Gallstones

Medical specialist	Digestive surgery, general surgery, internal medicine
Symptom	Generally asymptomatic, if the size of the stone is large, severe pain in the stomach
risk factor	Woman, overweight, age over 40
How to diagnose	Medical interview, physical examination, abdominal ultrasound
Treatment	Duct and or gallbladder surgery
Drug	Generally, no drugs are given except painkillers in patients with pain
Complications	Sepsis or infection of the blood, cholecystitis, cholangitis, and pancreatitis
When to see a doctor?	Severe pain in the stomach which can be accompanied by nausea and vomiting

Gallstones Understanding

Gallstones are the result of deposits of bile that solidify into hard particles resembling pieces of rock, such as pebbles.

Generally, these stones form in the pouch and or bile ducts. If gallstones enter the bile duct, blockage and infection of the bile duct (cholangitis) can occur.

A blockage that occurs in the bile duct will make bacteria grow and develop. As a result, there is an infection in the channel.

The bacteria can also spread through the bloodstream and cause infections in other parts of the body.

Gallstones can be divided into three types, namely cholesterol gallstones, pigment gallstones, and mixed gallstones. Here’s an explanation.

• Cholesterol Gallstones

As the name suggests, cholesterol gallstones are formed from cholesterol. These gallstones are usually yellow or green in color.

• Pigment gallstones/bilirubin

This type of stone is formed from too much calcium bilirubin in the bile. These gallstones are usually dark in color, like black or brown.

• Mixed gallstones

This is the most common type of gallstone – up to 80 percent. This type of stone is a mixture of cholesterol and bilirubin.

Gallstones Reason

The causes of gallstones depend on the type. Here’s an explanation.

• Cholesterol Gallstones

Cholesterol gallstones occur because the concentration of cholesterol in bile is high. This occurs as a result of very high cholesterol in the blood.

High cholesterol in the gallbladder can trigger deposits that eventually turn into stones.

Another cause is incomplete emptying of bile in the gallbladder. Residual bile in the pouch after the bile pumping process can also cause sedimentation.

• Pigment Gallstones

Pigment stones occur because bilirubin is difficult to dissolve in water. In addition, it is also due to the deposition of calcium bilirubin salts or due to infectious diseases.

• Mixed Gallstones

Gallstones this one is formed from cholesterol, bile pigments, and various calcium salts. It is usually double and contains little calcium.

Gallstones Risk Factors

There are several factors that can increase the risk of gallstone disease, including:

• Age 40 and over
• Woman
• Derived from the Caucasian race
• Obesity or overweight
• Pregnant
• Lack of physical activity
• Regular consumption of high cholesterol intake
• Eat red meat regularly
• Minimize consumption of fibrous foods
• Have a family history of gallstones
• Diabetics

Gallstones Symptom

Gallstones generally do not cause complaints in patients, as long as the stones do not enter the bile duct or the size of the stones is small.

If it is small, there is a possibility that the stone will easily pass through the bile duct and enter the duodenum.

These gallstones may not cause symptoms for decades.

However, if the size of a large stone or stone enters the end of the bile duct, you may feel certain complaints.

The symptoms of gallstones can include:

• Severe pain in the stomach

Pain due to new bile can occur if the bile duct is blocked by stones. Blockages can occur due to a large number of stones or large stones.

The blockage triggers severe abdominal pain that radiates to the back or shoulder. Pain from bile duct stones is usually persistent and gets worse on taking a deep breath.

• Nausea and vomiting

Nausea and vomiting often accompany pain attacks.

• Fever

Fever can occur as a result of an infection caused by stones in the bladder or bile ducts.

• Radiating pain

Generally, the pain radiates to the shoulder or scapula area.

• Bloating

Gallstones can also cause bloating.

• Diarrhea

Diarrhea is not a typical or common symptom in people with gallstones but it can occur.

Gallstones Diagnosis

There are several ways that doctors can do to diagnose gallstones. The first is by conducting a medical interview.

The doctor will collect information by asking about the symptoms experienced, medical history, and others.

In addition, physical and supporting examinations can be carried out on patients, namely:

• Plain photo of the abdomen

In this type of photo, the possibility of stones being seen is only 15-20 percent.

• Abdominal ultrasound

Ultrasound examination or ultrasound examination is the gold standard to confirm the diagnosis of gallstones. Ultrasound examination has a very high level of accuracy, which reaches 95 percent.

• Abdominal CT Scan

Apart from ultrasound, another examination that can also be done is a CT scan. However, an examination with a CT scan cannot give a good picture of pure cholesterol stones.

• MRI ( magnetic resonance imaging )

This examination is not commonly performed to diagnose gallstones, except in certain cases such as complications of jaundice.

