Gallbladder stones or cholelithiasis is a condition in which gallstones form in the gallbladder. While gallstones can also occur in the bile ducts, most gallstones come from cholesterol deposits that harden into stone formations. These conditions sometimes do not cause symptoms or are asymptomatic but can also cause symptoms or be symptomatic, both mild and can cause severe symptoms, so immediate treatment is needed to reduce the risk of complications.
Formation of bile occurs in the liver, which functions as a detergent to dissolve and absorb fats and some essential vitamins. The composition of bile consists of inorganic materials including Na, K, Ca, Cl, P and organic materials such as cholesterol, phospholipids, bile salts, conjugated bilirubin. In the bile duct system there is a gallbladder which functions as a reservoir and concentration of bile.
There are several types of gallbladder stones, namely cholesterol stones, pigment stones/infection stones or a mixture of cholesterol stones and infection. Cholesterol stones are the most common stones found in the gallbladder which are caused by excess cholesterol resulting in super saturation of bile and the formation of crystals which turn into stones over time. Pigment stones arise from the release of bilirubin, bilirubin pigment resulting from the breakdown of blood combines with calcium in the bile duct to form stones .
Predisposition
- Gender, more women than men
- Obesity
- Eat foods high in fat and carbohydrates
- Age over 40 years
- Pregnant
- Drastic weight loss
- Chronic digestive inflammatory disease
- Diabetes mellitus
- Blood disorders
- Chronic liver disease
Clinical Symptoms
Pain in the right upper abdomen and solar plexus that radiates to the right back is sometimes accompanied by nausea and vomiting and the pain increases when eating fatty foods. In some people can be asymptomatic.
Inspection
There is tenderness in the upper right abdomen sometimes accompanied by fever, nausea, vomiting. In some people there are no signs of pain. The next recommended examination is a blood test to evaluate the presence of an inflammatory process and signs of bile duct obstruction. Another necessary supporting examination is an ultrasound examination (Ultrasonography) and if necessary, it can be continued with an MRCP (Magnetic Resonance Cholangio Pancreatography) examination.
Complications
Gallbladder stones can cause inflammation of the gallbladder (cholecystitis) which can progress to severe inflammation resulting in adhesions with surrounding organs or leakage, stones can also enter the main bile duct, causing yellow complaints and can trigger inflammation of the pancreas (pancreatitis). . Chronic irritation caused by stones can also trigger the emergence of malignant tumors in the gallbladder.
Management
In asymptomatic (asymptomatic) cholelithiasis for non-surgical management needs to be considered carefully related to the presence or absence of comorbidities, stone size, condition of the gallbladder and the patient's clinical condition.
In symptomatic cholelithiasis (with symptoms) the management is by cholecystectomy, namely by removing the stone and its gallbladder. As for the gold standard for cholecystectomy surgery, it is a minimally invasive laparoscopic procedure with minimal incisions, minimal pain, and shorter length of stay. In conditions where there are complications, laparoscopic surgery can be converted into a longer incision to minimize existing complications.
If you have complaints or conditions like the above, don't hesitate to consult a doctor.
Article written by dr. Agung Sumastoro, Sp.B, SubBDig (Surgery Specialist – Digestive Surgery Sub Specialist at EMC Pulomas Hospital).