Gallbladder stones: causes, symptoms, diet, intervention


The colic caused by a gallbladder calculus they are compared to the pains of childbirth and those who have lived through those moments can confirm it. But it is good to diagnose the presence of one or more pebbles in the organ that collects the bile as soon as possible, not only to avoid hours of suffering and last-minute trips to the emergency room (perhaps at night and on Sundays: you know, it rains always in the wet). You can prevent calculations or get rid of them even without a scalpel or, at worst, by planning the right time to intervene definitively.

As he explains Michael Carluccichief physician of the General Surgery and Emergency Department of the IRCCS San Raffaele in Milan.

Calculi, a common problem due to diet

It is estimated that in Italy 15-20% of the population is a carrier of gallbladder stones (or gallbladder), and that up to 40% of these people develop symptoms.

«In a year we operate more than 200 patients in our ward alone: it is the most performed operation after the one for inguinal hernia» explains Carlucci. A phenomenon closely related to fat consumption, which increases the risk of stones. In fact, the gallbladder is nothing more than a deposit of concentrated bile, which is then expelled from this organ, at the beginning of the food digestion process, to facilitate its absorption».

So the calculus is formed because we eat too much fat habitually. This type of behavior stimulates bile, which is a substance that contains water, cholesterol, phospholipids and bile salts that make it soluble. “When this balance is lost, the bile begins to retain deposits of crystals (made of cholesterol, but also of calcium) which, in the long run, form the stones”, explains the expert.

Also not drinking enough can help this processbecause concentrated bile is more at risk of forming stones.

The “pebble” irritates the gallbladder and blocks it

When a stone forms in the gallbladder, it irritates the walls of the organ, interfering with its ability to absorb water, which it uses to dilute the bile coming from the liver.

«In this phase we do not feel symptoms or, if we have any, we are unable to attribute them to calculus because they are generic, such as laborious and slow digestionThe sense of bitterness in the mouthmore or less frequent headaches, some stomach aches», explains the expert.

«I would add that the diagnosis, without doing an ultrasound of the area, is difficult because, usually, a gallbladder with these problems is accompanied by other pathological situations of the digestive system, such as the hiatal hernia (with reflux) and the presence of diverticula in the intestine (with stomach ache)».

It is therefore a system that begins to not work well in general, and it is precisely the gallbladder that, if it starts to limp, sends the network of neurotransmitters that govern digestion as a whole into a tailspin. But the stone (or stones, they can be numerous), when it obstructs the way through which the bile must pass (the cystic duct, see drawing), makes the contractions of the gallbladder useless to facilitate its outflow, causing biliary colic.

“Pain is really comparable to labor pains,” emphasizes the expert. «It begins in the pit of the stomach to radiate to the right side also involving the shoulder, and often associated with nausea and vomit. If the stones are small, they could be expelled but end up in the main bile duct, where they risk doing more damage because, if they reach the duodenum, the liver also starts having problems discharging the bile, and then the patient turns yellow (jaundice). The most serious damage in these cases is pancreatitis, i.e. inflammation of the pancreas, which is dangerous».

Gallbladder stones, not just surgery

There are some drugs that can thin bilebased on bile salts. “They work if the calculation is pure cholesterol,” warns the expert.

“By using these substances, the pebble can be reduced or disappear. Unfortunately these cases represent a minority because often the calculations are composed of several substances. The calculation of pure cholesterol is distinguishable because it is radiolucent, therefore it cannot be seen with a plate (while the other types can) but only with an ultrasound ».

How do you live without a gallbladder

In most cases, when the gallbladder is surgically removed, it has long since ceased to effectively perform its function as a bile distributor.

“Removing it, then, brings the system that involves the intestine, stomach, pancreas and liver back into balance, which starts working well again,” explains the surgeon. «The side effect linked to no longer having a gallbladder is immediate but transient: it is what is called gastrocolic reflex, which consists in the need to go to the bathroom immediately after eating. In fact, the bile no longer concentrates in the gallbladder, but flows continuously into the intestine through the bile duct. But our body has good adaptation systems and everything will pass.

Gallbladder, foods don’t

All fat ones, starting from butter, dairy products and derivatives (yoghurt allowed), broth, desserts with cream, cured meats (bresaola allowed), a little salt, shellfish, eggs (they cause colic), the spirits.

Gallbladder, foods yes

The habitual consumption of foods such as extra virgin olive oil, fruit and vegetables (at least twice a day), white meats (including pork), rice and yoghurt is beneficial. It’s important to drink a lot, especially when you sweat: low-mineral water is fine.

Laparoscopy: at home in 2 days

The calculations are of different sizes: they can also reach i 4-5 cm and, below 1 cm, are considered small. “But it’s not just their size that makes us opt to remove the gallbladder (smaller stones are more dangerous), rather their positioning,” explains Carlucci.

«By obstructing the organ the greatest risk is acute inflammation: the symptoms increase and are localized on the right side, the pains are unspeakable, the fever sets in, the white blood cells rise. In these cases, the most correct attitude is to operate as soon as possible, preferably within 48 hours of the onset of symptoms because studies tell us that in this time most complications can be avoided. Beyond 7 days, however, the risks increase, and it may become impossible to perform laparoscopy, having to opt for laparotomy, i.e. cutting the abdomen”.

Then the hospital stay goes from 1-2 to 7 days and the recovery is longer and more complex.

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