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Gallstones often mean gallbladder removal

Procedure is simple, outpatient

By Andrea K. Walker, The Baltimore Sun

2:51 PM EDT, August 21, 2013

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Americans' bad diets are leading many people to have their gallbladders removed because of gallstones. The stones, which can vary in size, are not usually problematic if they are asymptomatic. People with symptoms such as extreme abdominal pain may be at risk for gallbladder gangrene and other complications, said Dr. Andrew Rosenstein, chief of gastroenterology at the University of Maryland St. Joseph Medical Center. Removing the gallbladder is often a remedy for these patients, Rosenstein said.

What are gallstones?

Gallstones are hard pebble-like deposits that form inside the gallbladder. They come in a variety of sizes and shapes, from the size of a grain of sand to as large as a golf ball. Gallstones are caused when chemicals in the gallbladder, which include cholesterol, calcium bilirubinate and calcium carbonate are out of balance. For example, there may be too much cholesterol in the gallbladder which could cause gallstones to form when the levels of calcium bilirubinate and calcium carbonate are unchanged.

There are two types of gallstones. One type is cholesterol stones which form if there is too much cholesterol in the bile. This is the most common type of gallstone. Pigment gallstones are less common. They form when there is too much bilirubin in the gallbladder. Bilirubin is a yellowish pigment produced when the body breaks down red blood cells that is found in bile, a fluid made by the liver. This type of gallstone is more common in patients who have liver disease or blood disorders such as sickle cell anemia.

How do you diagnose gallstones?

The diagnosis of uncomplicated gallstone disease should be suspected in patients who have classic gallbladder-related pain called biliary colic. This pain occurs in the right upper quadrant, often radiates to the back, and usually occurs 30 minutes to an hour after eating. The pain may be dull, severe or associated with bloating. Evaluation for gallstones usually begins with a transabdominal ultrasound, a very sensitive test for gallstones. However, if there are ongoing symptoms and a negative ultrasound, some patients will need an endoscopic ultrasound, which involves sedation and may be more sensitive for finding smaller stones.

How do you treat gallstones?

Treating gallstones depends on the patient's symptoms as well as results of the imaging tests. Patients who have gallstones and no symptoms are simply followed because there is less than 1 percent risk of the patient becoming symptomatic. Patients with significant symptoms are treated with pain control and surgical removal of the gallbladder. This is usually done laparoscopically, a minimally invasive procedure which often does not require an overnight stay in the hospital. A less common treatment for gallstones disease is ursodeoxycholic acid (Urso). Cholesterol stones may rarely be dissolved with Urso. Treatment with Urso can take up to 12 months and is not nearly as effective as surgery. This is usually reserved for patients at high surgical risk.

What is the danger of getting gallstones that are not treated?

Patients who have typical gallbladder-related symptoms and gallstones should have their gallbladders removed. Symptomatic gallbladder disease puts patients at risk for future attacks of biliary colic and also possible complications of gallstone disease such as gallbladder gangrene or less commonly perforation of the gallbladder. Acute pancreatitis can occur when the bile duct is blocked by a gallstone. Pancreatitis can be a severe and perhaps deadly complication of gallstone disease.

What happens if gallstones end up in the bile ducts within the liver?

Sometimes a gallstone will leave the gallbladder and end up in the bile duct. When this happens, a gallstone can cause an obstruction of the bile duct resulting in a severe liver infection called cholangitis or pancreatitis. Stones found within the bile duct of the liver can be removed through a specialized technique done under general anesthesia called ERCP, or endoscopic retrograde cholangiopancreatography. This technique uses small tools several millimeters wide and can prevent a patient from undergoing major surgery to remove the stones.

andrea.walker@baltsun.com

Twitter.com/ankwalker