to visit again after 5 days when the dressings are removed. On discharge, a discharge summary with the advised medication is handed over to the patient along with the date of the first follow up an appointment.
  • Round the clock helpline is available for any query or any other emergency.

 

Diet after gall bladder surgery

  • The patient is generally allowed to sip water immediately after the operation and liquids on the day of operation. The liquids may include water/ clear soups/ tea/ coffee/ salted lassi as advised by the dieticians.
  • Next day onwards, a normal diet is given and there are no specific restrictions on diet

 

Exercise/ Movement

  • As soon as the patient is out of anaesthesia and is shifted to the room, the patient is can start moving on his/her own and attend to toilet needs. In fact, movements are encouraged in most patients because this causes a dramatic reduction in pain and increase the sense of wellbeing. The patient is allowed to walk as soon as he/she recovers from sleep. There is no restriction on climbing stairs, lifting the weight.
  • The patient can resume his/her daily routine/ activities as he/she feels comfortable as there are no specific restrictions.
  • Medication chart is provided to the patient to ensure proper compliance with prescribed medications. Ensure compliance with pain and other medications prescribed by your doctor.
  • Regular follow up is advised
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