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Gallstones & Bile Duct Stones

General Surgery

Gallstones are solid structures formed in the gallbladder, typically composed of bile, cholesterol, bilirubin, and calcium salts. On the other hand, bile duct stones may be lodged in the bile duct or formed within it. Without treatment, there is a chance of causing pain, inflammation, and even complications, posing a threat to health.

Symptoms

Gallstones can lead to biliary colic, which is intense abdominal pain caused by the obstruction of the gallbladder or bile duct when the gallbladder contracts. As the gallbladder is located in the upper right abdomen, the primary site of pain is often in the upper right abdomen, and some individuals may also feel pain radiating to the shoulder or upper back. Other symptoms may include nausea, vomiting, and indigestion, particularly after meals when the gallbladder starts contracting.

Most gallstones do not cause symptoms, but immediate medical attention is necessary when the following complications arise:

Cholecystitis	Blockage of the bile duct outlet by gallstones can lead to inflammation of the gallbladder, causing severe abdominal pain and fever. In extreme cases, sepsis or even death may occur.
Bile Duct Obstruction	Blockage of the bile duct can lead to bile duct infection or jaundice and may even result in pancreatitis.
Pancreatic Duct Obstruction	Similar to bile, pancreatic fluid is a digestive fluid. When gallstones obstruct the pancreatic duct, it can lead to pancreatitis, causing severe and persistent abdominal pain.
Gallbladder Cancer or Bile Duct Cancer	Chronic irritation of the gallbladder mucosa by gallstones may contribute to developing gallbladder cancer. Although rare, individuals with a history of gallstones have a higher risk of developing gallbladder cancer.

Factors

Causes

The formation of gallstones is mainly related to the composition of bile and abnormal gallbladder function. Factors such as oversaturation of cholesterol inbile, abnormal contraction function of the gallbladder, abnormal mucin secretion in the gallbladder, as well as inflammation and infection, may contribute to the formation of gallstones. Additionally, genetic factors may increase the risk of gallstone formation.

High-Risk Factors
Here are some high-risk factors that may increase the likelihood of developing gallstones:

Advanced Age: Increasing age is one of the risk factors for the occurrence of gallstones.
Female Gender: Women are more prone to gallstones than men.
Obesity: Obesity is associated with an increased incidence of gallstones.
Rapid Weight Loss: Rapid weight loss may increase the risk of gallstones.
High Cholesterol Diet: Consuming excessive cholesterol-rich foods may increase the risk of gallstone formation.

Diagnosis

Diagnosing gallstones and bile duct stones usually involves a series of medical tests and imaging studies. Here are some standard diagnostic methods:

Blood Tests	Blood tests can measure liver function and detect signs of gallbladder inflammation or other complications.
Ultrasound	Ultrasound is one of the most common methods for detecting gallstones and bile duct stones. This non-invasive test can provide images of the gallbladder and bile ducts, helping to identify the presence of rocks.
CT Scan	CT scans offer detailed images, aiding doctors in determining the size and location of stones and checking for other complications.
MRI	MRI provides high-resolution images, especially effective for detecting stones within the bile ducts.
Endoscopic Retrograde Cholangiopancreatography (ERCP)	This procedure involves inserting a tube through the mouth, stomach, and duodenum to access the bile or pancreatic ducts in the opposite direction. A contrast agent is injected for X-ray imaging, allowing observation of the conditions inside the bile and pancreatic ducts. It is used for both diagnosis and treatment.
Gallbladder Function Test:	This test evaluates whether the gallbladder's contraction function is normal, helping determine if stones are causing abnormal gallbladder function.

Treatment

For symptomatic gallstones, gallbladder removal surgery is the optimal treatment. Currently, minimally invasive surgery using laparoscopic techniques has become the mainstream approach, offering the advantages of minimal trauma and quick recovery. Patients generally can be discharged one to two days after the surgery.

After gallbladder removal, there is no need to worry about digestion or diet issues, as the liver produces bile entirely. The gallbladder's role is to store and release bile, so only a tiny percentage of patients may experience temporary diarrhoea when initially consuming oily foods after surgery. This issue tends to be short-lived, and as the body adjusts, the problem gradually disappears, allowing for a normal lifestyle.

If complications such as bile duct stones or pancreatitis arise, Endoscopic Retrograde Cholangiopancreatography (ERCP) may be needed to treat obstruction and inflammation caused by stones before surgery can be performed.

Dietary Prevention

Here are some dietary recommendations to prevent the formation of gallstones:

Low Cholesterol Diet: Reduce the intake of high-cholesterol foods such as red meat, butter, and cheese.
High-Fiber Diet: Adequate fibre intake helps the digestive system operate smoothly, reducing cholesterol concentration in bile.
Healthy Fats: Choose healthy fats to replace saturated fats, such as olive oil, flaxseed oil, and nuts.
Moderate Protein Intake: Consuming an appropriate amount of protein contributes to maintaining overall health, but excessive intake may increase the risk of gallstones.
Balanced Diet: Maintain a balanced diet with abundant fruits, vegetables, and whole grains.