1. What is the gallbladder? Where does the bile come from? What does it do?
The gallbladder is a pear-shaped structure attached to the open extrahepatic bile duct under the liver and is called the gallbladder because it stores part of the bile from the liver. Bile is produced by liver cells and is drained into the intestine through the intrahepatic and extrahepatic bile ducts to help digest food.
2. How do gallstones form?
There are many things in bile that are normally in a dissolved state, just like sugar or salt dissolved in water. If the concentration is too high, some of them will form crystals, which then grow further and become clumps that stay or block the biliary system, affecting the flow of bile, and stones are formed. Due to the different composition of gallstones, the site of formation and the time of growth, the appearance and structure of gallstones are also varied, with large ones resembling eggs and small ones resembling mud and sand.
3. What are the dangers of bile duct stones?
Stones that grow in the bile ducts outside the gallbladder are called bile duct stones. Those inside the liver are called intrahepatic bile duct stones and those outside the liver are called extrahepatic bile duct stones. Bile duct stones can occur in the bile duct or drain from the gallbladder to the common bile duct, causing obstruction of the common bile duct and jaundice. In addition, it can also cause pancreatitis and bile duct cancer.
4. How does biliary colic arise? Is it unnecessary to treat the pain when it disappears?
When stones are blocked in the cystic duct or bile duct, the body will naturally produce a series of reactions to overcome it, such as spasm of the gallbladder or contraction of the lower sphincter of the common bile duct, which will produce severe pain if the stones cannot be discharged with great effort. If the pain disappears as a result of the complete expulsion of the stone, then no treatment is necessary, but this rarely happens. The majority of cases are due to the stone temporarily leaving the blockage site, and under certain conditions, such as eating fatty food, fatigue, drinking alcohol, etc., the attack can occur again. Therefore, as long as the stone exists, it should be removed firmly.
5.Why do gallstones cause yellow eyes, chills and fever?
Bile is produced by the liver and enters the intestine through the bile duct. The bile duct is like a tree, the intrahepatic bile duct is like a branch, and the common bile duct is like the trunk of the tree. If there is an obstruction in the trunk, the bile produced by the liver cannot be discharged and flows backwards into the bloodstream, where the bilirubin in the bile settles in the eyes and skin, manifesting itself as yellow sclera and skin staining, which is called jaundice. With stones in the bile duct causing poor bile flow, intestinal bacteria will easily enter and multiply, producing toxins, and the body will react with chills and fever.
6. Is it necessary to treat gallstones?
Strictly speaking, as long as there are stones, they should be treated, because there should not be stones in the normal biliary system. Because gallstones will inevitably cause different degrees of harm to the human body, some harm in the early stage, no obvious performance, and some have developed to the point where treatment is necessary, medical practice has proved that the earlier any disease is treated, the better.
7. Is it necessary to treat gallbladder polyps?
There are three types of gallbladder polyps. Cholesterol polyps are multiple, generally less than 3MM in diameter, not cancerous, so there is no need to treat; inflammatory polyps are multifocal mucosal hyperplasia on the background of gallbladder inflammation, although rarely cancerous, but if the gallbladder inflammation for a long time, affecting the quality of life, it is better to remove; the third is the real polyps, generally single, small and large, more than 10MM is prone to cancer, should be particularly vigilant. The following cases should be operated promptly.
(1) older patients.
(2) solitary polyps or oligometastatic polyps with diameter greater than 8MM.
(3) Recent ultrasound examination reveals significant polyp growth.
(4) Recent occult pain or pain in the gallbladder area.
In fact, it is incomplete and even wrong to decide whether to operate based on the size of polyps. Polyps do not tell you when they will change, and once clinical symptoms or ultrasound suggests cancer, it is often too late, and lessons in this regard are not uncommon. Happily, with the improvement of people’s economic and cultural level and the enhancement of disease prevention awareness, especially the emergence of laparoscopic cholecystectomy, the occurrence of gallbladder polyp cancer has been significantly reduced.
8. What lesions can the gallbladder produce?
The gallbladder is a disease-prone structure, with cholecystitis, gallbladder stones, gallbladder polyps, gallbladder cancer and some rare lesions.
9. Who is prone to gallbladder stones?
A large number of epidemiological surveys have been conducted at home and abroad, and the following groups of people are found to be prone to gallbladder stones.
(1) women.
