Welcome to everyone reading this blog. Hope you all are doing well. As promised we are going to talk about another very common condition. This time it’s cholelithiasis ( stones in your gall bladder)
Let’s get started
To start with make one thing very clear that stones in gall bladder ( cholelithiasis) have nothing to do with stones in kidney or renal system and both are separate entities
Gall bladder lies on the under surface of the liver and stores bile, bile emulsifies fat and helps in fat digestion
Know one thing about gallstones, they are mostly asymptomatic. This means that you might have them and yet never know about them. Many a times gallstones are a incidental finding on a abdominal ultrasound meaning a scan was done for some other problem and incidentally gallstones were seen on the scan. For such asymptomatic stones no treatment is required. We will discuss later when does asymptomatic gallstone requires surgery

Cholelithiasis: Sign and symptoms. HOW DOES SYMPTOMATIC GALL STONE PRESENT

The most common presenting complaint is pain in the right upper quadrant of the abdomen or can also be in the epigastrium. The location is specific and pain is actually steady rather than typical colicky pain. It can radiate to right shoulder or between your scapula but radiation is not very common. Pain is commonly associated with nausea, vomiting and some people also experience bloating, dyspepsia or early satiety. Pain usually starts or gets worse with eating ( especially fatty food) but has no specific timing. You might be thinking what area on your abdomen is right upper quadrant and epigastrium. We are attaching a picture to tell you that. Roughly it is the right side of upper one third of your abdomen just below where your right side rib cage ends. But make it clear that it is not a pain in ribs or muscles, it is a pain your abdomen.
Investigation of choice

Cholelithiasis: investigations, blood test and scans required

Now once your doctor is suspecting a stone in your gall bladder they will order an USG abdomen, which is all that is needed for a gall stone ( strictly speaking for a gallstone because if the stone has slipped into some other duct, other investigations might be required)
In blood test detailed LFT ( liver function test), CBC (complete blood count) , viral markers ( Hepatitis B and C), RFT ( renal function test) . RFT and VMs are required when you are undergoing surgery and LFT tells about the function of your liver, and CBC tells about your hemoglobin level or any active infection
Now let’s come to the real question why do need to get a surgery for gall stone or when do you need to get a surgery for gall stone. As said earlier gall stones are mostly asymptomatic. Symptomatic gall stone is the single most common indication for surgery. If a gall stone is symptomatic ( symptoms are described earlier) you need a surgery. Reason is once symptomatic there is almost no chance that the condition will resolve on its own and every now and then you will be experiencing the symptoms ( frequency and severity may vary). The second reason is, once symptomatic there is a good chance that the gallstone will develop complication. Another question you might ask is why can’t we just remove the stone. Well gall bladder is the reservoir of bile and once removed the stones will form again and the only option is removing the gallbladder

Cholelithiasis: Complications

•Acute cholecystitis characterized by severe right hypochondrium pain, nausea, vomiting, intolerance to food, positive Murphy’s sign ( press right hypochondrium with your fingers and it will be tender) raised TLC on CBC ( blood test) and USG shows signs of cholecystitis.
•Choledocholithiasis ( stone in CBD that is common bile duct). Stone slips from the gall bladder into the CBD which can lead to more extensive illness longer hospital stay and more extensive surgery or ERCP ( stone is remove be endoscope) followed by Cholecystectomy.
•Acute or chronic pancreatitis: gall stone can lead to inflammation of Pancras and the patient will once again need hospital admission
•Acute cholangitis ( CBD stone with infection)
•empyema of gall bladder ( pus in gall bladder)
Other uncommon complications include
Gangrenous gall bladder
Perforation of gall bladder
Gall stone ileus
Mirizzi syndrome
Here take a short note that if the stone slips into the CBD ( choledocholithiasis) then you will need an MRCP ( a type of MRI), can develop jaundice and severe symptoms, more extensive blood tests, either ERCP ( endoscopic removal of stone from CBD if stone is small) or laparoscopic/open CBD exploration if stone is large in size followed by cholecystectomy

Cholelithiasis: treatment options

Now that we have answered many questions like what are the sign and symptoms of cholelithiasis, do you need a surgery for cholelithiasis, when and why you should go for surgery, what can happen if you don’t go for surgery, what are the investigations required now the final question is what is the treatment and the answer is relatively simple
Laparoscopic Cholecystectomy, rarely open Cholecystectomy would be required. For symptomatic gall stones without complications this is no emergency and elective procedure can be planned but remember delaying the procedure for very long period of time can increase the rate of complication. Mild attacks of pain can be treated with analgesics, PPI, avoiding fatty food until surgery is planned ( only take medicine when you experience symptoms and don’t take it regularly), an episode of acute cholecystitis would require an antibiotic as well and surgery either within 72 hours of episode or at least 2 weeks later ( interval Cholecystectomy)
Some with gall stones should avoid fatty food like fried food, red meat, and spices. Do not eat too much at once and take small frequent meals
Now the only question that comes to my mind is what happens to fat digestion if gall bladder is removed and the answer is ” actually not much”. At maximum you need to be cautious for first six weeks after surgery. Do not take very large amount of fatty food or eat small frequent meals. Actually even this is not required and life goes on as normal because gall bladder is just a reservoir and bile is still being produced
Let me conclude this blog by telling you that we discuss the common aspects of a disease or condition and avoid things that are rare or uncommon. We definitely can’t cover minor details in a blog. We try to keep it relevant and simple so that you can benefit from our blogs and help yourself and your loved ones live a healthy life.
Stay blessed
Goodbye