Gallstone disease commonly perceived gastric/gastritis
“Gosh, I am having gastric again!” a complaint from a middle age lady.
“Why my gastric keep coming even I am taking gastric medicine”, another complaint from a middle-aged man.
“I feel indigestion and mom said my eyes look yellowish.” said a young gentleman.
Gallstone disease is commonly perceived by the public as gastric/ gastritis (inflammation of the stomach lining) hence was ignored until complication arises from it.
Gallstones form when bile stored in the gallbladder hardens into stone-like material due to imbalance between cholesterol, bile salts, or bilirubin (bile pigment).
Dr Teng Wei Woon, KPJ Sabah Specialist Hospital Resident Consultant General Surgeon said, “There are several factors that may influence the formation of bile stone or gallstones.”
Women are at higher risk, twice as likely as men due to higher amount of hormone oestrogen.
Diet high in fats, cholesterol and obesity are another risk factors with higher cholesterol levels in the blood.
Elderly individuals above the age of 60 have higher incidence of gallstones.
Individuals with diabetes mellitus carry higher number of triglyceride and cholesterol in their blood circulation.
Drugs that lower cholesterol levels in the blood also increase the amount of cholesterol secreted into bile.
Gallstone is quite common and can be found in approximately 6% of men and 9% of women. Despite how prevalent gallstones may be, more than 80% of people remain asymptomatic. Biliary pain, however, will develop annually in 1% to 2% of individuals previously asymptomatic. Those who started to develop symptoms may continue to have major complications (cholecystitis, choledocholithiasis, gallstone pancreatitis, and cholangitis) occur at a rate of 0.1% to 0.3% yearly.
Most patients with gallstones have no symptoms. These gallstones are called “silent stones” and may not require treatment.
Patients with symptomatic stones most often present with recurrent episodes of right-upper-quadrant or epigastric pain, often accompanied by nausea and vomiting, that steadily increases for approximately 30 minutes to several hours. Patient may also experience referred pain between the shoulder blades or below the right shoulder region. Often, attacks occur after a particularly fatty meal and almost always happen at night.
Some patients with gallstones have inflammation of the gallbladder wall (acute cholecystitis) causes:
Severe abdominal pain, especially in the right upper quadrant, with nausea, vomiting and fever.
Less commonly, gallstones can become lodged in the common bile duct (central passage of bile from liver to small bowel) and cause obstruction which led to yellowish discoloration of eye, pale colored stool and dark urine.
Infection of the static bile in the bile ducts presents with fever and is termed Ascending Cholangitis.
If left untreated it may be fatal. The passage of common-bile-duct stones can provoke acute pancreatitis, probably by transiently obstructing the main pancreatic duct where it passes near the common bile duct. Gallstones can impact at the narrowest portion of small bowel causing an obstruction termed gallstone ileum.
The treatment for gallstones depends on the symptoms and its location. Surgery may be necessary in certain situations. Discussion with a surgeon would be advised in such circumstances.
Symptomatic gallstones are treated by admission to ward and treatment with painkiller and antibiotics if there are signs of infection. Upon symptom resolution, patients are offered to remove the gallbladder, a procedure called cholecystectomy, which is done on a planned admission. This surgery is done mainly through a key-hole surgery (laparoscopic).
If acute cholecystitis does not resolve with antibiotics, emergency cholecystectomy is performed, risk of converting from key-hole surgery to open method is higher due to complexity of the case.
When a patient presents with yellow discoloration due to obstruction in the bile duct, they are treated in a similar manner as symptomatic gallstones and may need extra emergency procedure call ERCP (Endoscopic retrograde cholangiopancreatography) to remove the biliary stones if the patient does not show any improvement with antibiotic or too ill for surgery. In this situation a plastic stent is inserted to relieve the obstruction and ensure that the bile flow into the small bowel. Cholecystectomy can be performed once the patient improves. Occasionally the obstructed biliary stone is removed during open Cholecystectomy. This involves surgically opening up the bile duct.
Gallstone disease is a common disease among the community. There is no proper statistic recorded for Sabah population. However as a general surgeon we see these cases day in and day out.
Prevention is always better than cure, seek your nearest doctor for advice if you have any symptoms descripted above and discuss about the management plan.