Is surgery necessary for every gallstone?
(Update: ) - Digestive System Diseases
One day you went to the doctor for a simple swelling. Gallstones were found in the tests. Do not panic that Hayda is going to die now. That's what I wrote this article for. Dr. Ertan BEYATLI
The gallbladder is a 10 cm, pear-shaped organ that functions as a bile reservoir. It is located in the upper right part of the abdomen, just below the liver. English of the gall bladder Gallbladder dir. Horses have large livers and large bile ducts sufficient to store bile. That's why there is no gall bladder in horses.
- Causes of stones in the gallbladder
- What are the symptoms?
- Are there any damages to gallstones?
- Gallstones treatment
- Bile Diet - Fasting
- Do those without gall bladder gain weight?
- What is Bile Mud?
Why do stones form in the gall bladder?
Gallstones, calculus also called, are crystal structures formed in the gallbladder. Latin Cholelithiasis dir. It can also be a single stone or hundreds of stones. To these stones in English Gallstones It called. What are impacted teeth? When one or more teeth fails to grow in the correct position and is therefore held below the normal gum line, it is called an impaction. This can be complete, such as completely unerrupted (buried) third molars (wisdom teeth) or partial when just part of the tooth is visible in the mouth. Why are impactions important? For best function and appearance the teeth should grow in a healthy alignment. When one or more teeth is impacted, this can affect the function of that tooth but also the function and appearance of other teeth. Whether all impactions should be treated is still controversial and your dentist and oral and maxillofacial team can explain the advantages and disadvantages or treatment for you, which is usually surgical.
The main causes of stones include hereditary causes, obesity. (obesity), gallbladder immobility, and eating habits (not eating breakfast, shock-attenuation diets, etc.).
There are two types of gallstones, cholesterol and pigment stones. Cholesterol gallstones are common and will be green or ocher in color. These stones are made up of unresolved cholesterol. Pigment gallstones are dark brown or black stones and contain high amounts of bilirubin.
How do I know if I have stones in my gall bladder?
Answer: You can not understand !!
Because; Gallstones sometimes do not cause complaints for years. This is called "silent stone" or "asymptomatic gallstones". There is no direct link between the size and number of stones and symptoms. A small stone can cause excessive complaints. A large stone or even a giant stone covering the gallbladder can be silent.
If one of the stones falls into the bile duct or becomes obstructed, the following symptoms may be seen:
- Pain: There may be pain in the upper right part of the abdomen, in the right shoulder between the two shoulder blades
- Bloating, nausea, vomiting
- when late: fever, sweating, chills, jaundice
Positive Murphy's sign is a common finding on physical examination.
How is the diagnosis made?
Some tests can be done after the examination. Ultrasound is the most used test Its sensitivity and specificity is 95%. Small stones can be seen by endoscopic ultrasound (EUS).
Other tests: oral cholecystography, HIDA scan (hepatobiliary iminodiacetic acid), computed tomography (BT), magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP).
Blood tests can show the extent of stone damage. Liver tests (KCFT) indicates liver damage. At the diagnosis stage, to distinguish whether the complaints are caused by the stomach or the gall bladder endoscopy important to do.
What are the Damages of the Stone?
Stones cause inflammation of the gallbladder (cholecystitis) why could it be. Cholecystitis can cause severe pain and fever. If the bile ducts are blocked, severe pain, jaundice (obstructive icterus) and bile duct inflammation (cholangitis) can.
Pancreatic inflammation if the pancreatic duct is obstructed (pancreatitis) may occur. Pancreatitis is a life-threatening condition. Rarely, stones can cause gallbladder cancer. The situations in which these damages occur are called complications.
Not all gallstones require surgery.Dr. Ertan BEYATLI
Stones that do not complain do not require treatment (Silent asymptomatic stone). Tracking is sufficient. An abdominal ultrasound once a year for follow-up and liver tests can be done. Diet, medication or surgery can be performed for stones that make noise and cause complaints.
Oral medications can dissolve gallstones. However, this form of treatment can take months or years. Such drugs are for patients who have no chance of surgery. Medicine sample, Ursodeoxycholic Acid, Ursactive. Surgical removal of the gallbladder Cholecystectomy called. There are some criteria for gallbladder surgery.
Closed Gall Bladder Surgery (Laparoscopic Cholecystectomy)
Time required: 1 hour.
Under general anesthesia, the patient is placed on his back. The surgical area (abdomen) is cleaned with an antiseptic (Baticon) solution.
