In recent weeks, many patients have asked me questions about gallbladder stone disease on the internet, and most of them are about disease etiology and prevention, disease symptoms, treatment and post-surgical complications and “after-effects”. Today, in my free time, I would like to summarize these questions and write a vernacular article for you, which is a sharing of my clinical work, and I hope it will be helpful to you. Of course, personal views may have a lot of shortcomings, if other colleagues have better insights, please criticize and correct.
1.The causes of gallbladder stones?
Gallbladder stones are actually long stones in the gallbladder. (As Figure 1)
This is common in the northern and urban populations of China, more women than men, and the incidence increases with age. Any factor that affects the altered cholesterol to bile acid concentration ratio and causes bile stagnation can lead to stone formation. Region, hormone levels, obesity, pregnancy, irregular diet, long-term parenteral nutrition, diabetes mellitus, hyperlipidemia, and after gastrectomy or gastrointestinal anastomosis surgery are common triggers. In the early stage, gallbladder stones have a lighter impact on the damage and function of gallbladder tissues, but with the prolongation of the existence of stones, the damage and function of gallbladder will gradually increase, which can lead to chronic cholecystitis, acute cholecystitis, hydrocele, gallbladder atrophy, gallbladder cancer and other pathological changes, and gallbladder stones entering the common bile duct can lead to cholangitis and or acute pancreatitis.
2. What are the clinical symptoms and manifestations of gallbladder stones?
Most patients are asymptomatic and only found during physical examination and surgery, which is called stationary gallbladder stones. In a few patients, the typical symptom of gallbladder stones is biliary colic, which is manifested as acute or chronic cholecystitis. The patient often suffers from colic due to contraction of the gallbladder or displacement of the stone combined with vagal nerve excitation after a full meal, eating fatty food or during sleep when the position changes, and the stone is embedded in the abdomen or neck of the gallbladder, causing obstruction to the emptying of the gallbladder. The pain is located in the right upper abdomen or epigastrium and is paroxysmal, or the continuous pain is intensified paroxysmally and can radiate to the right scapula and back, and can be accompanied by nausea and vomiting, and will recur in about 70% of patients within a year after the first occurrence of biliary colic.PS: Because of the characteristic of inaccurate localization of visceral pain, some patients cannot tell the exact location of the pain because of severe pain, plus the gallbladder, pancreas and stomach are all in the middle and upper abdomen. Most patients only feel vague pain in the upper abdomen or right upper abdomen when they over-eat, eat high-fat food, work under stress or have poor rest, or have fullness, belching, erratic, etc., which are easily misdiagnosed as “stomach disease”. In addition, it is found that smaller gallbladder stones are more likely to cause inflammation and pain in the gallbladder, which is related to the fact that small stones are more likely to become lodged in the tiny gallbladder duct.
3.How to detect and diagnose gallbladder stones and gastritis?
Based on the typical clinical history of colic, imaging examinations can confirm the diagnosis. Clinicians generally prefer non-invasive tests, such as ultrasonography, in the order of test selection, followed by invasive tests. 95% of gallbladder stones can be detected by ultrasonography with specific specificity. The diagnosis of gallbladder stones is confirmed by the presence of a strong echogenic mass in the gallbladder visible on ultrasound, which moves with position change and is followed by acoustic shadowing. Less than one fifth of gallbladder stones contain calcium, so although they can be shown on X-ray, CT, and MRI, they are not used as such in clinical practice. However, it is not used as a routine examination in clinical practice. Of course, if ultrasonography can exclude gallbladder disease, then “stomach disease” should be considered and gastroscopy should be chosen if necessary.
4.What are the treatment methods for gallbladder stones?
A: Non-surgical treatment. Asymptomatic gallbladder stones may not be treated in healthy adults, and patients with combined diabetes or long-term intravenous nutrition may undergo prophylactic cholecystectomy; non-surgical treatment is mainly to relieve symptoms, and it is difficult to expel or clean the stones.