(2) people over 40 years of age
(3) Obese people
(4) People who have gallbladder stones in their family
(5) people with a high-fat diet
(6) Those with liver lesions
(7) Breakfast fasters
(8) Oral contraceptive pill users
10. What are the risks of gallbladder stones?
Patients with gallbladder stones have chronic inflammation of the gallbladder, which can cause the gallbladder to lose its contraction function after long-term stimulation, and some of them can become cancerous. If the stone is blocked in the abdomen or the cystic duct, it can cause pain like cutting. If the stone cannot leave the obstruction site by changing the position or medication, high pressure will be generated in the gallbladder and the blood supply to the gallbladder wall will be reduced or stopped, so bacteria can easily enter and produce a lot of toxins, causing necrosis or even perforation of the gallbladder wall. The common bile duct, causing obstruction of the common bile duct (produce jaundice).
11. What if there are no stones in chronic inflammation of the gallbladder?
There are two types of chronic inflammation of the gallbladder, one with stones and one without stones, called lithopathic cholecystitis, which may be related to allergic reactions or microbial infections, or may be part of hepatitis, with clinical manifestations mainly of epigastric distension and vague pain, aggravated by eating fatty foods, some of which can be more severe, occurring frequently and affecting daily life. Despite the absence of stones, the only solution to this problem is the removal of the gallbladder, due to the ineffectiveness of drug therapy and the irreversible chronic inflammatory process of the gallbladder wall.
12. What are the methods of treatment for gallbladder stones?
There are two major types of treatment methods: one is the treatment method to preserve the gallbladder, such as Chinese herbal lithotripsy, lithotripsy with Chinese and Western drugs, and lithotripsy with shock wave lithotripsy; the other is the method to remove the gallbladder, such as cesarean cholecystectomy, small incision cholecystectomy and laparoscopic cholecystectomy. The purpose of the first method is to preserve the gallbladder, but the disadvantage is that the treatment effect is poor, while the second method is somewhat traumatic, but the treatment effect is reliable.
13. What is the best treatment for gallbladder stones?
An ideal treatment method should have the following conditions.
(1) no damage to the body; (2) preservation of gallbladder function; (3) reliable results; and (4) no recurrence of stones, but so far there is no treatment method with the above conditions. Almost 100%, gallbladder stones are not likely to recur.
14.I really want to keep my gallbladder, under what circumstances can my request be met?
For every patient with gallbladder stones, we are obliged to listen to his or her personal wishes and first see if there is a requirement to preserve the gallbladder. If so, then an objective examination should be used to understand the functional status of the gallbladder and the nature of the stones in order to make a judgment about the value of gallbladder preservation and the possibility of recurrence. Explain to the patient the pros and cons of gallbladder preservation for stone extraction. If the conditions for gallbladder preservation can be met, then the patient’s needs should be met as much as possible and instructions should be given on how to prevent stone regrowth. However, surgical resection should be an option for patients whose gallbladder is no longer functional or is largely non-functional or for patients with a very high likelihood of stone recurrence (e.g., multiple stones or mucoid stones) or who have had pancreatitis or are suspected of having bile duct stones. Prerequisites: preferably a single stone; good gallbladder function and no previous violent attacks.
15. What are the effects of gallbladder removal on the body?
Firstly, gallbladder is a useful auxiliary organ, but it is proven that it is not indispensable, only a few patients have a change in stool habit for a period of time after surgery, and the adjustment of diet and proper regulation of intestinal function recover within 1-3 months; secondly, we remove the gallbladder which is diseased and may cause many serious complications, and the result is to cure the disease, improve the patient’s nutrition and improve the quality of life. The overall effect is that the benefits outweigh the disadvantages. Finally, more than 100 years of clinical evidence shows that cholecystectomy does not cause serious effects on the human body.
16.What do I need to pay attention to in my diet after gallbladder removal?
In the immediate postoperative period, you should eat low-fat and easily digestible food, and as the gastrointestinal function recovers, you can let go of the restrictions later on. There is a misconception that you cannot eat fatty or high protein foods after gallbladder removal, which is not based on science. However, if you have other problems and need to adjust your diet, there is no need to change the original plan.
17.What causes diarrhea for a period of time after cholecystectomy?
