Gallstones (Cholelithiasis) Treatment in Delhi, India

There are two main types of gallbladder stones:

• Cholesterol Stones: These stones are usually yellow-green in colour and account for approximately 80% of gallstones. Despite the name, cholesterol stones are not directly related to cholesterol levels in the blood. They are formed when there is an imbalance in the components of bile, including cholesterol, bile pigments, and calcium salts.

• Pigment Stones: These are smaller and darker in colour and are composed primarily of bilirubin. They form when there is an excess of bilirubin in the bile, often due to conditions such as the destruction of red blood cells (Haemolysis) or liver disease.

The symptoms of gallbladder stones can vary, and some people may remain apparently asymptomatic. However, if symptomatic, the following symptoms can occur:

• Sharp and sudden or dull pain in the upper right abdomen or upper back

• Nausea or vomiting: These symptoms may occur along with abdominal pain.

• Indigestion or bloating: Gallbladder stones can cause indigestion or bloating after eating.

• Fatigue: People with gallbladder stones may feel tired or weak due to pain and discomfort.

• Jaundice: In some cases, gallbladder stones can blockage in the bile duct, causing yellowing of the skin and eyes.

• Clay-coloured stools: Complicated Gallbladder stones can cause the stools to turn pale or clay-coloured.

• Fever or chills: Inflammation of the gallbladder or infection of bile can lead to fever or chills.

• Loss of appetite: People with gallbladder stones may experience a decreased appetite due to pain and discomfort.

• Sweating: Some individuals may experience sweating along with abdominal pain.

• Rapid heartbeat: The pain and discomfort caused by gallbladder stones can also lead to a rapid heartbeat.

Common causes are-

• Obesity and rapid weight loss: Being overweight or rapid weight loss may prove to be a risk factor for developing gallstones.

• Genetics: A family history of gallstones can increase an individual's susceptibility to developing them.

• High levels of bilirubin in the blood: Conditions that cause an excess of bilirubin, such as hemolysis, can increase the risk of pigment stone formation.

• Hormonal imbalances: Hormonal changes occur during pregnancy or with the use of certain medications like birth control pills or estrogen replacement therapy, and it can increase the risk of gallstones.

• Inflammatory bowel disease: Conditions like Crohn's disease and ulcerative colitis can increase the risk of gallstone formation.

• Metabolic disorders: Metabolic conditions like diabetes can contribute to the development of gallbladder stones.

• Prolonged fasting or a diet high in fat and cholesterol: Certain dietary factors can increase the risk of gallstone formation.

Diagnosing gallbladder stones typically involves a combination of imaging tests and physical examination. Common diagnostic methods include:

• Ultrasound: This is the most common imaging test, which uses high-frequency sound waves to create detailed images of the gallbladder and diagnose gallstones.

• CT scan: A CT scan uses X-rays and can detect radio-opaque small stones or stones located in difficult-to-see areas.

• MRI: Although not typically the primary diagnostic tool, an MRI can create detailed images of the gallbladder and the bile ducts and surrounding organs using a magnetic field.

• HIDA scan: This test involves using a small amount of radioactive material and a special camera to create images. It can detect blockages or other issues with the gallbladder.

• Blood test: It can be used to check for signs of infection, inflammation, or other issues with the gallbladder. These may include tests for bilirubin, alkaline phosphatase, and amylase.

• Physical examination: Doctor may check for signs of inflammation in the upper right side of the abdomen, which can indicate complicated gallbladder stones.

Treatment options for gallbladder stones depend on factors such as the size and location of the stones and the individual's overall health. Treatment options include:

• Medications: Medications may be prescribed to prevent stones from forming in high-risk individuals. Ursodeoxycholic acid and chenodiol are commonly used for this purpose.

• Surgery: It is the only curative procedure for gallstones, especially if they are causing severe pain or blockages. The most common surgery for gallbladder stones is cholecystectomy, which involves removing the gallbladder. It can be performed laparoscopically or using advanced robotic systems.

• Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure uses an endoscope with a camera on the end to locate and remove the stones from the bile duct.

Complications of gallbladder stones can include:

• Acute cholecystitis: Inflammation of the gallbladder caused by a blockage in the bile ducts, leading to severe abdominal pain, nausea, vomiting, and fever.

• Pancreatitis: Inflammation of the pancreas, which can occur if a gallstone obstructs the bile duct and blocks the flow of enzymes from the pancreas, causing severe abdominal pain, nausea, vomiting, and fever.

• Intestinal obstruction: A gallstone can become lodged in the small intestine, causing blockage and difficulty passing stool.

• Jaundice: If a gallstone blocks the common bile duct, it can cause jaundice, characterised by yellowing of the eyes and skin.

• Septicemia: A serious complication that can occur if a gallstone becomes infected and spreads bacteria to the bloodstream, causing symptoms like fever, chills, and a rapid heartbeat.

• Bile duct injury: Surgical removal of gallstones carries a risk of injury to the bile ducts, leading to complications such as bile leakage or infection.

• Recurrent gallstones: After gallbladder removal, individuals may develop gallstones again in the bile ducts.

• Chronic gallbladder disease: Long-term inflammation of the gallbladder can cause chronic discomfort, as well as an increased risk of gallbladder cancer.

There is no definitive preventive strategy for gallstones, though adopting a healthy lifestyle may delay its progression:

• Maintain a healthy diet

• Maintain a healthy weight

• Avoid crash dieting

• Limit processed foods

• Get regular exercise

• Limit alcohol consumption

• Take vitamin C supplements

• Consult a doctor if there is a family history of gallstones

• Get enough sleep

• Consider taking ursodeoxycholic acid (UDCA) supplements

It is recommended to consume certain foods in moderation:

• High-fat foods: Foods such as cheese, red meat, and fried foods should be consumed within limits.

• Processed foods: Packaged snacks and frozen meals often contain high levels of added sugars and unhealthy fats, which can increase the risk of gallstone formation.

• Dairy products: Consuming too much dairy, like whole milk and cheese, can contribute to the formation of gallstones.

• Refined carbohydrates: Foods like white bread, pasta and sugary drinks can increase blood sugar levels rapidly, which can worsen gallstone disease.

Reviewed by Dr. Pradeep Chowbey, Chairman - Max Institute of Laparoscopic, Endoscopic, Bariatric Surgery & Allied Surgical Specialities, Laparoscopic / Minimal Access Surgery, Bariatric Surgery / Metabolic, Institute of Laparoscopic, Endoscopic & Bariatric Surgery, Robotic Surgery on 08-Aug-2023.

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