Beware of “stones” in the bile
”There are many parts of the body where stones can grow, and gallstones are the ‘stones’ that grow in the biliary system.” “Gallbladder stones to open or not depends on the specific situation.” The day before yesterday at 2:30 p.m., the third floor of Wenzhou Book City on Park Road in the city came to a lot of listeners, we listened carefully to the “treatment and prevention of gallstones” health lecture by the first hospital of Wenzhou Medical College, chief physician of hepatobiliary surgery Shi Hongqi, Dr. Shi explained the characteristics of gallstones and treatment methods in easy-to-understand language. The two-hour lecture was very quiet. Some people came to the lecture prepared and consulted the doctor with various examination sheets as soon as the lecture was over.
Why do stones grow in the gallbladder?
At the beginning of the lecture, Dr. Shi showed several pictures and introduced in detail the physiological functions of the gallbladder and bile ducts. The liver is the chemical factory of the human body and plays an important metabolic function. The liver secretes bile daily, the bile ducts are responsible for transporting bile to the gallbladder and duodenum, while the gallbladder concentrates and stores bile, and when people eat food, the gallbladder expels bile to help digestion and absorption. Gallstones are the “stones” that grow in the biliary system, including gallbladder stones, common bile duct stones, and hepatobiliary duct stones. In the 1980s Wenzhou common bile duct stones, liver and bile duct stones are more common, now most of the gallbladder stones, mainly related to the structure of the diet, such as high fat cholesterol has increased.
Dr. Shi said, the gallbladder long stones because the gallbladder bile metabolism problems, such as changes in the cholesterol composition of the bile, the ratio is out of whack, is supersaturated, precipitation crystals form stones. The lack of breakfast, long-term intravenous nutrition, post-gastrectomy, etc., cause the gallbladder to contract less, causing the gallbladder bile to accumulate and form stones.
Some people show symptoms of indigestion, such as feeling bloated in the upper abdomen after eating greasy food, which is often misdiagnosed as a stomach problem. Some people present with biliary colic, which is very severe and is also caused by eating fatty food or eating too much, along with paroxysmal colic in the right upper abdomen, radiation from the back of the right shoulder, nausea and vomiting.
Bile duct stones are mainly caused by intrahepatic infection, biliary parasitic disease, bile stagnation, and malnutrition. The symptoms of bile duct stones are heavier than those of gallbladder stones, especially abdominal pain, chills, fever, jaundice, and if there is also confusion and shock, it is the most serious acute obstructive purulent cholangitis and should be sent to the hospital for rescue.
Choose to open or “hole”
Should we do surgery for gallbladder stones, is it open or “hole”? This is a problem that many patients struggle with. Dr. Shi said that cholecystectomy is currently the best choice for the treatment of gallbladder stones, and now it is very common to do stone surgery in hospitals, several cases a day. Those with typical biliary colic attacks, secondary or combined common bile duct stones, cholangitis, history of biliary pancreatitis attacks, and suspected gallbladder cancer are recommended for surgery. In addition, stones more than 3 cm in diameter with gallbladder polyps and larger than 1 cm, thickened and calcified gallbladder wall, and gallbladder stones more than 10 years old may be considered for surgery.
The technique of open cholecystectomy is very mature and it is suitable for any patient with gallbladder stones. Laparoscopic surgery has been developed more rapidly in recent years, with the advantages of less trauma, less pain, less interference with the abdominal viscera, faster postoperative recovery, shorter hospital stay, and smaller scars left behind. The disadvantage is that the complication rate is somewhat higher than that of open cholecystectomy, and it cannot completely replace open surgery.
When it comes to the treatment of common bile duct stones, Dr. Shih said that the main treatment for such stones is to remove as many stones as possible, release bile duct strictures and obstructions, keep bile drainage open, and prevent gallstone regeneration.
The most common procedure for extrahepatic bile duct stones is choledochotomy + T-tube drainage. Intrahepatic bile duct stones, on the other hand, are more problematic to treat. Scattered, diffuse stones are difficult to remove, and partial hepatectomy can be used if they are localized.
Regular eating to prevent stones
Good habits and regular eating is the best way to prevent stones, because the gallbladder is full of bile during fasting, the gallbladder mucosa absorbs water to thicken the bile, and the viscosity of bile will increase, making it easy to form bile sludge.
Dr. Shih said that the human body is wonderful, when food enters the duodenum, it can stimulate the secretion of gallbladder contraction hormone, prompting the gallbladder to contract, when a large amount of viscous bile is discharged to reach the intestine, which helps prevent stone formation. Therefore, we advocate eating breakfast to promote gallbladder movement and prevent long-term bile stagnation. Nowadays, some young people do not eat in the morning, which is a very bad habit. Because the human body sleeps from night to morning, the gallbladder has not been contracted, if it is contracted only at noon, the long time bile stagnation will be easy to grow stones.
Actively treat some primary diseases that can cause gallbladder stones, such as hemolytic anemia and hepatic steatosis, because these diseases tend to induce the production of bile pigment-like stones. Wash and eat things to prevent and control bacterial and parasitic infections in the liver.
Choose a reasonable diet structure and avoid high protein, high fat and high calorie diet. Eating a proper fiber-rich diet to improve cholesterol excretion may be beneficial to prevent stone formation, but for intrahepatic bile duct stone patients should enhance nutrition and not eat too poorly.
Ask a question
Q: I have had a cholecystectomy and still have abdominal pain, why?
A: There are many reasons for abdominal pain. Some are preoperative combined with small bile duct stones, intrahepatic bile duct stones or sphincter of Oddi stenosis and other lesions, the treatment of which was missed during the surgery, and postoperative stomach pain may occur. There are recurrent episodes of cholangitis due to stenosis after bile duct injury caused by surgery, poor bile drainage. There are also small gallbladders with inflammation that can form when the gallbladder duct is left too long and secondary infection occurs. A few are due to bile duct dysfunction after gallbladder surgery, which is more common in young women and can be triggered by mental factors or endocrine dysfunction. There are also patients with heart disease, pleurisy, ulcer disease, chronic gastritis, chronic pancreatitis, etc. What is more serious is that some gallbladder stone patients have combined gastrointestinal tumors, such as colon cancer and other tumors. After gallbladder removal surgery, although the symptoms of gallbladder stones disappear, the symptoms of these combined diseases manifest themselves.
Q: I have gallbladder stones and want to have surgery, can I keep my gallbladder?
A: Most patients with gallbladder stones have their gallbladder removed during surgery because cholecystectomy is the most classic procedure for gallbladder stones and has been performed for nearly 130 years and is still the best method. However, with the development of medical science, gallbladder preservation surgery has emerged in recent years, but fewer patients are suitable for gallbladder preservation surgery, which requires that there is no inflammation of the gallbladder, the number of gallbladder stones is relatively small, and it is easier to remove them. In short, preserving the gallbladder is not currently available as a routine procedure.
Q: I have sandstones in my gallbladder and I usually don’t feel them, should I have surgery?
A: If you have never had any stomach pain, the sandstone in the gallbladder is very small and there is no inflammation in the gallbladder, you may not have surgery first. You can take some choleretic drugs and treat for a period of time before having a checkup.
Q: I found cholesterol crystals in my gallbladder during my physical examination, will they become gallstones, is it because of more cholesterol?
A: Cholesterol crystals in the bile are caused by excessive precipitation of cholesterol in the bile. It is difficult to be sure whether it will become gallstones or not. Some people may excrete it, while others may form cholesterol stones over time.