In some cases, although the clinical symptoms are heavy, the gallbladder function is not completely lost, and it has a certain regulatory effect on the bile flow. After gallbladder removal, the bile flows directly into the intestine during the inter-digestive period, causing the intestinal movement to accelerate, resulting in an increase in the number of stools. In addition, the absorption of medium and long chain fats requires the emulsification of bile. After gallbladder removal, there is no gallbladder depot, and there is not so much bile to help digestion after eating fats, and the impaired fat absorption leads to diarrhea.
Why do I still feel pain in the upper abdomen after gallbladder removal?
Most of the symptoms will disappear after gallbladder removal, but some patients still have symptoms, because the causes of upper abdominal pain or other symptoms, besides gallbladder stones, are chronic gastritis, bile reflux, chronic pancreatitis, colonic hepatic flexure syndrome, etc. These pathologies can coexist with gallbladder stones, so the original symptoms can persist after gallbladder removal. If this situation is encountered, further examination is needed, and we should not just think of gallbladder problems to avoid misdiagnosis.
19.There is a method to break up the stones and drain them out. Is this method reliable?
Rationally speaking, breaking up the stones is good for discharging them, which is the purpose of inventing shock wave lithotripter. However, the results of millions of cases treated by medical experts at home and abroad are very unsatisfactory, why? Firstly, gallbladder stones are not easy to be broken, and the efficacy of lithotripsy for stones larger than 15mm is very low; secondly, even if stones are broken, most of them are not small enough to be discharged; furthermore, the clinical standard for effective gallbladder stone treatment is to eliminate all stones, and as long as one stone is left, the treatment is not considered successful. Finally, the lithotripsy process as well as the stone expulsion process can cause complications. This method, which was prevalent in the late 1980s, has been eliminated.
20. What is laparoscopic cholecystectomy all about?
Laparoscopic cholecystectomy is performed by cutting open the abdominal wall and then operating directly under the naked eye. The incision is usually 15-20 cm, and the surgeon enters the abdominal cavity with instruments in hand to perform various operations. But laparoscopic cholecystectomy, as the name implies, the doctor does not observe the abdominal cavity with the naked eye, but transfers the image to a TV screen through a 1cm thick laparoscope to watch the TV surgery, so that the doctor just has to make 3-4 small holes (usually in 0.5-1cm) in the abdominal wall, insert special instruments, cut down the gallbladder and then remove it from the small holes in the abdominal wall. Therefore, this operation is also called TV laparoscopic surgery, commonly known as “small-hole cholecystectomy”.
21.What are the advantages of laparoscopic surgery?
It has many advantages, summarized as follows: (1) small incision, light injury, fast postoperative recovery, generally the same day can get out of bed, the next day can eat, 1-3 days can be discharged, 7 days can resume daily activities (2) clear intraoperative field of view, while other organs can be observed; (3) the operator’s hands do not enter the abdominal cavity, less interference with other organs; (4) after the operation does not leave obvious scars, does not affect the appearance. Last but not least, this stone will not recur due to the removal of the gallbladder.
22. What if both gallbladder and common bile duct stones are present?
Endoscopic cholangiopancreatography (ERCP) can be done first for common bile duct stones and laparoscopic removal of gallbladder for gallbladder stones
23.Stones have been detected by ultrasound for many years, but only symptoms such as vague pain in the upper abdomen, abdominal distension and indigestion are related to stones?
There are three possibilities: first, it is caused by gastrointestinal lesions or pancreatitis lesions; second, it is caused by gallstones; third, both conditions exist at the same time. It is especially worth emphasizing that the presence or absence of biliary colic alone should not be used to determine whether stones are causing symptoms. The clinical symptoms of gallbladder stones come from two sources: first, from stones obstructing the gallbladder duct, causing the typical biliary colic; second, from chronic inflammation of the gallbladder wall, manifesting as intestinal-like symptoms. In fact, most patients with gallbladder stones have these atypical manifestations.
24.Why do gallstones cause pancreatitis?
The pancreas is behind the stomach and its main role is to produce enzymes for digesting proteins, fats and starches, which are dissolved in pancreatic juice and drained through the pancreatic duct to the intestines to digest food. In the very majority of cases, the bile ducts and pancreatic ducts converge before entering the intestine. If the opening is blocked, bile may flow back into the pancreas, activating digestive enzymes in the pancreas and causing the pancreas to “self-digest”, thus causing pancreatitis, which is called cholestatic pancreatitis.