• ERCP ( endoscopic retrograde cholangiopancreatography )

ERCP is a procedure to diagnose and treat disorders of the bile duct, pancreas, and gallbladder.

This procedure is more commonly performed when there is suspicion of malignancy in the area of ​​the pancreas and gallbladder. However, the procedure can also be intended as a diagnostic modality for gallstones.

• histopathology

This examination is carried out by an anatomical pathologist. Stones that are removed through surgery will be looked at under a microscope and then identified the type.

Gallstones Treatment

Gallstone treatment must be adjusted to the impact it has. If the stone does not cause significant complaints, generally no surgical procedure is performed. The doctor will suggest lifestyle changes.

However, if the stone is interfering with your quality of life, such as prolonged pain, there are several medical procedures that can be performed.

Following are the steps for treating gallstones:

• Asymptomatic Stone

As previously explained, gallstones do not always cause symptoms. If gallstones don’t cause any symptoms, doctors usually won’t take special medical action.

However, the doctor will make sure in advance that there are no possible complications that will occur.

If there is a possibility of complications or other diseases that are at risk of increasing complications, further treatment is needed.

• Stones with Symptoms of Pain

At this stage, it is necessary to see the level of severity that occurs. If the symptoms of pain that you feel are still relatively mild and appear rarely, taking medication is sufficient.

Usually, the drug needed is a type of pain reliever. In addition, you should also change your diet to make it healthier.

However, if the pain that appears – especially in the stomach area – feels very intense, further medical action is needed.

Especially if the pain appears quite often, surgery may be needed.

• Operative Actions

This medical action is needed only if the symptoms you feel are very severe and severe. The worst possibility is that your gallbladder will have to be removed.

This procedure is performed by a digestive surgeon or general surgeon. There are several operative measures that can be taken to treat gallstone problems.

• Laparoscopic Cholecystectomy

This is the most frequently recommended operative procedure because it results in very minimal incisions.

This action is also known as keyhole surgery because the size of the incision is very small—much like a keyhole. The recovery period you need lasts 1-2 weeks.

• Open Cholecystectomy

This action is necessary if the size of the gallstones is large enough that they cannot be removed through keyhole surgery.

Or it can also be done if your condition does not allow for laparoscopic cholecystectomy.

The reasons can be various, such as the location of the gallbladder that is difficult to reach or in cases of obesity. The recovery period is quite long, which is 1-1.5 months.

• ERCP ( Endoscopic Retrograde Cholangiopancreatography )

Apart from diagnostic purposes, ERCP can also be performed as a curative measure.

This procedure can dilate the gallbladder without removing it. This procedure can be performed by a digestive surgeon or internal medicine doctor.

• ESWL ( Extracorporeal Shock Wave Lithotripsy )

This is a rock-breaking procedure using sound waves. Several years ago, the use of the ESWL procedure was very popular.

However, this procedure cannot be done for everyone. Patients with large stones or located in areas that are difficult to reach cannot do this procedure.

If surgery cannot be performed, for example in elderly patients, there are other ways to break up gallstones.

For example, oral dissolving therapy. This therapy usually uses the drugs ursodiol and chenodiol to break up gallstones.

These medicines contain bile acids to break down stones. This treatment is most suitable for cholesterol stones.

Gallstones Prevention

You can reduce your risk of gallstone disease if you do a number of things, such as:

• Don’t skip meals

Skipping meals on a regular basis can increase the risk of gallstones.

• Lose weight slowly

Drastic weight loss in a short time can trigger the formation of gallstones. Safe and recommended weight loss is 0.5 – 1 kg per week.

• Increase consumption of high-fiber foods

Such as fruits, vegetables and whole grains.

• Sport

Obesity and being overweight increase the risk of gallstones. Exercise can help lose excess weight.

• Reduce consumption of red meat

Red meat or other high-fat foods have a role in forming gallstones. Don’t eat more than 200 grams of red meat per week.

• Limit alcohol consumption

Alcoholic beverages can also trigger the formation of gallstones.

Gallstones Complications

Gallstone complications may include:

• Inflammation of the gallbladder

Gallstones can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause pain and high fever.

• Jaundice

Or jaundice can occur when gallstones enter the bile duct and interfere with bile flow.

• Acute cholangitis

This happens because the bile duct is blocked and an infection occurs.

• Pancreatitis me

This condition occurs due to blockage by gallstones in the pancreatic duct and results in inflammation of the pancreas.

• Sepsis or blood infection

Sepsis is a life-threatening emergency. In sepsis, the immune system will fight infection by attacking the body’s own organs.

• Gallbladder cancer

This is a possible complication of gallstones, although it is not that common.

• Ileus

Ileus is a disorder of the passage of the intestine. Ileus rarely results from gallstones. However, ileus is a serious complication. The stone will clog the intestine and can cause the intestine to rupture. This condition needs to be treated quickly.