Treating Complications Of Gallbladder Disease
Certain complications may arise in patients with gallbladder disease. Your doctor will discuss with you the risks of complications.
- Acute cholecystitis: This is the most common complication, and it occurs when the gallstone becomes impacted in the cystic duct. The bile is then trapped in the gallbladder, causing damage and inflammation. Usually, a cholecystectomy is the best treatment.
- Choledocholithiasis: This occurs when gallstones become displaced to the common bile duct rather than to the gallbladder. Choledocholithiasis can cause life-threatening conditions. An ERCP can be performed to diagnose and treat these gallstones.
Less common complications include:
- Cholecystoenteric fistulas, which form when a large stone erodes through the gallbladder into the bowel. Treatment involves cholecystectomy and bowel resection.
- Mirizziâs syndrome is the result of a gallstone blocking the cystic duct, compressing the common bile duct and causing inflammation. ERCP is used to diagnose and treat it.
- Porcelain gallbladder occurs when the gallbladder wall calcifies , usually because of gallstones. This can lead to gallbladder cancer, so removal of the gallbladder is recommended.
Robotic Head And Neck Surgery
Robotic-assisted surgery to remove throat cancer, especially tumors of the tonsils and tongue, is becoming a treatment of choice when appropriate because of its minimal side effects and positive patient outcomes.
The doctors at Orlando Health Cancer Institute are skilled in robotic procedures utilizing the da Vinci® Surgical System, which offers increased control and precision in the operating room. With robotic tools that offer more flexibility than the human hand, surgeons are able to work within a patients mouth, avoiding external incisions in the neck and jaw that can leave permanent scarring and difficulties in speaking, eating and swallowing. Robotic procedures also eliminate the need for a tracheotomy a procedure that creates an airway through a breathing tube during surgery. Furthermore, robotic surgery for cancers of the throat often reduces or avoids the need for chemo-radiation therapy.
In addition, throat cancer patients may also benefit from other advantages of robotic surgery, including less blood loss, less chance of complications, less scarring, reduced hospital stays and faster recovery to normal eating and speaking.*
Can Gallstones Go Away Without Surgery
Gallstones in your bile ducts that arent stuck can successfully pass through them and into your intestines. You can pass them out through your poop. That’s a lucky scenario, but in general, you dont want to risk having gallstones in your bile ducts in the first place. If they dont pass all the way out of you, they will only grow bigger over time.
There are some medications that can help to dissolve smaller gallstones. These take many months to work, so they arent the most practical option for people experiencing symptoms. But they offer an alternative for people who may not be in a safe health condition for surgery. They may also be practical for people who have gallstones but dont have symptoms yet.
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How Are Gallstones Treated
If gallstones are not causing symptoms, treatment is usually not needed. However, if a person has a gallbladder attack or other symptoms, a health care provider will usually recommend treatment. A person may be referred to a gastroenterologista doctor who specializes in digestive diseasesfor treatment. If a person has had one gallbladder attack, more episodes will likely follow.
The usual treatment for gallstones is surgery to remove the gallbladder. If a person cannot undergo surgery, nonsurgical treatments may be used to dissolve cholesterol gallstones. A health care provider may use ERCP to remove stones in people who cannot undergo surgery or to remove stones from the common bile duct in people who are about to have gallbladder removal surgery.
Gallstones Watch Out If You Are A Woman Over 40+
Amazingly, cholesterol gallstones have been commonly found in women above 40 mainly owning to elevated estrogen levels, resulting in increased hepatic secretion of biliary cholesterol and cholesterol supersaturated bile. Other risk factors include hypercholesterolemia , taking medications that contain estrogen such as oral contraceptives or hormone replacement therapy, having had several children, being diabetic or being diagnosed with thalassemia.
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When Should I Seek Care For Gallstones
If you experience anything like biliary colic, seek immediate attention. Biliary pain is dull and persistent, growing for about 20 minutes and lasting for one to several hours. Its usually in the upper right quadrant of your abdomen, but sometimes its referred elsewhere. Its often accompanied by nausea and vomiting, but vomiting doesnt relieve it.
A note from Cleveland Clinic
Gallstones are common, and most people will never be bothered by them. If they stay put in your gallbladder, youll probably never know theyre there. But once they begin to move, they become dangerous. These tiny, pebble-like pieces can do a lot of damage when they get into the tight spaces of your delicate biliary system.
A gallbladder attack can be intense and scary, especially if you didnt know you had gallstones to begin with. It may be alarming to find out that the recommended treatment is surgery. But laparoscopic gallbladder removal is a common procedure with an excellent prognosis. Your whole ordeal may be over within hours of your first symptoms.
Last reviewed by a Cleveland Clinic medical professional on 06/27/2022.
Gallbladder Disease Treatment: Endoscopic Gallbladder Stenting
Endoscopic gallbladder stenting is another nonsurgical approach to treat gallstones. It is useful in treating high-risk patients who cannot undergo surgery, usually due to an illness. During this procedure, your doctor performs an ERCP and inserts a stent from the gallbladder to the duodenum. The stent relieves biliary symptoms and complications.
