What are gallstones? These are crystalline structures formed by the hardening or accumulation of normal or abnormal bile components. The incidence of gallstones increases with age. Women account for nearly 70% of those treated, although mortality rate is higher in men.
Gallstones form when bile becomes supersaturated with cholesterol and calcium and they crystallize to form stones. Gallstones are classified by their predominant substance. Cholesterol stones are the most common type – smooth and whitish yellow to tan. Prevalence is higher in women and incidence increases with age. Pigment stones contain an excess of unconjugated bilirubin in bile and colored black. Mixed stones may be a combination of both or either of these with some other substance like calcium carbonate, phosphates and bile salts.
Most gallstones are formed in the gallbladder, but others may be found in the hepatic ducts of the liver. Once you manifest symptoms of having these stones, treatment and follow-up are essential to prevent severe and fatal complications of gallbladder disease.
Complications occur when a gangrenous area becomes necrotic allowing bile to break into the abdominal cavity. Formation of pus or abscess accounts for 50% of the complications. Occasionally, a stone is discharged into the small intestine. If the stone is large enough, it can obstruct the narrow end part of the small intestine.
The most specific manifestation of this disease is pain or biliary colic, which is caused by spasm of the biliary ducts as they try to dislodge the stones. This pain starts in the upper midline area, radiating around to the back and right shoulder blade. You will be restless, changing positions as often as possible to relieve the intensity of the pain, and the interval between attacks is variable.
Analgesics may be administered intramuscularly or intravenously on a schedule. Antacids are given to neutralize gastric hyperacidity and to reduce pain. Antiemetics are administered to minimize nausea and vomiting while antibiotics will reduce the likelihood of infection. The test of choice for gallstones is an abdominal ultrasound study. Ultrasound is very sensitive and very specific. Another accurate test is the gallbladder nuclear scanning.
Nonsurgical treatments include endoscopy, gallstone dissolution, and shock wave lithotripsy. You can recover from this disorder in a few days without complications. Once the biliary system is allowed to rest, inflammation decreases and recovery progresses. Medications should be continued at home. Oral medications must be taken over a long period and devising ways to remember them is truly innovative on your part. Diet instructions may be necessary for modifications.
Most importantly, you should be advised of what to do if another attack occurs. Whether to operate or not is an area for debate. Serious complications can pose significant risks. Possible complications of surgery or anesthesia include damage to the biliary tract and hemorrhage. But in recent years, laparoscopic cholecystectomy has become the treatment of choice for this disease. You are at less risk because you are up and about sooner than you think and it requires only oral analgesics.