Hindustan Times (Lucknow) - Hindustan Times (Lucknow) - Live
The silent gallstones
Once, a young woman from a group of young visitors to our hospital had volunteered to lie on the couch to have me demonstrate how an ultrasound machine works. When I put the probe on her abdomen intending to show them what normal organs in the abdomen looked like, we were all surprised to find that her gallbladder was packed with multiple stones. On repeated questioning however she denied ever having had pain!
Stones form quite commonly in the gallbladder. Of every hundred adults walking on the streets in northern India, stones will show up in the gallbladder in at least five of them if they are all subjected to an ultrasound test. This figure goes up to around fifteen in Western Europe and America.
Why stones form in the gallbladder of some individuals are still not clear. Medical students are often taught the risks of Six Fs: fat, females, forty, fertile and those having a family history.
Gallstones usually appear yellowish or whitish and are composed of cholesterol. They form due to excess amounts of this sludgy material that the liver excretes in the bile. Around 15 percent of stones however are black in colour, and consist of a black pigment formed from the breakdown of bilirubin.
Medical scientists distinguish two types of stones: the naught ones that come to attention by causing severe pain and the silent ones that are picked up incidentally. The painful ones are likely to cause pain repeatedly, and are best removed by surgery.
Doctors seem divided opinion about how to deal with silent gallstones. Dr Gracie had followed up a group of 200 Americans with silent stones for several years in the 1980s, and found that only 18 percent developed pain in their lifetime. In other words, 82 percent went through life harbouring stones without any problems.
On the other hand, most attacks of pancreatitis in alcohol non-consumers, a potentially fatal disease, or obstructive jaundice occur due to stone slipping out into the bile duct. Also cancer of gall bladder, seen frequently in India and South America seem to occur in those who harboured stones. With laparoscopic cholecystectomy being as safe and easy as it has become, most surgeons tend to advise getting them removed before they cause trouble.
A senior female doctor who had sought my consultation for silent gallstones and had followed up every six months for check-up for two years, finally had enough of the anxiety. She got her gallbladder removed and told me “I don’t have to worry about them every day anymore”, when we met at a party.
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