B: Surgical treatment, in recent years, there are many places mentioned biliary stone retrieval, I personally believe that in addition to complications or side effects through lithotripsy, lithotripsy, percutaneous cholecystotomy, etc., there is a common problem is the recurrence of stones, and its recurrence rate is increasing at a rate of about 10% per year, and if there is no recurrent cholecystitis, it can be controlled by diet without treatment. If recurrent cholecystitis is not treated, it can be controlled by diet. Therefore, the most common surgical treatment for gallbladder stones is still cholecystectomy. In the past, open surgery was used, but laparoscopic surgery has been carried out in our hospital since 1993, and now laparoscopic cholecystectomy has become the most conventional and classical operation, with the advantages of small incision, light pain, less bleeding, light interference with organ function, fast recovery and short hospitalization time. To sum up, I think the following cases need to be treated surgically.
(1) stones ≥ 3 cm in diameter.
(2) Combined surgery requiring open abdomen.
(3) with gallbladder polyps.
(4) gallbladder stones with recurrent episodes of chronic cholecystitis and thickening of the gallbladder wall.
(5) calcification of the gallbladder wall or porcelain gallbladder.
(6) gallbladder stones in which acute pancreatitis has occurred
(7) Gallbladder that has become smaller, with thickened walls or no bile in the gallbladder on ultrasound, suggesting that the gallbladder is no longer functional.
(8) gallbladder stones suspected to be gallbladder cancer.
5.What are the effects after cholecystectomy?
Many friends struggle with the impact of gallbladder removal on life, this needs to be said from the gallbladder function (Figure 2).
Some people say that the gall is related to the gall, and after gall removal, the gall becomes smaller, in fact, this few is a joke, and there is no scientific basis. So what is the function of gallbladder? (1) storage of bile: a hungry person (i.e. non-digestive period), bile stored in the gallbladder, when digestion needs, and then discharged from the gallbladder, so the gallbladder is called “bile warehouse”. At the same time, it plays the role of buffering the pressure of the biliary tract; (2) concentrated bile: most of the water and electrolytes in the golden-yellow alkaline liver bile are absorbed by the mucous membrane of the gallbladder and returned to the blood, leaving the active ingredients of bile stored in the gallbladder, which turns into brown or dark green weakly acidic gallbladder bile. (3) Secretion of mucus: The gallbladder mucosa can secrete 20ml of thick mucus every day to protect the bile duct mucosa from erosion and dissolution of concentrated bile. (4) Emptying: 3-5min after eating, the food passes through the duodenum, stimulating the duodenal mucosa and producing a hormone called cholecystokinin, which makes the gallbladder contract and discharges the bile in the gallbladder into the duodenum immediately to help digestion and absorption of fat, and at the same time of discharging the bile, it also discharges the bacteria in the bile duct together with the bile.
Besides, the main function of the gallbladder is to store bile, and the role of bile is mainly to emulsify and digest fat. After eating, the gallbladder undergoes contraction, so that the stored bile is discharged into the duodenum to help digestion and absorption of food. Although the gallbladder loses its function of concentrating and storing bile after gallbladder removal, it does not have a great impact on the patient’s digestive and absorption functions. After gallbladder removal, the wall of bile duct will be thickened and the mucus glands of bile duct will be increased, and the bile duct often discharges bile into duodenum to compensate for the loss of gallbladder’s function of storing and concentrating bile, and at the same time, it does not affect the digestion and absorption of fat, and scientific experimental research shows that the digestion and absorption function of patients after gallbladder removal is not much different compared with normal people. Therefore, there is no need to worry about the adverse effects on health and digestion and absorption after gallbladder removal. PS: Here is an inappropriate example: if the water pipe of the toilet is not closed tightly, we have a bucket to store water inside, and every time we flush the toilet, the water in the bucket will be dumped at once to flush. Now, if we take away the bucket and let the pipe flush with a long flow of water, we can flush cleanly, but it takes a long time, which is the same reason as gallbladder removal. So I generally advise my surgery patients to eat less fatty foods in the first month after surgery, and slowly try to increase the amount after the first month to eat without diarrhea. Nowadays, the social environment is still low in the number of people who like to eat fatty foods, so the impact will be less.
I hope the above can provide a little help for gallbladder stone patients, Taiwan has further questions welcome you to consult in my work website, I wish you good health.