Gallstones were found after a physical examination, should I have surgery? How come I don’t feel anything even though I have a stone? Is it okay to ignore it? ……
A. How did the gallbladder get sick?
The gallbladder is located in the upper right side of a person’s abdomen, below the right rib cage. The gallbladder is hidden under the liver and cannot be touched directly in a healthy state. The gallbladder belongs to the organs of the digestive system and is the place where bile is stored. Its main physiological function is to concentrate and store bile, which plays a role in facilitating the digestion and absorption of fats. The liver secretes bile that is first stored in the gallbladder, and when needed, it is then discharged from the gallbladder, through a thin section of bile duct, to the intestines, where it participates in the digestion of food.
Various factors that may affect the composition of bile may increase the risk of gallstones. As we age, the body’s metabolism gradually degenerates and the proportion of various components in the bile changes. The rise in the proportion of cholesterol tends to lead to deposits in the gallbladder, which accumulate over time to form stones, a phenomenon especially seen in obese women over 40 years old.
There is also a saying that you will get gallstones if you don’t eat breakfast. At night when you sleep, the liver is not idle, still secreting bile and stored in the gallbladder. If there is no breakfast to stimulate the gallbladder to empty, then the concentration of stored bile will increase, and some components of bile may precipitate crystals under such conditions, and the risk of forming stones is higher over the years. It is not true that you will get gallstones if you don’t eat breakfast, but this diet may increase the risk of gallbladder stones. Therefore, from the perspective of healthy diet and prevention of gallbladder stones, we should still try to develop the good habit of eating breakfast regularly.
Second, to cut or not to cut, that is the question!
It has been controversial for a long time whether gallstone patients should have gallbladder removal surgery or not.
The “no-cut school” believes that many stones will not attack until death, so there is no need for patients to receive this knife; some patients’ symptoms such as hidden pain and belching are not relieved after surgery; and there are risks when it is surgery.
The “cut out school” believes that surgery should be actively performed. The possibility of future symptoms, triggering acute cholecystitis and cholangitis, is completely ruled out. If the attack occurs at an older age when the patient has poor cardiopulmonary function and cannot tolerate surgery, wouldn’t the best time for treatment be missed?
After nearly a decade of controversy, in 2011, the Biliary Surgery Group of the Chinese Society of Medical Surgery published in the Chinese Journal of Gastrointestinal Surgery, “Expert consensus on treatment decisions for benign gallbladder disease”: cholecystectomy is the standard treatment for benign gallbladder disease, and laparoscopic cholecystectomy should be the first choice. Don’t get too hung up if your doctor thinks the following surgical conditions are met after examination
1. Acute attack of gallbladder stone combined with cholecystitis, such as serious condition, poor effect of medication and possibility of recurrent attacks;
2, when the gallbladder ruptures after trauma;
3, when a hole is broken in the gallbladder due to other diseases.
There are also some gallbladders that do not necessarily need to be cut: 1.
1, gallbladder stones combined with chronic cholecystitis, surgery is recommended.
2.Surgery is recommended when the gallbladder wall is thickened and the possibility of gallbladder cancer should be alerted.
In fact, a simple understanding is: the gallbladder that cannot be cured by internal medicine, cannot be cured by medicine, has a ruptured fistula, or has the possibility of cancer needs to be removed.
What should we know after the gallbladder is removed?
The first thing: after gallbladder removal, the function of gallbladder is suddenly interrupted, and the digestion and absorption of fat is impaired due to the lack of sufficient concentration of bile after eating, and bile cannot be concentrated and stored after gallbladder removal, and a large amount of bile salts continuously enter the colon, which promotes intestinal peristalsis and intensifies diarrhea. Most of the diarrhea symptoms can be gradually relieved after 3 months. With the compensatory expansion of the biliary tract, it can play the role of part of the gallbladder to temporarily store bile, so that the bile secreted at the base does not enter the digestive tract directly and alleviate the stabbing into the intestine, thus increasing the residence time of the contents and reducing the number of bowel movements. Also the bile released in large quantities after eating promotes digestion and also increases digestive function to reduce steatorrhea.
The second thing: after cholecystectomy, the gallbladder loses its function of concentrating and storing bile, and bile enters the duodenum. The vagal reflex arc between the gallbladder and the gastric pylorus is damaged, and symptoms of pyloric dysfunction can occur. Most patients complain of persistent burning pain in the upper and middle abdomen, which cannot be relieved after taking acid-suppressing drugs or is seen to increase. A few patients may also present with retrosternal pain, or indigestive sensation in the stomach, or even vomiting bile-like vegetarian food. Bile reflux is less common than bloating and diarrhea symptoms and lasts for a relatively shorter period of time.
The third thing: the diet mainly consumes foods rich in high protein, dietary fiber and vitamins, such as lean meat, aquatic products, soy products, seafood, fruits and vegetables, etc., to meet the needs of metabolism. Meals are mainly small and multiple meals, avoid overeating, and develop regular eating habits. Since high-fat diet can promote the release of cholecystokinin from the small intestinal mucosa, which can easily lead to reflux of gastrointestinal contents, they are all consistent in controlling postoperative complications, emphasizing that in addition to paying attention to diet, attention should also be paid to: minimizing activities that increase intra-abdominal pressure, such as excessive bending, wearing tight-fitting clothes and pants, tightening the belt, etc.; abstaining from smoking and alcohol to avoid relaxing the esophageal sphincter.