- Incision (incision)
The abdomen is inflated with carbon dioxide (CO2) gas through several holes made in the abdominal wall.
- Laparoscopy instruments
First endo-camera, then other laparoscopic instruments are entered.
- Surgical procedure
The gallbladder duct (cystic duct) and bile vessels are tied and cut.
- Gall Bladder Removed
The gallbladder is removed through one of the holes made in the abdomen.
Calot's triangle or hepatobiliary triangle is the space in the lower part of the cystic duct, bounded by the common hepatic artery. The upper border of the cystic artery in the medial. It was described by Jean-François Calot in 1891. It is an important surgical milestone.
More information contact here You can now.
If you do not have a complaint, follow-up is sufficient. If you have experienced complaints only once, you do not need to be operated immediately, medication and gallbladder protective diet can prevent recurrence of these complaints. In a second attack, surgery is a must!
Surgery is recommended if the gallbladder wall is thick, there are signs of cholecystitis, or the sac is attached to other organs. Sometimes there is inflammation and thickening of the gallbladder without stones, in these cases surgery is recommended to prevent damage to other organs (especially liver and pancreas). Stony Cholecystitis to the gallbladder in this situation (acalculous cholecystitis) It called. What are impacted teeth? When one or more teeth fails to grow in the correct position and is therefore held below the normal gum line, it is called an impaction. This can be complete, such as completely unerrupted (buried) third molars (wisdom teeth) or partial when just part of the tooth is visible in the mouth. Why are impactions important? For best function and appearance the teeth should grow in a healthy alignment. When one or more teeth is impacted, this can affect the function of that tooth but also the function and appearance of other teeth. Whether all impactions should be treated is still controversial and your dentist and oral and maxillofacial team can explain the advantages and disadvantages or treatment for you, which is usually surgical.
Gallbladder Stone Factor
How many mm of gallstones, surgery is required? It is as follows: Stones below 3mm can be followed if they are not complaining. These stones can be resolved with diet.
The risk of 3-7mm stones falling into the bile ducts and causing blockage (obstructive icterus) Because it is useful to be operated (cystic canal, ductus cysticus normal diameter 2-3mm, normal common bile duct diameter 5-10mm). Stones over 10 mm have a lower chance of falling into the canal, so they can be followed without surgery (if he does not complain !!).
Some physicians recommend removing the stone regardless of the size, even if they do not complain. There are good reasons for this view, because when even one stone falls into the bile ducts, it is very unpleasant. to complications can cause.
Especially in diabetics (diabetes DM) Since there is damage to the nerve tissues that feed the gallbladder, the complaints may not be too severe and they are deceiving. Perforation of the gallbladder wall and bile leakage may occur over time in this group of patients. Therefore, surgery is recommended for these patients.
Surgery is not recommended for very old (> 70y) or very young (<16y) patients. In patients with other health problems (for example, patients with advanced heart failure, stroke, terminal cancer and metastases, etc.), a judgment and comparison should be made between the benefits and harms of the surgery and the decision should be made according to the prevailing situation.
Surgery is recommended for patients with frequent complications. In this group of patients, in order to avoid postoperative problems, pre-operative biliary tract (intra and extra hepatic biliary tract) be sure to be clear. For this MR Cholangio (MRCP) and / or ERCP (endoscopic retrograde cholangiopancreatography) is useful.
For Frequently Asked Questions About Surgery click here
Bile Diet (Fasting)
After the operation, there will be a period of remedy for a while. This time may vary from patient to patient. At this stage, it is useful to pay attention to what you eat and drink. Which foods are harmless and which are objectionable? You can access my article on this topic from the link below:
related article: What should be considered after gallbladder surgery?
How to prevent gallstones?
You can reduce the risk of gallstones if:
- Do not skip meals. Try to stick to your normal meal times each day. Skipping meals or fasting can increase the risk of gallstones.
- Slowly lose weight. If you need to lose weight, go slow. Rapid weight loss can increase the risk of gallstones. Aim to lose 1 or 2 pounds (about 0,5 to 1 kilogram) per week. for example Gastric Sleeve Surgery Those with a higher risk of gallstones.
- Eat more high-fiber foods. Include more fiber-rich foods in your diet, such as fruits, vegetables, and whole grains.
- Maintain a healthy weight. Obesity and being overweight increase the risk of gallstones. Try to maintain a healthy weight by reducing the number of calories you eat and increasing the amount of physical activity. When you gain a healthy weight, try to maintain that weight by maintaining a healthy diet and continuing to exercise.
