Gallstones - Symptoms and Surgery

The gallbladder is a small pear-shaped pouch located in the upper right quadrant of the abdomen, just below the liver. Cholelithiasis is the name we give to the presence of stones in the gallbladder, a condition that may be asymptomatic in some cases, but can also cause abdominal pain if there is inflammation of the gallbladder.

Gallstones
Gallstones
 


What is the gallbladder?

The gallbladder is a small pouch located below the liver, whose main function is to store bile, a yellow-green, rich in cholesterol, bicarbonate and liquid pigments, produced by the liver itself. Bile is a substance that aids in the digestion of fats from food.

Acts as bile?

The bile after its production by the liver cells, the liver is drained to the biliary duct, joining the substances produced by the pancreas, thereby forming a juice of essential enzymes for the digestion of food. This mixture is cast into the duodenum, where you will find with food fresh from the stomach. As bile is a substance used in digestion, there is no need to release it into the duodenum when there is no food leaving the stomach. So while we are on an empty stomach, the output of the biliary tract is closed and all the bile produced is stored in the gallbladder.

Therefore, when we are fasting, bile produced by the liver and is stored in the gallbladder. When we eat, the gallbladder contracts and expels bile toward the biliary tract, so that they can reach the duodenum.

The storage capacity of the bladder is of about 50 ml, which is not much. The solution found by the agency to meet this little storage capacity was the most concentrated bile into it, to dissolve in pancreatic juice and food, has a very powerful action. Concentrating bile, the gallbladder begins to lose water, making it increasingly thicker and much stronger than originally bile produced by the liver.

How come the gallstones (cholelithiasis)?

The process of concentration of bile in the gallbladder is done so as to make it thicker, but without it solidify. The gall stones, called gallstones or gallstone, arise when an imbalance between the amount of water and the substances in the bile occurs. The stone may arise when the amount of water removed from the gallbladder is excessive or when the amount of bile substances such as cholesterol and pigment are in exaggerated quantities, making it saturated.

Biliary sludge

Biliary sludge is a stage just before the solidification of bile. It is a very thick gelatinous bile. In most cases, biliary sludge causes no symptoms and usually ends up being deleted by the bladder. Biliary sludge is a common finding in the gallbladder of pregnant women. The problem is that it mud is a major risk factor for the formation of gallstones, especially those formed by cholesterol. The patient who has mud is a step of forming stones.

Risk factors for cholelithiasis

  • Age: uncommon in young people, the risk of developing cholelithiasis (gall calculation) is 4x greater after 40 years of age.
  • Sex: a gall stone is 3x more common in women, probably as a result of the action of estrogen on bile. After menopause, the risk of stones drops significantly, becoming similar to that of men.
  • Pregnancy: excess estrogen during pregnancy increases the saturation of bile.
  • HRT: another mechanism in which estrogen is involved.
  • Obesity: is the main risk factor in young, mainly female.
  • Family history: having 1st degree relatives with a history of gallstones increases at 2x the risk.
  • Rapid weight loss: large weight losses in a short time or with very low calorie diets are also risk factors and are associated with the development of biliary sludge.
  • Diabetes.
  • Cirrhosis.
  • Prolonged fasting: the longer the duration of bile in the gallbladder, it becomes more dehydrated and the greater the risk of stone formation. Prolonged fasting can also cause biliary sludge.
  • Medicines: Ceftriaxone, contraceptives and fibrates are drugs that increase the risk of forming gallstones.
  • Sedentary lifestyle.
  • Crohn's disease.
  • Sickle cell anemia.

Symptoms of gallstones

Most people with gallstones have no symptoms. The pebbles are inside the vesicle, quiet ones, without causing any problem. Sometimes they are so small that they leave bile together and end up being eliminated in the stool, without the patient becomes aware of the fact.

Symptoms begin to arise when the rock becomes greater than the outlet orifice of the bladder. A large stone may become impacted in the output of the gallbladder, blocking the drainage of bile from the rest. When the patient eats, the stomach and duodenum send signals to the bladder warning that food is coming, causing it to contract. The problem is that the output is blocked and the contraction ends up generating a lot of pressure inside the bladder, leading to the typical pain of biliary colic.

Biliary Colic is a sharp pain on the right side of the abdomen, below the ribs, which usually occurs after a meal. The more fat is the power, the greater is the stimulus for contraction of the gallbladder and hence more intense the biliary colic. The pain usually occurs 1 hour after the meal, when the food starts coming to the duodenum. After all the food passes through the duodenum, the gallbladder relaxes, the pressure within it decreases the pain disappears. The biliary colic is thus typically associated with a pain supply.

In some cases the patient has multiple calculations within its bladder. The greater the number of stones, the greater the chance of blockages and symptoms occur.

