Gall bladder is a sac like organ situated at the under surface of liver. Bile is formed in liver and is collected in gall bladder. So, gall bladder acts like a store house of bile. When our food reaches small intestine, gall bladder releases bile and then the bile reaches intestine through cystic duct (duct of gall bladder) and Common Bile duct and helps in digestion of our food.
Stones in Gall bladder is one of the common clinical entity. Stones form in the gall bladder from the components of bile. The main constituent in gall bladder stones is cholesterol. Stones can form only in a diseased gall bladder. Gall bladder stones are common in certain situations-
- Rapid weight loss
- Women using oral contraceptives
- Women taking Hormone replacement therapy in menopause
- High fat content in diet
- Persons taking statins (cholesterol lowering medications)
- More common in females than men
Presentation of patients with Gall Bladder Stones:
Most gall stones do not cause any symptoms and remain silent (Asymptomatic Gall stones). When there is inflammation in gall bladder(Cholecystitis) people present with various symptoms. Common presentation is pain over right upper abdomen radiating to back. The pain may be retrosternal too. Other common symptoms are Dyspepsia (bloating, nausea), vomiting etc.
When stones dislodge from gall bladder and blocks the common bile duct or the pancreatic duct, it causes complications. Jaundice generally indicates stones lodged in common bile duct.
Ultrasonography(USG) of abdomen is the diagnostic modality of choice
Complications of Gall bladder stones can involve gall bladder itself, common bile duct, pancreas and intestine. Empyema and mucocele of Gall bladder, Perforation of gall bladder, gall bladder cancer, obstructive jaundice, pancreatitis are common
Laparoscopic Cholecystectomy (removal of Gall bladder) is the treatment of choice in symptomatic Gall bladder stones.
Generally, patients with asymptomatic gall stones do not need any surgery. But in certain populations, surgery is indicated to prevent some dangerous complications like Obstructive jaundice and gall bladder cancer.
Cholecystectomy in asymptomatic patients is advised in certain situations:
- Age: Gall stones in children and young adults, even if asymptomatic, as the cumulative lifetime risk of developing Gall Bladder cancer may be higher.
- Thick-walled gall bladder (wall thickness >3 mm on US) as the risk of an incidental Gall bladder cancer in them is higher.
- Larger stones in gall bladder
- Associated conditions like Porcelain Gall bladder, large gall bladder polyp, Anomalous pancreatico-biliary ductal communication
- Patients with diabetes, post-transplant status or with immunosuppressive therapy
- Race and geographical locations: Certain races and geographical locations are more susceptible to gall bladder cancer. e.g Native American Indians, Northern belt of India