Galling gallstones

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A radiating pain in the back that continued for hours, loss of appetite along with nausea forced Mr N to see a doctor. On investigation it was revealed that he had stones in his gallbladder.

Gallbladder, the pear-shaped organ of our digestive system, stores and concentrates bile which helps to absorb the complex fatty food that we consume. It also helps us in the absorption of fat soluble substances including fat-based vitamins such as Vitamin A, D, E and K.

A common ailment associated with the gallbladder is gallstones. One of the most common reasons for this, especially in Pakistan, is the saturation of bile with cholesterol. This saturation happens due to the increase of cholesterol — which in itself is insoluble within bile but is made soluble and eliminated due to the presence of bile salts — or reduction of bile salts. Loss of gallbladder motility, increased bilirubin, obstruction in the bile fluid pathway and localised infection may also contribute towards the formation of a gallstone.


Women over the age of forty who are overweight need to be particularly vigilant


What are gallstones?

Gallstones are hard, pebble-like structures that obstruct the bile pathway. Based on the composition there are different types of gallstones, of which cholesterol stones and mixed stones are the most common type.

Pre-disposing risk factors

The predisposing factors for gallstones can best be understood by the ‘5Fs of the gallstones’. These factors may, singly or in combination, provide for the most conducive pre-requisite of gallstone formation, and are as follow:

1-Fat (being over-weight. BMI more than 30)

2-Forty (age nearing 40 years or above; rare in young)

3-Female (it is proposed that roughly every three female to one male carry gallstones)

4-Fertile (one or more children)

5-Fair (Caucasians are more vulnerable to gallstones)

In case of a younger individual carrying gallstones the ‘F’ for 40 is replaced with ‘F’ for Familial. It is very likely that a younger individual may have a positive family history.

Gallstones may also occur in pregnancy, rapid weight loss, diabetes, etc. Reduced physical activity, prolonged fasting, smoking, alcoholism, high calorie diet with refined carbohydrates and low in fibre and unsaturated fats including fried food, whole milk dairy products, fatty red meat and highly processed food like bakery items are all associated with gallstones.

Signs and symptoms

It is believed that more than 80 per cent of gallstones remain symptom free. These are referred to as ‘silent stones’. Mostly these gallstones are unveiled when the patient undergoes any investigation for some other issue, most of the time related to the digestive system.

For the presenting gallstones, very vague symptoms like upper abdominal pain, heartburn, nausea, vomiting, bloating and indigestion may occur. A very indicative symptom, however, is the radiating pain at the right shoulder and upper back which may occur from few minutes to several hours along with nausea and vomiting.

Investigations and treatment

Different tests may point towards the possibility of gallstones’ existence, but may not provide for an accurate diagnosis. Generally, ultrasound is the method of choice for the diagnosis of gallstones.

If the complications of gallstones hamper the patient’s quality of life then a surgery is recommended. Cholecystectomy (open and laproscopic) is one of the most common surgeries being done globally. The patient can resume normal activities within seven to 10 days. In most people, gallbladder removal is not associated with any impairment of digestion. Silent gallstones may not require any management. Although not recommended, gallstones in some medical cases may be dissolved with the help of oral medications, which may take few months to years; but there is no assurance that gallstones are completely dissolved.

Complications

Gallstones may result in severe abdominal pain, jaundice, inflammation of the gallbladder, obstruction of the biliary pathway, inflammation of pancreas, (rarely) perforation, gangrene, and empyema. In one per cent cases, cancer may also occur.

kalishahid@hotmail.com

Twitter: @Ali_Shahid82

Published in Dawn, Sunday Magazine, July 31st, 2016