25. What are the causes of pancreatitis? Can it be prevented?
The most common cause is the obstruction or irritation of the common opening of the bile duct and pancreatic duct by gallstones, and other causes include alcoholism and overeating. Therefore, on the one hand, we should pay attention to the regularity of life, not to drink alcohol and not to overeat, and more importantly, we should treat gallstones in time.
26. Do gallstones affect the heart?
Although the gallbladder and the heart are located far away from each other, the human being is a whole body, so it can be said that “the whole body is affected by the gallbladder”. If the patient has a pre-existing heart problem, such as coronary artery disease, then it may trigger or aggravate the heart disease, which is clinically called “biliary heart syndrome”. If this condition exists, it is important to treat the gallbladder stones as early as possible for safety and when the patient is not too old and in good physical condition.
27. Can laparoscopic cholecystectomy be performed for heart disease?
With the improvement of the level of anesthesia and the reduction of surgical trauma, in most cases, gallbladder removal can be performed even if there are heart problems. However, patients with significant cardiac failure or hemodynamically compromised rhythm disturbances should be performed after these problems have improved. The advent of laparoscopy has made gallbladder removal safer for patients with heart disease.
28. Is laparoscopic cholecystectomy safe for diabetic patients?
Laparoscopic cholecystectomy can be performed safely in almost all patients with diabetes as long as the complications arising from the disease are properly controlled. The main concern in the past was incisional infection, but since laparoscopic cholecystectomy is performed with only 3-4 small holes, this problem can be avoided.
29. Can laparoscopic cholecystectomy be performed in patients with hypertension?
If there are no serious cardiac, renal or cerebrovascular complications, it is safe to perform this surgery as long as the blood pressure is controlled at a normal level or above. In fact, the laparoscopic surgery itself is very traumatic and as long as the other organs can withstand the effects of anesthesia, there is no problem at all.
30. Are there any contraindications to laparoscopic cholecystectomy?
Like other surgeries, laparoscopic cholecystectomy also has contraindications, such as severe cardiopulmonary disease, coagulation disorders, concomitant intra- and extrahepatic bile duct stones, suspected cancer, recurrent acute attacks of chronic cholecystitis with hyperthermia, suspected extensive intra-abdominal adhesions. However, the contraindications are relative, and with the improvement of technology, many of them have been broken, such as. Atrophic cholecystitis, acute attacks of gangrenous cholecystitis, intra-abdominal adhesions with a history of previous abdominal surgery, and even internal fistulas formed between the gallbladder and the colon may all be accomplished laparoscopically.
31. Can I work as normal after gallbladder removal?
You must establish the belief that since a diseased gallbladder was cut away, it must be healthier than it was. It is very wrong that many patients who have had surgery will have the psychological idea that they are not as good as others. Remember this famous saying: As long as you think you are sick, you will be sick, and as long as you think you are healthy, you will be healthier. So as long as you get reasonable treatment, there is no need to worry about working. Of course, if you really feel discomfort somewhere, you can ask your physician to check again. Generally, there will always be mild discomfort, and you will recover after some time, so there is no need to have a psychological burden.
32. What preparations should be made before laparoscopic cholecystectomy?
Just do some routine preoperative examination. If the surgery is performed the next morning, only fasting after dinner is required on the same day, no intestinal preparation is needed, and no gastric tube is needed before surgery. There is usually no blood preparation, which is very different from traditional cesarean surgery.
33. What should I pay attention to after laparoscopic cholecystectomy?
6-8 hours after surgery, you can get up to urinate and defecate by yourself or with the help of your family members, do not rely on the potty, and you should get out of bed the next day and eat liquid or soft and easily digestible food, without waiting for the anal vent to eat. There will be mild pain in the puncture hole after surgery, which is usually tolerable, or if you are sensitive, you can use painkillers. In conclusion, early return to daily activities should be sought after surgery and traditional practices should be forgotten.
34. Is it a recurrence of common bile duct stone found soon after gallbladder removal? What should be done?
No! A recurrence means that stones grow back in the area where they were originally found. There are two possibilities for finding stones in the common bile duct: one is that there was a primary stone in the common bile duct, and the other is that the stone drained from the gallbladder to the common bile duct before surgery. Because the lower end of the common bile duct is covered by the intestine, the ultrasound may not be able to see it clearly, so even if the diagnosis is missed, it is not the fault of the ultrasonographer or the technical level. The good news is that the incidence of this condition is less than 1%. Therefore, the key is early detection and treatment.