Gallstones – Manipal Nurse Sunday Column

What and where is the gall-bladder?

The gall-bladder is a small pear-shaped organ on the underside of the liver that is used to store bile. Bile is made in the liver and is stored in the gall-bladder until it is needed to help in the digestion of fat.

What is gallstone disease?

Gallstone disease is a common condition that affects mainly women, although men can suffer from it too.

The symptoms vary widely from discomfort to severe pain, which mainly begins after eating food. In severe cases the patient can suffer from jaundice, nausea and fever. It is the most common gall-bladder pathology.

What are gallstones?

Gallstones are solid stones formed in the gall-bladder from cholesterol, bile salts and calcium. They can vary in size from a few millimetres to a few centimetres.

upper-digestive-system

What causes gallstones?

Gallstones are formed when bile contains too much cholesterol. The excess cholesterol forms crystals from which gallstones are made.

Who is at risk of developing gallstones?

A ‘fat, fertile, flatulent female of fifty‘ is the classical sufferer from symptomatic gallstones. Gallstones are seen in all age groups but they are rare in the young. The possibility of developing gallstones increases with age. The following groups are considered to be at increased risk:

  • People who have relatives with gallstones
  • Obese people
  • People with a high blood cholesterol level
  • Women who take drugs containing oestrogen, eg contraceptive pills
  • Women who are pregnant
  • Those who suffer from blood diseases (thalassemia, sickle cell anaemia, malaria,artificial heart valves)
  • People with diseases such as chronic intestinal inflammation (Crohn’s disease and ulcerative colitis)

What are the features of gallstones?

1. Gall stones may be without any symptoms and may be just found incidentally on ultrasound scans.

2. Chronic inflammation of the gall bladder (Chronic cholecystitis) which can have the following symptoms:

  • Occasional pains in the middle of the upper abdomen, or just below the ribs on the right side
  • Pain which becomes worse over the period of an hour and then stays the same
  • The pain may spread to the right shoulder or between the shoulder blades.
  • The pain can be accompanied by nausea and vomiting and sometimes excessive wind.
  • The attack can last from a few minutes to two to three hours before getting better.
  • The frequency and severity of attacks are very variable.
  • Attacks can be triggered by eating fatty foods such as chocolate, cheese or pastry.
  • It can be difficult to distinguish the pain from other diseases, such as gastric ulcer, back problems, heart pains, pneumonia and kidney stones.

3. Acute inflammation or infection of the gall-bladder (Acute cholecystitis). This condition results in:

  • Persistent pain and a temperature lasting more than 12 hours
  • Pain and tenderness under the ribs on the right side
  • The pain is made worse by movement or coughing.
  • Patients with acute cholecystitis may not always have gallstones but usually do.
  • The condition must be treated by a doctor and usually requires admission to hospital.
  • The treatment consists of a course of antibiotics, but if this is not effective emergency surgery may be required to remove the gall-bladder.

4. Jaundice (yellow discolouration of the skin and whites of eyes). This is caused when there is an obstruction to the flow of bile from the liver by stones.

5. Perforation

6. Pus in gall bladder

7. Carcinoma

8. Pancreatitis

What can be done at home?

Recurrent painful attacks, if mild, can be treated with over-the-counter painkillers. Placing something warm on your stomach may be helpful, taking care not to scald the skin. The frequency of attacks may be reduced by a low-fat diet.

How are gallstones diagnosed?

Blood samples are often taken to test if the liver is working normally. The most accurate method of detecting stones is by using an ultrasound scanner. This technique is quick and painless.

If the result of ultrasound scanning is inconclusive, other possible tests include a CT-scan and an MRI scan.

How are gallstones treated?

1. Surgery

2. Non-surgical methods

Surgery for gallstones

Surgery is the mainstay for gall bladder-stone disease. When an operation is required for gallstones in the gall-bladder it is usual to remove the gall-bladder and gallstones together – this is called cholecystectomy.

If the gall-bladder is left behind it is quite likely that further gallstones will form in it. There are two ways of removing the gall bladder and nowadays more than 90 per cent are removed by laparoscopic or keyhole surgery.

This involves making four small cuts less than 1cm long in the abdomen, and the use of a tiny camera inserted though one of these cuts to see the gall bladder.

Other instruments are placed in the abdomen through the other cuts. If the operation is successful most patients are able to go home the day after surgery and return to normal everyday activities within two weeks.

In some cases laparoscopic surgery is considered too dangerous or too difficult, and it is then necessary to do a traditional or ‘open’ cholecystectomy. This involves making a cut in the abdomen between 9 and 18cm long. The patient will usually need to stay in hospital for at least five days and will not be able to return to work for six to eight weeks.

Alternatives to surgery

Some people are able to manage mild symptoms with a combination of a low-fat diet and painkillers to control their abdominal discomfort.

Will the patient notice any difference after surgery?

After the gall-bladder has been removed most people will discover that their pain has completely disappeared and they no longer need to avoid fatty food.

Complications following gall-bladder surgery are very rare, and there are usually no long-term effects from having a gall-bladder removed.

About Nurse 67 Articles
When I think about all the patients and their loved ones that I have worked with over the years, I know most of them don't remember me nor I them. But I do know that I gave a little piece of myself to each of them and they to me and those threads make up the beautiful tapestry in my mind that is my career in nursing.