A Simple Guide to Gallstones

A Simple Guide to Gallstones
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What are gallstones?
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Gallstones are stones which are found in the gallbladder which is a sac storing bile from the liver.
They are made from cholesterol and other substances in the bile.


What causes gallstones?
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Gallstones are formed when cholesterol and other substances like calcium found in bile combine to form stones.

They are more common in
1.overweight people

2.Females more than males

What are the symptoms?
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Most people with gallstones do not have symptoms.

Symptomsoccur when a gallstone causes blockage in the bile duct causing obstruction to flow of bile from the liver to the intestine.

The symptoms may be:

1.mild pain in the upper right part of the abdomen and also just below the sternum just like gastritis.

2.Pain in the right upper back or shoulder blade area.

3.Pain is worse when you eat.

4.fever and chills

5.Yellowness of the eyes or skin

6.Dark coloured urine

7.Chest pain occurs when the pain radiates to the chest

How are gallstones diagnosed?
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1.Pain in the right side of the abdomen

2. Murphy's sign positive.
A thumb pressing against the right of the epigastrium causes more pain when the patients breathes in deeply

3.An ultrasound of the right side of the abdomen is the best way to find gallstones.
Most gallstones can be detected from the ultrasound.

4.gallbladder scan. A dye is injected into a vein in your arm.
X-rays are taken as the dye moves through your liver, bile duct, gallbladder.

What are the complications of gallstones?
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A gallsone which is stuck in the bile duct(a tube which leads the bile from the liver to the gallbladder and small intestine) can give rise to:
1.Gallbladder inflmmation or infection(Cholecystitis)

2.Swelling and inflammation of the Pancreas(pancreatitis)

3.Hepatitis due to reflux of the bile back to the liver

4.Peritonitis(inflammation of the inner lining of the abdomen) if the bile duct or gallbladder perfoates or burst.
This is an emergency.

What is the treatment of gallstones?
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1.If there is no symptoms, treatment is not needed.

2.If there is mild pain, some pain and antispasmodic medicines are given.
Patient is kept for observation.
If the pain goes away, the gallsone may have become unstuck in the bile duct and pass out into the intestine.

3.If there is severe pain or recurrence of another attack of pain, it is advisable to have the gallbladder removed.

a.Normal surgery to remove the gallbladder and the gallstones involve 4 holes in the abdomen and the use of a laparoscopic to cut away the gallbladder followed by stitching.
The surgery is usually very safe and the patient may not need to be hospitalised.

b.In an emergency, such as perforated gallbladder, immediate surgery may be required to remove the gallbladder and cleared the inner abdomen of leaked bile.

What is the prognosis of gallstones?
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Most people with gallstones do not have symptoms.

Sometimes gallstones may be detected while having tests for other health problems.

Sometimes an ultrasound done on an woman during pregnancy may show gallstones.

The prognosis for patients after surgery is usually good.

The bile will go straight to the intestine from the liver.
Digestion of oily food may not as good as before and is usually not noticeable.

A Simple Guide to Cholecystitis

A Simple Guide to Cholecystitis
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What is Cholecystitis?
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Cholecystitis is an acute or chronic inflammation of the gallbldder.

What are the causes of Cholecystitis?
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Cholecystitis is usually caused by the following:

1. obstruction of the cystic duct by a gallstone -most common cause 80-90% of cases

2. bacterial infection following obstruction in 50% of cases

3. bacterial or viral infection following gastroenteritis-
germs from gut going up the cystic duct into gallbladder.

4. chronic disease follows attacks of acute infection.

Cholecystitis is more common in
the female,
>forty years of age,
fat,
flatulent person.

What are the symptoms and signs of Cholecystitis?
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Persons who has Acute Cholecystitis has the following symptoms:

1.gradual onset of abdominal pain starting from the epigastrium,
moving to the right subcostal area,
may be felt in the back at the subscapular region.

2.nausea and vomiting

3.loss of appetite

4.mild fever and bodyaches

5.slight jaundice

Signs:

1.Tenderness at the right subcostal area with involuntary muscle spasm

2.Murphy Sign positive: sharp increase of tenderness at the subcostal area on palpation with thumbs pressed inwards below the ribs when the patient is asked to breathe deeply

3.Gallbladder may sometimes be felt(palpable)

In chronic Cholecystitis, there may recurrent biliary colic which may be mistaken for signs of gastritis.

How do you diagnose Cholecystitis?
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Diagnosis can usually be made by :
1.Physical examination -a positive Murphy's sign suggest Cholecystitis.

2.Plain X-rays can show the presence of gallstones in 10-15%

3.Oral cholecystogram is 95% accurate if the liver and intestinal functions are normal but may unreliable during the acute attack.

4.Ultrasound is highly reliable in showing up the presence of gallstones

5.Intravenous,transhepatic and endoscopic retrograde cholangiography may be more accurate in diagnosing the gallbladder function and stones

What is the complications of Cholecystitis?
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1.gangrene of the gallbladder due to obstruction of blood supply

2.perforation of the gallbladder due to obstruction of the cystic duct

3.cholangitis - infection of the bile duct which can lead to hepatitis and intestinal infection

What is the treatment of Cholecystitis?
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Acute Cholecystitis:
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Admission to hospital

Gastric suction and fluid replacement

Analgesic or antispasmodic medicine usually by injection

Antibiotics for infections

Cholecystectomy -surgical removal of the gallbladder and stones now usually done through 4 holes in the abdomen.

Chronic Cholecystitis:
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Cholecystectomy

What is the prognosis of Cholecystitis?
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Prognosis is usually good after surgery.

However some pain may persists after surgery due to scar tissue.