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What Other Information Should I Know
Keep all appointments with your doctor and the laboratory. Your doctor will order blood tests to check your liver function every few months while you take ursodiol. You will also have to have an ultrasound to see how your gallstones are responding to ursodiol.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Signs And Symptoms Of Gallstones:
Gallstones range in size from as small as a grain of sand to the size of a golf ball. The size of stones may increase with time. There might be only a single stone or up to several hundreds of stones at the same time. The risk to develop gallbladder cancer is strongly associated with a larger size of gallstones.
Gallstones may cause no signs or symptoms. However, if a gallstone lodges in a duct and causes a blockage, the consequent signs and symptoms may include:
- Bloating or having chronic digestive problems after consuming high-fat diets
- Severe and sudden pain in the upper right abdomen.
- Pain that radiates to right shoulder or back
- Nausea and vomitting
- High fever and chills
- Jaundice, dark urine or pale stool
- Hematologic disorders such as anemia and thalassemia
- Being pregnant or having had several children
- Taking medications that contain estrogen such as oral contraceptives or hormone replacement therapy
- Losing weight very quickly or having fasting period
- Taking some lipid lowering drugs
- Having a family history of gallstones
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How Should This Medicine Be Used
Ursodiol comes as a capsule and as a tablet to take by mouth. It is usually taken two or three times a day with or without food to treat gallstones and two times a day to prevent gallstones in people who are losing weight quickly. If you are taking the tablets to treat primary biliary cirrhosis, they are usually taken 2 or 4 times a day with food. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ursodiol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
If you need to break the tablet for your specific dose, place the tablet on a flat surface with the scored section on the top. Hold the tablet with your thumbs close to the scored part and apply gentle pressure to snap the tablet into two parts. Take the half tablet as directed by your doctor with food, and store the other tablet half in the opened blister package. Use the stored half tablet within 7 days. If you have any questions, your doctor or pharmacist will tell you how to break the tablets and how you should take them.
Is There Medical Treatment To Dissolve Gallstones
There is a drug which helps to prevent the formation of gallstones and will also indeed decrease the size of some gallstones. Historically this has been used in elderly patients who are not fit for anaesthetic. More recently, these drugs have been considered in patients who have had bariatric or weight loss surgery, that prevent them developing gallstones as gallstone formation can be a consequence of rapid weight loss. However there is no substantive evidence that this is beneficial in the long term. Therefore at present medical treatment of gallstones is not proven to be effective, although prophylaxis to prevent formation of the stones may be of benefit to some patients.
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What Happens If Gallbladder Stones Are Not Removed
Surgery becomes necessary when you start experiencing discomfort, pain or indigestion. These could be a sign of acute cholecystitis where the stone has caused an obstruction in one of the gallbladder ducts.
More serious complications such as obstructive jaundice or pancreatitis may also occur if the gallstone manages to slip further down. This also necessitates the need for surgery.
Keen to know more about the operation, Ritesh asked the doctor his concerns.
Diagnosis Of Gallbladder Stones
Initial diagnosis can be made through blood tests which include a liver function test. Often the alkaline phosphatase and bilirubin levels are elevated on the blood report. A complete blood count may show an increase in the total white blood cell count which is indicative of an active infection. ESR and CRP may also be elevated.
A simple diagnostic tool in determining whether the patient has got gallbladder stones is an ultrasound scan. This is a painless procedure and can be done in just a few minutes. While gallbladder stones can be visualized fairly easily, the presence of thickening of the gallbladder wall and fluid around the gallbladder indicates acute cholecystitis or gallbladder infection.
Additional imaging of the gallbladder is rarely required.
However, if there is concern or if further information is required, a test called a magnetic retrograde cholangiopancreatography, or MRCP, will be performed. This is essentially an MRI scan.
In individuals in whom the gallbladder stone is stuck, a procedure called an endoscopic retrograde cholangiopancreatography, or ERCP, may be performed. This is a test where an endoscope is inserted through the oral cavity all the way into the stomach up until the opening of the gallbladder into the digestive tract. Once a stone is removed, a stent is usually placed to keep the cystic duct and common bile duct open to allow free flow of bile from the gallbladder.
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Can Gallstones Be Treated With Lipotripsy Like Kidney Stones
This is a common question and unfortunately the answer is no. Lipotripsy involves the ultrasonic breaking up and fragmentation of kidney stones, which then travel from the kidney and are excreted in the urine. Lipotripsy energy cannot be used near the gallbladder as there are too many very important anatomical structures such as blood vessels that may be damaged. In addition, the fragmentation of a gallstone would mean that it will be more likely to travel into the common bile duct and cause complications such as jaundice and pancreatitis. These complications can be very severe.
Treatment Of Asymptomatic Gallstones
Surgical treatment of asymptomatic gallstones without medically complicating diseases is discouraged. The risk of complications arising from interventions is higher than the risk of symptomatic disease. Approximately 25% of patients with asymptomatic gallstones develop symptoms within 10 years.
Persons with diabetes and women who are pregnant should have close follow-up to determine if they become symptomatic or develop complications.
