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Gallstones are solidified materials that form inside the gallbladder, and may be small little specks or be as large as the gallbladder itself. Gallstones form when bile solidifies and hardens under certain disease conditions.
Bile is the yellowish liquid that is secreted by the liver, and stored in the gallbladder. It contains water, cholesterol, fats, bile salts, proteins and bilirubin, and is responsible mainly for the emulsification of dietary fat.
What Is The Gallbladder, And What Are Its Functions?
The gallbladder is a pear-shaped sac with a muscular wall, measuring 5-15cm long, located under the liver on the upper right side of the abdominal cavity. It is connected by the cystic duct to the bile duct, which is a tube connecting the liver to the small intestine (duodenum) allowing the passage of bile for digestion.
When the bile is not required, it flows into the gallbladder, which acts like a bile reservoir. During a meal, the gallbladder contracts, allowing the passage of bile into duodenum through the bile duct, where it mixes with the food and allows digestion.
The gallbladder is not essential for a healthy digestive tract.
What Causes Gallstones?
It is not entirely clear, but when there is an imbalance of 2 of the constituents of bile, there is a higher risk of developing gallstones.
If your bile contains too much cholesterol, the excess forms crystals that eventually congregate into cholesterol stones. This can possibly occur as a result to hormonal changes, obesity and diet.
If your bile contains too much bilirubin, the excess bilirubin can crystalise into pigmented stones. These are more common in patients with certain blood disorders, infections and liver cirrhosis.
If your gallbladder does not empty completely, the residual bile may become too concentrated, contributing to stone formation.
What Are The Symptoms Of Gallstone Disease?
Gallstones may cause no symptoms, but when they do become symptomatic, symptoms range from a mild upper abdominal discomfort or bloating to a severe constant abdominal pain associated with yellowing of the skin and fever.
What Are The Complications Of Gallstones?
Gallstones can cause gallbladder infection, which can be a festering long-term inflammation, to an aggressive acute infection that can lead to gallbladder gangrene and perforation. When a gallbladder is gangrenous and perforated, the infected contents of the diseased gallbladder leaks into the free abdominal cavity causing generalised contamination that can be fatal.
When gallstones drop into the bile duct, they can potentially cause obstruction to the flow of bile from the liver, resulting in jaundice (yellowing of the skin) and infection of the bile duct (cholangitis). As the bile duct shares an opening into the duodenum with the duct from the pancreas, an obstructing stone can occasionally cause a blockade to the flow of pancreatic juices. This pancreatic duct blockade can then lead to inflammation of the pancreas of varying severity (gallstone pancreatitis).
How Are Gallstones Diagnosed?
Many gallstones are discovered incidentally during tests for other problems. However, when gallstones are suspected to be the cause for abdominal or digestive problems, your doctor may ask for an ultrasound examination. An ultrasound examination is a simple investigation employing sound waves to create images of the internal organs.
Alternatively, a CT (computed tomography) scan can also reveal gallstones, and provide further information of the rest of the abdominal organs, which might be useful in the setting of complicated gallstone disease.
Occasionally, further tests might be required for the diagnosis and possible treatment of gallstones that have dropped into the bile duct. This includes the MRI (magnetic resonance imaging) scan of the biliary tract or the invasive ERCP (endoscopic retrograde cholangiopancreaticography).
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Dr Foo Chek Siang, Clinic For Digestive Surgery