Gallstones

Have you ever heard of medical cases where people talked about having stones, or specifically gallstones, extracted from their bodies?


Gallbladder opened to show numerous gallstones.

In medicine, gallstones are crystalline bodies formed in the gallbladder and the common bile duct by aggregation of bile components. Bile is the greenish-brown fluid secreted by your liver and is stored in the gallbladder. It is needed for emulsion and digestion of fat.


The green organ indicates the gallbladder in this schematic.

There are 2 major types of gallstone: cholesterol and pigment stones.

Cholesterol stones:
They are usually greenish-yellowish in colour, large and often solitary. They are made primarily of cholesterol. They account for 80% of gallstone cases.


Cholesterol stones

Pigment stones:
They are small, dark stones, usually friable and irregular. They are made of bilirubin and bile salts that are found in bile. They account for 20% of gallstone cases.


Pigment stones

Unlike infectious diseases like tuberculosis, you do not get gallstone disease from another person. This disease is caused within the person himself due to factors like lifestyle and habits. If you get this disease, it your fault.

Aetiology:
Gallstones develop when bile contains imbalance amount of cholesterol and bile salts. Two other factors are important in causing gallstones. The first is how often and how poorly the gallbladder contracts to overconcentrate and contribute to gallstone formation. The second factor is the presence of proteins that either promote or inhibit cholesterol crystallization into gallstones.

Researchers believe that gallstones may be caused by inherited body chemistry, body weight, gallbladder motility (movement), and perhaps diet.

Risk factors:
Obesity, age, type IV hyperlipidaemia, cirrhosis, smoking, being female, and parity (having given birth).

Prevalence:
8% of those over the age of 40, where 90% of these people remain asymptomatic.

Gallstone disease cause cholecystitis by obstructing bile flow, leading to concentration and stasis of bile, and promoting infection from intestinal microorganisms.

It results in cholecystitis, that is the inflammation of the gallbladder.


Cholecystitis is a painful disease!

Cholecystitis manifests itself in the following ways:

Symptoms:
Severe and constant pain at the right upper quadrant (RUQ) of the abdomen, fever, vomitting, nausea and anorexia (loss of appetite); which may lead to jaundice and diarrhoea.


Pain at the right upper quadrant in cholecystitis.

What should you do?

Consult a physician immediately, unless you are fond of the severe and constant pain.


Always trust your doctors.

Your physician would then examine you physically. Special and specific signs are performed to confirm cholecystitis. Signs are diagnostic examinations founded by great physicians of the past and are named in their honour.

Murphy's sign:
This is the standard sign of cholecystitis worldwide. Pain is felt during inhalation or coughing when the physician palpates your RUQ due to the inflammation of the gallbladder.


Murphy's sign: Pain during deep palpation.

However, as stated in my previous post, Russians emphasise greatly on the importance of practical skill. Therefore, Russian physicians test not one, but several other signs.

Boas' sign:
Increased sensitivity below the right scapula.

Kalk's sign:
Pain during percussion on area of gallbladder.

Ker's sign:
Pain during simultaneous inhalation and palpation on area of gallbladder.

Kurvuasie's sign:
Enlarged, distended gallbladder is felt during palpation.

Mussi-Georgievsky's sign:
Pain during palpation between pedicles of the sternocleidomastoid muscle of the right side.

Ortner's sign:
Pain during striking of the right costal arch by ulnar margin of the hand.

Razba's sign:
Pain during light punches of the right costal arch.

Shetkin-Bloomberg's sign:
Pain after sudden release of deep palpation of RUQ.

Vasilenko's sign:
Pain during percussion at peak of inhalation on area of gallbladder.

Zaharin's sign:
Pain during moderate stroking of gallbladder area.

Your physician would then perform several hi-tech diagnostic tests on you.

Diagnostics:
Blood taking to detect changes.
Ultrasonography to look for thickened gallbladder walls and gallstones.
Hepatobiliary scintigraphy to assess ability of gallbladder to expel bile.
Abdominal X-ray to look for gallstones.

Patients confirmed with gallstones are usually referred from your physician to surgeons.


Shiny scalpel. Gonna cut him up.

Recovery from this disease is possible with proper treatment, however, usually not without invasive intervention. Depending on the severity of the disease, patients are operated on with different surgical procedures.


Laparoscopic cholecystectomy as seen through laparoscope.

Treatment:
Antibiotics for preoperative preparation.
Oral ursodeoxycholic acid to dissolve gallstones.
Extracorporeal shock wave lithotripsy, to break up gallstones.
Laparoscopic cholecystectomy, using endoscope.
Traditional open surgical cholecystectomy.


X-ray during laparoscopic cholecystectomy

Surgery should be performed as soon as possible; delay in treatment will increase chances of morbidity, mortality and complications.

Remember, this disease is caused by unhealthy lifestyle and habits. So stay healthy, or suffer!