Do those without gall bladder gain weight?
No organ or tissue in the body is superfluous (this can even include appendix, foreskin). With today's knowledge, we may not know every benefit of every organ. Of course, removal of the gallbladder can cause some symptoms.
The degree of these symptoms varies from patient to patient and may increase from time to time even in the same patient. Among these symptoms is weight gain. Weight gain can occur in 85% of patients. While this increase is 2-3 kg in some patients, it can be as much as 30-50 kg in others. There are two reasons for this situation.
- Real weight gain. After the operation, the complaints disappear. Patients begin to eat and drink comfortably. Weight gain may occur.
- Pseudo-weight gain sensation. When there is no bile store, bile flows irregularly into the intestines. This situation causes digestive problems. It causes gas bloating in patients as if they have an increase in weight. Some patients describe it as pregnancy swelling.
Diet may be applied occasionally to prevent or reduce weight gain and bloating. You can take a look at the title of Bile Diet on this topic.
13 on February 2018 In Our Gallbladder Group 111 people who had gall bladder surgery participated in the survey we conducted. The survey results are as follows:
According to the survey, the rate of those who gain weight after gallbladder surgery is 60.3% (67 people). Some of the patients who participated in the questionnaire and answered "NO" are patients who have just undergone surgery and their future weight gain should be considered.
What is Bile Mud?
SThe gallbladder is the gallbladder of our body. Bile fluid produced in the liver is stored here and secreted into the small intestine (duodenum) when necessary. Normally, bile is in fluid and liquid consistency. Over time and for some reason, this liquid solidifies and causes many troubles and diseases with it.
Why is bile sludge formed?
Bile fluid → Bile Mud → Gall sand and crystals → Gallbladder Stone
Periods in which gallbladder muds increase pregnancy, fasting, long-term fasting, etc., such as strict weight loss diets, applied for obesity tube stomach or gastric bypass surgeries cause the formation of sludge but also increase it. If these situations are corrected and a normal process is started, firstly, the sludge will decrease and then disappear.
Bile Mud Symptoms
Muds that form in the gallbladder are generally asymptomatic. Complaints may develop in the presence of inflammation of the gallbladder or stones in the gallbladder with mud. Symptoms are as follows: sweating, chills, chills, abdominal and chest pain, belching, nausea, clay or mud-like stools, and right shoulder pain.
Bile sludge is usually detected incidentally on films such as ultrasound, CT or MRI, which are applied to the abdomen for other ailments and during periodic check-ups. If not complaining, most gallbladder muds dissolve spontaneously over time and do not require any further treatment.
Surgery is not always required to remove the sludge formed in the gallbladder. Regular nutrition list, you can eat as a program without skipping meals, and you can clean the mud. Kiss. Dr. Ertan BEYATLI. Surgical surgery may be required for bile sludge that continues despite diet. In these surgeries, the gall bladder is completely removed by a closed or open method.
Keywords: Gallbladder, calculus, cholelithiasis, bile diet, gallbladder surgery, bile sludge, ursactive
Frequently Asked Questions (FAQ)
Horses do not have a gallbladder because horses have a constant eating habit. Also, horses have large livers and wide biliary tract. This situation is enough to store bile. That's why it doesn't need a storage organ like the gallbladder.
Generally, oily, sauced, spicy fries are not good for the gall bladder. It can also be woven into coffee, nescafe and carbonated drinks.
This situation may vary from center to center. In addition, the general condition of the patient and the inflammation of the gallbladder also play a major role.
General Surgery Specialists looks after. In addition, Gastroenterology and Internal Medicine specialists follow up before and after surgery.
The most important test is Abdominal Ultrasound. In addition, abdominal CT, MR or ADBG stones can be seen.
The gallbladder is in the upper right side of the abdomen. It acts as a bile storage.
The answer to this question may vary according to each physician. Some physicians do not consider the size of the stone and recommend surgery. Some also set criteria for surgery. You can look at the criteria I explained above on this subject (Surgery Criteria).
It is beneficial to be operated, especially since there is a risk of 3-7 mm stones falling into the bile ducts and causing obstruction, otherwise it may cause serious problems (see. Gallstone damages) (damages of the stone described above). In patients who have more than two complaints in a year, surgery is recommended in order that the gallbladder does not stick to the surrounding tissues and does not complicate the operation.
