What are Gallbladder Stone Symptoms? How is the treatment done?

The gallbladder is a pear-shaped sac located under the liver. It stores and concentrates bile produced in the liver. Bile helps digest fat and is released from the gallbladder to the upper small intestine in response to food (especially fats). Gallstones are seen in approximately 10% of adults.

How Gallstones Develop?

If there are stones in the gallbladder, it is called cholelithiasis. When gallstones are present in the bile ducts, it is called choledocholithiasis. When gallstones cause inflammation in the bladder, this condition is called acute cholecystitis. If the bile is concentrated, stones ranging from small grains of sand to 2-3 cm in diameter may form in the pouch. Gallstones are cystic, duct-blocking, hard, pebble-like structures.
Gallstones are named according to the specific component in them. They are generally divided into two groups; cholesterol and pigment stones. Subtypes of gallstones are pure and mixed cholesterol stones, black and brown pigment stones. When the structures of gallstones are examined, a small amount of iron, phosphorus, carbohydrates, cell debris and mucus are found in addition to cholesterol, bile pigment and calcium, which are the basic elements. Bladder emptying is delayed or stopped in conditions such as pregnancy, total parenteral nutrition (TPN), chronic octreotide therapy, somatostatinoma, obesity, and high-level spinal canal injury. The result is bile stasis. When the pouch is not empty enough, a suitable environment for clustering is provided. Most of the gallbladder stones are formed in the bladder due to the bile losing its fluidity.
Pigment stones contain more inorganic matter and mucin. These stones are 2-6 mm in diameter, rock-hard, shiny and radiopaque. Pigment stones are frequently seen in hemolytic diseases, cirrhosis, long-term parenteral nutrition, ileal resection and elderly patients. In cases where liver functions are not complete, bilirubin cannot be made soluble in water at the required rate and precipitates by combining with free ionized calcium.

What are the Risk Factors in Gallstone Formation?

The two most important factors in stone formation are advanced age and gender. Gallstones are 2-3 times more common in women. p known. Other risk factors include familial predisposition, obesity, hormones, concomitant diseases and factors. Studies have shown that pregnancy, birth control pills and hormone replacement treatments during menopause accelerate the formation of gallstones.
Disease or resection of the ileum, which is a part of the small intestine, has an important role in the formation of cholesterol stones. It is known that the use of hypolipidemic drugs such as diabetes, hyperlipoproteinemia and clofibrate lead to stone formation by different mechanisms.

What Are the Symptoms of Gallstones?

Gallstones blocking the bile ducts can lead to a serious or life-threatening infection of the bile ducts, pancreas, or liver. 70-80% of gallstones can remain asymptomatic for life and can be detected incidentally. Biliary symptoms (due to insufficient drainage of bilirubin) may occur in 12% of patients with silent stones each year.
Common gallstone symptoms are pain in the upper abdomen, stabbing pain spreading to the back and right shoulder, nausea, vomiting, fever, chills, jaundice, abdominal bloating, indigestion after eating fatty foods, belching and gas, indigestion.
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How to Diagnose Gallbladder Stones?

A detailed medical history and physical examination are required in order to reach an accurate diagnosis in biliary system diseases. Then, complete blood count, liver function tests, bilirubin, amylase, and urinalysis and abdominal ultrasonography (USG) are performed for detailed imaging.

Oral cholecystography: Patients with gallbladder complaints but no pathology detected in ultrasonography and who will undergo medical treatment should be treated with oral cholecystography. assessable. With the oral cholecystography method, the function of the sac, whether the cystic duct is open, the number and size of the stones are evaluated according to the uptake of the oral contrast material.

Computed tomography (CT): With this imaging method, obstructive jaundice can be evaluated; Features of space-occupying lesions such as tumors, cysts or abscesses in the biliary system are determined.

Endoscopic retrograde cholangiopancreatography (ERCP): Bile and pancreat It is a method that combines endoscopy and X-rays applied to the upper digestive system to treat the problems of the primary ducts. Doctors also use ERCP to diagnose problems of the bile and pancreatic ducts.

Percutaneous transhepatic cholangiography (PTC): It is an invasive method. Under the guidance of USG or CT, the skin is passed under the skin and the contrast agent is administered directly into the intrahepatic bile ducts. It also provides therapeutic support as a drainage catheter can be placed in the bile duct.

Magnetic resonance cholangiography: It is a non-invasive method that does not use contrast material. It provides visualization of the bile ducts.

Intravenous cholangiography: It shows bile excretion in the liver by administering the contrast agent intravenously (intravenously). The choledochal and gallbladder become visible immediately after injection. If the bile ducts are visible but the sac is not visible, it is understood that the cystic duct is blocked. It is not in routine use due to the risk of anaphylaxis.

How to Treat Silent Gallbladder Stones?

Although the general approach is follow-up in silent gallstones, prophylactic (protective) cholecystectomy (biliary) is used in patients with an increased risk of developing symptoms and complications.

These patients:

• Child patients with silent gallstones (assuming they will show symptoms one day),
• Sickle cell anemia (this is hemolytic crises occur in patients. To avoid confusion whether the abdominal pain is due to hemolytic crisis or gallstones, it is taken when the bladder is in suitable conditions),
• The gallbladder that has lost its function is an indication of common disease and it is more appropriate to take it before the symptoms begin.
• If the stone diameter is >2.5 cm, the risk of causing an acute crisis by causing obstruction and/or inflammation in the bile duct is high.
• In the presence of calcification in the gallbladder wall, also called porcelain gallbladder, to prevent the development of gallbladder cancer The gallbladder must be removed.

Early removal of the gallbladder would be more appropriate in patients with a genetic predisposition, who developed gallstones at an early age, and who belong to the high-risk group for gallbladder cancer. 20-30% of patients with silent gallstones have symptoms and complications later in life. cations occur.

How to Treat Gallbladder Stones?

Treatment methods in gallbladder pathologies are divided into two as surgical and non-surgical. If the gallbladder stones give very severe symptoms, the sac is surgically removed. Today, laparoscopic gallbladder surgeries are more accepted than open surgery. In order for these treatments using litholytic agents to be successful, the gallbladder must not have lost its function and the gallstone must be pure cholesterol stone. Treatment success is not permanent. Stone formation recurs in approximately half of the patients after treatment is stopped. The methods used in the treatment of bile duct stones are endoscopy, interventional radiology (wig approach), and open or laparoscopic stone removal.

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