GALL BLADDER CALCULI – SURGERY
GALL BLADDER CALCULI – SURGERY
Gall bladder calculi are one of the common problems encountered in the general population in the gastroenterology departments. Nowadays the advent of USG scans and awareness for a screening of gastro health in the people have resulted in early pick up of Gall bladder problems. This section aims to inform and educate people regarding the Gall bladder calculi and some common misconceptions encountered in daily practice.
The gall bladder is a pear-shaped organ present beneath the liver in the upper abdomen. Gall bladder functions to store bile juice secreted by the liver as a reservoir function and releases the bile into the small intestine after intake of every meal.
The gallbladder, the bile ducts, act together to store and regulate the flow of bile. The main function of the gallbladder is to concentrate and store hepatic bile and to deliver bile into the duodenum in response to a meal. In the fasting state, approximately 80% of the bile secreted by the liver is stored in the gallbladder.
Digestive juices secreted in the GIT begins from the gastric acid secretion. followed in the small intestine by the bile secreted by the liver and released by the gall bladder and the pancreatic juice.
Bile is most important for
– breakdown and elimination of cholesterol consumed in the diet,
-transport and absorption of fat-soluble vitamins
– anti-bacterial and breakdown of toxins properties
The bile secreted by the liver is stored in the gall bladder and released into the small intestine after food intake along with pancreatic juices. The bile duct joins the pancreatic duct and is called a Common bile duct (CBD)
An imbalance in the components of bile- cholesterol, bile salts, and bilirubin leads to- formation of gall stones
How are they diagnosed:
Gall bladder stones mostly present without any symptoms. They are diagnosed when a patient presents with abdomen pain and undergoes evaluation in a gastro department. Ultrasound (USG )Abdomen scan is the simplest of tests which can pick up stones. CT scan of the abdomen is done if the patient presents with other conditions or complications where they are seen clearly and gives the details of whether they are single or multiple stones
Who are all at risk of developing gall bladder calculi:
Mostly they occur in middle-aged people and do not have any specific cause.
Certain conditions predispose to the development of gallstones. Obesity, pregnancy, dietary factors, Crohn’s disease, gastric surgery, hereditary spherocytosis, sickle cell disease, and thalassemia are all associated with an increased risk of developing gallstones. Women are three times more likely to develop gallstones than men
Symptoms and risks:
Mostly they are present silently and get diagnosed when USG scan is taken for pain abdomen.
The symptoms occurring usually is a pain in the upper abdomen, vomiting, and nausea.
- The gall bladder may get infected leading to severe pain abdomen and fever and necessitates emergency surgery
- The stones may sometimes get impacted in neck of gall bladder leading to severe distension and pain.
- The stones may sometimes slip into the bile duct and cause obstruction to flow of bile leading to pain, jaundice
- The infection may be severe and repeated infection may lead to perforation of the gall bladder and peritonitis infection
Other causes mimicking Upper abdomen pain-
-most commonly gastritis/acidity related pain occurs similarly but gets cured
After taking antacids and proper healthy diet
- Gastric ulcer
Evaluation is done using Ultrasound Abdomen scan to look for the position of stone and if the gall bladder is normal or infected ( shown by the accumulation of fluid, thickening of the gall bladder wall). Infected Gall bladder requires emergency surgery to prevent further complications
Laparoscopic Cholecystectomy( Gall bladder removal):
Daycare surgery concept is followed at ELCE Hospital here. The patient can undergo surgery and get discharged the next day. This is the advantage of laparoscopic surgery.
Through small keyhole size incisions, the abdomen is entered and the gall bladder is visualized. gall bladder is separated from liver bed and clips used to ligate the cystic duct (duct joining gall bladder to CBD). The gall bladder along with all the stones are removed. There are no large sutures involved like in open surgery. Hence patient can start taking normal diet from next day and can go back to routine activities in 5 days.
The patient can take a regular diet after gall bladder removal and does not need any special precautions