Sometimes acute cholecystitis and gallbladder perforation due to gallstones that do not respond to medications may require urgent surgery. Apart from this, gallbladder surgery is an elective condition and can be planned at an appropriate time. There is no need to rush all the time!
Today, most gallbladder surgeries are performed as closed (laparoscopy cholecystectomy). The duration of the closed surgery is 30-60 minutes.
This period may vary depending on the general condition of the patient, the condition of the gallbladder, the material used and the surgeon's experience. Remember, the more important thing than the duration is that the operation is uncomplicated and smooth. The duration of open gall bladder surgeries is between 1-2 hours.
As with any surgical intervention, anesthesia and surgery have risks. These include bleeding, infection, clip opening, bile leakage, stenosis in the biliary tract, liver abscess, lung and diaphragm injury, bowel injury, etc. are risks.
In some of these complications, pain and disturbing abdominal complaints may persist after gallbladder surgery in patients. In the medical language Post Cholecystectomy Syndrome called. Liver and bile ducts should be examined in detail in patients experiencing this condition.
Perhaps this is one of the most important questions! When the decision is made correctly according to the criteria determined as described above, 85-90% of the patients do not experience serious problems after surgery and most of the postoperative complaints (such as burping, nausea, bloating, stomach pain, etc.) is temporary and disappears completely within 2-3 months on average. These patients breathe a lifetime of relief and are always grateful that they have undergone surgery.
However, unfortunately, 10-15% of the patients face different complaints after the surgery although everything goes well. These complaints can sometimes be a simple nausea that lasts a lifetime or unbearable abdominal pains and cramps. Patients in this group “Post Cholecystectomy SyndromeIt is called ”.
The complaints in these patients are unfortunately caused by the lack of bile storage and it is impossible to predict or see this situation before surgery. However, there is an important point that should never be forgotten.
Closed sac, which has become the gold standard in gallbladder surgeries (Laparoscopic cholecystectomy) surgeries may sometimes be encountered. Patients in this group are called "Post Cholecystectomy Complication".
Patients in both groups have almost the same complaints, but the pathologies are very different. For example, unconscious puncture of the liver, small intestine or other organs during surgery, removal of only a part of the gallbladder, gallstones falling into the abdomen during surgery, leaving the cystic duct long or cutting the common bile duct, incorrectly discarding the clips during surgery, etc.
The number of stitches in gallbladder surgeries is a curious and discussed issue. Many patients have the same questions. In open surgery, the abdomen is opened in the midline or from the right side. In closed surgeries, 1,2,3, 4, XNUMX or XNUMX holes are drilled and a port is placed.
In open gallbladder surgeries, an average of 30-50 stitches are applied as the cardiac wall and membrane (fascia) are opened. In closed (Lap. Col.) Gallbladder surgeries, 7-10 stitches are applied and additionally 2-6 clips are used (bile duct and veins are clipped as they are not sutured). In single-port closed surgeries, an average of 1-3 stitches and 2-6 clips are used.
This situation may vary depending on the type of stitches thrown. In closed surgery, sometimes absorbable sutures are used and do not need to be removed. Non-absorbable stitches can be removed within an average of 5-6 days. In open gallbladder surgeries, the time to remove stitches is slightly longer and is an average of 10-18 days (see When Are Surgical Sutures Removed?)
The answer to this question depends on the condition of the gallbladder.
Caffeine is a stimulant substance found in the central nervous system of living things (humans, animals and some plants). A cup of coffee has about 100mg of caffeine (70mg in tea, 50mg in a can of cola). There is 100 mg of caffeine in 20 grams of milk chocolate. When caffeine is taken by mouth, it stimulates the brain as well as in the liver and gall bladder and regulates its functioning. Our liver produces 1 liter of bile daily and stores it in the gallbladder.
Therefore, caffeine taken in a reasonable amount (200-400 mg) daily prevents the formation of gallstones as it activates the liver and gall bladder. However, when the gallbladder is formed, drinks and foods containing caffeine start to harm because the gallbladder containing stones can cause severe pain when stimulated and contracted. In addition, some millimetric stones can fall into the bile ducts and cause dangerous consequences (see. Gallstone Damages).
The same logic applies to patients who have had gallbladder surgery. When people who have had gall bladder ingested caffeine, it stimulates the liver and excessive amount of bile (since it will not be stored in the gallbladder) is poured into the small intestine. In this case, digestive problems occur, such as bile reflux, biliary gastritis, bloating, nausea etc.