Gall Stones

Gall bladder is a small organ under liver and connected to CBD via cystic duct. GB Stores bile during starvation and secrets bile into small intestine when food enters.Gall Stones are found into Gall bladder aggregation of cholesterol and bile pigment particals.

Gall Stone is more common in female (80 %) and most of stones are radioleucent (90%)

CAUSES

  1. Risk factor for cholesterol stones any condition which either increases cholesterol secretion in bile or reduces bile salt concentration causes cholesterol stone formation.

    Female(specially before menopause)

    Forty(people near for above 40 years)

    Fatty(obesity)

    Drugs(ocp,clotibrate,cholestyramne)

    Lack of melalinin

    Nutritional Factors-rapid weight loss,constipation,eating fewer meals per day long intake of nutrients folate magnesium calcium and vitamin c.

    Ileal disease,ileal resection,altered entrohepatic circulation.

  2. Risk factors for pigments stone

    Hemolytic anemiss (sickle cell disease heridetery spherocystosis)

    Cirrhosis

    Billiary tract infection

    Erythropoietic protoporphyris

TYPES OF GALL STONES

Gall Stones can vary in shape from as a grain of sand to as large as a golf ball.

The Gall bladder may vary in size and number from single large stone or many smaller one.

  • Cholestrol stone 6% very from light yellow to dark green or brown or chalk white and    are oval, usually solitary between 2 to 3 cm long.
  • Black Pigment Stones;Small,multiple,  and black or greenish black.it is composed of bilirubine(insoluble bilirubine pigment polymer) and calcium salts(calcium phosphate)
  • Mixed stones (brown pigment stone)(90%) these stone are composed of cholesterol(20 to 80%) calcium carbonate,palmitata phosphate,bilirubine and other bile pigments.These stones are often radiologically visible.

SYMPTOMS

Gall Stone may be asymtomatec for many years which does not depends open size and number of stones.These stone may not require treatment but these silent stone may cause varies complication.

Billiary colic or gall stone attack is a characteristic symptoms of gall stone in which a person experience intence pain in right upper abdomen that steadily increases for 30 minites to several hours pain is often associated with nausea and vomiting.

COMPLIATIONS

  • Acute cholecystitis (inflametery condition gall bladder)
  • Chronic cholecystitis ,empyema gb,mucocele gall bladder, carcinoma gall bladder choledocholithiasis or commen bile duct stones
  • Cholangitis
  • Acute pencreatitis ( gall stone passes distally to pancreatic duct )
  • Peritonitis
  • Gall stone ileus
  • Cholecystoduodenal fisula

DIAGNOSIS

Gall stone can be diagnosed using USG

TREATMENT

Medical – oral ursodeoxycholic acid : patients have to take this medicine for upto 2 years and gall stone may recur once drug stopped

Surgical : Cholecystectomy this is technique to remove gall bladder. It has 99 % chance of eliminating the recurrenc of gall bladder stone. There are two surgical options for cholecystectomy

  • open cholecystectomy: This is done via an abdominal incision below lower right ribs. Recovery requires 3-5 days of hospitalization with return to normal diet a week after discharge & to normal activities several weeks after discharge.
  • Laproscopic cholecystectomy : This is done via 3-4 small puncture holes for a laproscope & instruments. Gall-bladder is seen on T.V. by laproscope & gall-bladder is caught , cystic duct is cut after ligating & gall-bladder is separated from liver bed with help of instruments & then gall-bladder is removed from abdominal cavity via one of its key-hole. Post operative recovery is fast & patient is discharged on same day or after a one night hospital stay. In general patient can resume normal diet & light activity after a week of discharge. Patient experience lesser pain & require lesser amount of analgesics as compared to open surgery.

Laproscopic cholecystectomy is latest & best treatment for gall stone disease & facility of this technique is available at Devasya Superspeciality Kidney & Multispeciality Hospital.