Everything you need to know about gallstones

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Contd. from last edition

Blockage of the pancreatic duct: The pancreatic duct is a tube that runs from the pancreas and connects to the common bile duct just before entering the duodenum. Pancreatic juices, which aid in digestion, flow through the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.

Gallbladder cancer: People with a history of gallstones have an increased risk of gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of cancer is elevated, the likelihood of gallbladder cancer is still very small.

You can reduce your risk of gallstones if you:

Don’t skip meals: Try to stick to your usual meal times each day. Skipping meals or fasting can increase the risk of gallstones.

Lose weight slowly: 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) a week. 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. Work to achieve a healthy weight by reducing the number of calories you eat and increasing the amount of physical activity you get. Once you achieve a healthy weight, work to maintain that weight by continuing your healthy diet and continuing to exercise

Diagnosis

Endoscopic retrograde cholangiopancreatography (ERCP): Tests and procedures used to diagnose gallstones and complications of gallstones include:

Abdominal ultrasound: This test is the one most commonly used to look for signs of gallstones. Abdominal ultrasound involves moving a device (transducer) back and forth across your stomach area. The transducer sends signals to a computer, which creates images that show the structures in your abdomen.

Endoscopic ultrasound (EUS): This procedure can help identify smaller stones that may be missed on an abdominal ultrasound. During EUS your doctor passes a thin, flexible tube (endoscope) through your mouth and through your digestive tract. A small ultrasound device (transducer) in the tube produces sound waves that create a precise image of surrounding tissue. Other imaging tests: Additional tests may include oral cholecystography, a hepatobiliary iminodiacetic acid (HIDA) scan, computerized tomography (CT), magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP). Gallstones discovered using ERCP can be removed during the procedure.

Blood tests: Blood tests may reveal infection, jaundice, pancreatitis or other complications caused by gallstones.

Laparoscopic cholecystectomy

Most people with gallstones that don’t cause symptoms will never need treatment. Your doctor will determine if treatment for gallstones is indicated based on your symptoms and the results of diagnostic testing. Your doctor may recommend that you be alert for symptoms of gallstone complications, such as intensifying pain in your upper right abdomen. If gallstone signs and symptoms occur in the future, you can have treatment.

Treatment options for gallstones include: Surgery to remove the gallbladder (cholecystectomy): Your doctor may recommend surgery to remove your gallbladder, since gallstones frequently recur. Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder. You don’t need your gallbladder to live, and gallbladder removal doesn’t affect your ability to digest food, but it can cause diarrhea, which is usually temporary.

Medications to dissolve gallstones: Medications you take by mouth may help dissolve gallstones. But it may take months or years of treatment to dissolve your gallstones in this way, and gallstones will likely form again if treatment is stopped. Sometimes medications don’t work. Medications for gallstones aren’t commonly used and are reserved for people who can’t undergo surgery.

Dr. Pargat Singh Bhurji
MD,FRCP ( C ) Consultant Pediatrician Surrery BC

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