However, cholecystectomy for asymptomatic gallstones may be indicated in the following patients:
Patients with large gallstones, greater than 2 cm in diameter
Patients with nonfunctional or calcified gallbladder observed on imaging studies and who are at high risk of gallbladder carcinoma
Patients with spinal cord injuries or sensory neuropathies affecting the abdomen
Patients with sickle cell anemia in whom the distinction between painful crisis and cholecystitis may be difficult
Patients with risk factors for complications of gallstones may be offered elective cholecystectomy, even if they have asymptomatic gallstones. These groups include persons with the following conditions and demographics:
Heuman DM, Moore EL, Vlahcevic ZR. Pathogenesis and dissolution of gallstones. Zakim D, Boyer TD, eds. Hepatology: A Textbook of Liver Disease. 3rd ed. Philadelphia, Pa: WB Saunders 1996. 376-417.
Center SA. Diseases of the gallbladder and biliary tree. Vet Clin North Am Small Anim Pract. 2009 May. 39:543-98. .
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What Is The Main Cause Of Gallstones
As much as 75% of the gallstones healthcare providers discover are made up of excess cholesterol. So, we could say that having excess cholesterol in your blood is the leading cause of gallstones. You might have extra cholesterol for a variety of reasons. Some of the most common reasons include metabolic disorders, such as obesity and diabetes.
High blood cholesterol leads to higher cholesterol content in your bile. Your liver filters cholesterol from your blood and deposits it in bile as a waste product before sending the bile to your gallbladder. Chemicals in bile are supposed to dissolve cholesterol. But if theres too much of it, these chemicals might not be up to the task.
What else causes cholelithiasis?
Other factors that contribute to gallstones include:
Who gets gallstones?
Anyone can get gallstones, including children, but they are more common after the age of 40. Thats because gallstones grow very gradually. It may take 10 to 20 years for gallstones to grow large enough to cause an obstruction. They are also more common in people assigned female at birth than in those assigned male at birth, by a ratio of 3:1. This is due to the effects of female hormones.
Other common risk factors include:
Does Everyone With Gallstones Qualify For Lithotripsy
No. Patients must have cholesterol gallstones, no history of acute cholecystitis, pancreatitis or common duct stones, not more than three gallstones, total stone size less than 30 mm, a functional gallbladder by oral cholecystogram and no medical contraindications. About 10 to 15 percent of patients with symptomatic gallstones are eligible for lithotripsy.
What Are The Symptoms Of Gallstones
A person with gallstones may have what are called “silent stones”. Studies show that most people with silent stones may not experience any symptoms at all for awhile, remaining symptom-free for years and requiring no treatment. Silent stones may go undiagnosed until they begin to cause discomfort.
For those that are not quite so lucky, the symptoms my include
- Acute pain, possibly very severe, that occurs very suddenly. It may last a few minutes, or many hours
- Pain is usually located behind your breastbone, but may occur in the upper right abdominal area
- Pain between your shoulder-blades
It is not uncommon for attacks to be separated by weeks, months, or even years.
Medicine To Dissolve Gallstones
If your gallstones are small and don’t contain calcium, it may be possible to take ursodeoxycholic acid tablets to dissolve them.
But these aren’t prescribed very often because:
- they’re rarely very effective
- they need to be taken for a long time
- you can get gallstones again after treatment is stopped
Side effects of ursodeoxycholic acid are uncommon and are usually mild. The most commonly reported side effects are feeling sick, being sick and itchy skin.
Ursodeoxycholic acid isn’t usually recommended for pregnant or breastfeeding women.
Sexually active women should either use a barrier method of contraception, such as a condom, or a low-dose oestrogen contraceptive pill while taking ursodeoxycholic acid, as it may affect other types of oral contraceptive pills.
Ursodeoxycholic acid tablets may occasionally be used to prevent gallstones if it’s thought you’re at risk of developing them.
For example, ursodeoxycholic acid may be prescribed if you have recently had weight loss surgery, as rapid weight loss can cause gallstones to grow.
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Causes And Risk Factors For Gallstones
Gallstones are more common in women than in men. They are also more common in overweight people and people with a family history of gallstones.There is no single cause of gallstones. In some people, the liver produces too much cholesterol. This can result in the formation of cholesterol crystals in bile that grow into stones. In other people, gallstones form because of changes in other components of bile or because the gallbladder does not empty normally.
Gallstone Disease Treatment: Surgery
Cholecystectomy is surgery to remove your gallbladder. It is the only treatment option to cure symptomatic gallstones. Laparoscopic cholecystectomy is the most common procedure instead of a traditional, open procedure. During a laparoscopic cholecystectomy, your surgeon:
- Makes a few small incisions in your abdomen rather than one large one
- Inserts a miniature video camera and laparoscopic instruments into the incision
- Removes the gallbladder and closes the incisions with stitches
Advantages of a laparoscopic procedure include:
- Shorter hospital stay
- Faster return to normal activities
Sometimes, a surgeon begins the procedure using a laparoscopic approach but then switches to an open approach because of scarring, infection or other complications. No matter which approach your doctor uses, he or she has your best possible outcome in mind.
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