Possible complications of gallstone


Cholecystitis


The cholecystitis is inflammation of the gallbladder which normally occurs after frequent clogging of the same by a stone. The bladder is obstructed more susceptible to infections and inflammations. Natural bacteria in the intestines, such as E. coli, Enterococcus, Klebsiella and Enterobacter, which usually infect the bile stagnates in the obstructed bladder, leading to the picture of infectious cholecystitis. Cholecystitis (inflammation of the bladder) is therefore a complication of cholelithiasis (gallstones).

Unlike biliary colic where the pain is limited and disappears after relaxation of the vesicle outside periods of feeding, cholecystitis the gallbladder becomes inflamed and permanently pain is constant, and usually associated with vomiting and fever. In cholecystitis pain can also worsen with power, but does not disappear completely with fasting.

Interestingly, about 10 % of patients with no evidence of cholecystitis gall stones, with no apparent cause for the onset of inflammation.

And when the stone gets stuck in the bile ducts?


Apart from biliary colic and cholecystitis, the gall stone can still cause another problem. Some calculations are small enough to exit the bladder, but are larger than the diameter of the bile ducts, getting impacted in the same, without reaching the duodenum. The impaction of a stone in the bile ducts also cause obstruction to the flow of bile. This picture is called choledocholithiasis.

Only when there is obstruction of the gallbladder, bile is stored stagnant, but the bile that continues to be produced in the liver can usually be disposed of through the biliary tract. On the other hand, when the stone impacts the bile or bile from the liver or gallbladder bile can overcome the barrier. This bile dammed back to the liver and begins to be absorbed into the blood, leading to a framework called jaundice, which is yellowing of the skin and eyes due to accumulation of bilirubin (bile) in the blood and skin. Jaundice also occurs in other liver diseases such as hepatitis and cirrhosis.

An even more serious situation arises when the obstructed bile is contaminated with some bacteria coming from the intestines. As the stagnant bile in the gallbladder can become infected causing cholecystitis, the stagnant bile in the biliary tract when contaminated causes a frame called cholangitis. The cholangitis is a serious infection of the biliary tract, a situation that often leads to sepsis and has a high mortality rate.

Gallstone pancreatitis


A third mode of obstruction caused by a gallstone is the impaction of the stone at the exit of the duct of the pancreas. In this case, the stone prevents the secretion of pancreatic enzymes, leading to acute pancreatitis.

Diagnosis of gallstones

The initial examination for the diagnosis of diseases of the gallbladder and biliary tract ultrasonography is. In the patient with abdominal pain diagnosis is made in two parts, first identified the presence of rock(s) and then try to find out if these are the cause of the symptoms. Gall stones are very common and not all abdominal pain can be attributed to the same. Often the patient has gastritis, but ends up blaming a stone asymptomatic for your pain. Both biliary colic as cholecystitis have characteristic clinical picture. Do not just find a gall stone to find that a diagnosis of any abdominal pain will be.

Examinations such as scintigraphy, MRI or CT scan may be useful when there is doubt whether or not there is inflammation gallbladder.

Treatment of gallstones

In asymptomatic patients, who find a stone accidentally during routine examinations in general, the management is expectant. Studies show that less than 15 % of people with stones develop symptoms within a period of 10 years. Furthermore, most of the patients symptoms such as gallstones do biliary colic, not cholecystitis, cholangitis or pancreatitis. Therefore, unless there is other data on clinical history usually does not take surgery patients with asymptomatic cholelithiasis.

Gallbladder surgery


If the patient presents with symptoms of stone, even if only biliary colic, surgery is indicated. The most common treatment in these cases is cholecystectomy, surgical removal of the gallbladder. The cholecystectomy may be made by traditional surgery or laparoscopy. Laparoscopic surgery is currently the most used.

In cases of cholangitis, stones in the biliary tract or pancreatitis, the procedure is surgical and is aimed at unblocking the bile ducts. After clearance, also withdraws the vesicle in the same surgery to prevent recurrences.

The gallbladder is an important organ, but it is not vital. Most patients without gallbladder lives without major problems. The main symptoms that arise after removal of the gallbladder are rising gases and more loose stools, especially after eating fatty foods.

Nonsurgical treatment of gallstone


In patients with predominantly cholesterol stones and no evidence of complications, there is the option for treatment with medicines. There is a substance called ursodeoxycholic acid or ursodiol, which dissolves this type of calculation. Computed tomography is often possible to assess the composition of rocks and indicate drug treatment. Treatment with this drug is very slow and may take years to fully dissolve the stone. If the patient is having biliary colic, this type of treatment is not indicated, since no one will keep the patient in pain for so long.

There is also the option for treatment with shock waves (lithotripsy), similar to that done with the kidney stones.

The major problem of non-surgical treatment is the high rate of recurrence of stones. Over 50 % of patients still present stones at an interval of 5 years.

Calculations formed by use of the antibiotic ceftriaxone usually spontaneously disappear a few weeks after discontinuation of medication.
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