Gallbladder Stones – Cholelithiasis

So you have been diagnosed with stones of your gallbladder? The medical term for this is Chole (stands for gallbladder) lithiasis (stands for stones). In the following video we discuss the diagnosis, treatment, follow-up care, and when to return to the ER if you have been diagnosed with gallbladder stones. Gallstones are solid particles that form from bile inside the gallbladder. The gallbladder is a small sac-like organ in the right upper part of the abdomen. Located under the liver, just below the rib cage on your right side. The gallbladder is part of the biliary system which includes the liver and pancreas, and is responsible for producing bile and digestive enzymes. Bile is a fluid made by the liver to help in the digestion of fats and contains different substances like cholesterol and bilirubin. Bile is stored in the gallbladder until is needed. When we eat a high fat, high cholesterol meal the gallbladder contracts and releases bile into the intestines where it assists in the digestive process. There are 2 types of gallstones: cholesterol stones compromise 80% of them and form due to excess cholesterol in the gallbladder. Pigment stones – form most often in  people with liver or blood disease which have high levels of bilirubin. Gallstones can be any size. As tiny as a grain of sand, to as large as a golf ball. Gallstones within the gallbladder are often asymptomatic, which means they cause NO symptoms or problems. If there are many or large stones, then they can cause pain when the gallbladder contracts in response to a fatty meal. They may also cause problem if they move out of the gallbladder. If the movement leads to blockage of the ducts connecting the liver, pancreas, or gallbladder to the intestine then serious complications can result.  Blockage of the duct can cause these digestive enzymes to be trapped in the duct this can cause inflammation and ultimately severe pain, infection, and ultimately organ damage. Risk factors for the formation of gallbladder stones include the following: 1. Female Gender 2. Being Overweight 3. Loosing large amounts of weight too fast / starvation diets 4. Certain medications like BCPs (birth control pills), and cholesterol lowering drugs. What are the symptoms of gallstones? The most common symptom is pain in the right upper or central part of the abdomen. Because the pain comes in waves it is termed colicky pain and is commonly referred to as a gallbladder attack. Attacks can occur daily, every few days, or every few months. Sometimes but once a year. The pain usually starts within 30 minutes of ingesting a fatty meal. The pain is usually severe, dull, and constant can last 1-5 hours and can radiate to the right shoulder or back.  it may occur in the middle of the night may even awaken the patient from sleep.  pain usually makes the patient uncomfortable and have the urge to move in order to relieve the pain.  other common symptoms include nausea, vomiting,  indigestion, belching, abdominal distention and bloating, intolerance to fatty or greasy foods.   More severe side effects include fever, jaundice (which is the yellow discoloration of the skin  due to the accumulation of yellow pigment). The diagnosis of gallstones –  because the symptoms of gallstone pain resemble or other abdominal conditions  the physician will ask questions related to the symptoms,  duration, severity, quality of the pain and perform a focused abdominal exam.  This will help to zone in on the diagnosis and rule out other potential diagnoses.  There is no specific blood tests to identify the presence or absence of gallstones.   The blood work done in the emergency department is actually done to rule out other potential causes of upper abdominal pain,  or to identify the presence of biliary obstruction and/or infection. Ultrasound is the best way to image the gallbladder for the presence of stones.  ultrasound weighs help create an image of the internal organs as the son weighs travel through or bounce against different structures inside the body.  it is exceptionally good at scene abnormalities in the biliary system including gallbladder stones,  dilated bile ducts,  swelling of the gallbladder wall,  free fluid or inflammation surrounding the gallbladder. A HIDA scan –   In this test as solution is injected  through an IV line in the patient,  and the solution absorbed by the liver  and then stored in the gallbladder.   The solution contains harmless radioactive markers which can be detected by special cameras  that detect the radiation.   If the gallbladder is inflamed or the biliary duct system is blocked been non-of the radioactive markers will make it into the gallbladder itself. A CT scan –  similar to an x-ray however  produces a much more detailed picture.  taken showed the gallbladder and the biliary ducts,  and can detect gallstones, blockages, and other potential complications.  he can also help see the liver, pancreas, kidneys and other internal organs. An ERCP –   A thin flexible endoscope is introduced through the throat and into the stomach and floated through the intestines.   The device can then inject  dye into the biliary ducts.   The dye can then help see any obstructions (filling defects) in the biliary tree system.  sometimes this procedure can result in interventions to remove the stones themselves. Treatment –   There is no permanent medical cure for gallstones,   But there are medical treatments  and measures that can be taken to remove the gallbladder stones and relieve the symptoms.  these measures are only temporary.   Ultimately surgical removal of the gallbladder is the only permanent treatment.  Asymptomatic gallstones do not require any specific treatment. ESWL (Extracoporal Shock Wave Lithotripsy)  is a device that generates   sound waves to break stones  into tiny pieces. Medications to attempt to dissolve stones  do not work immediately.  He may take months even years for the gallstones to dissolve with medications.  And the stones often come back after treatment is finished.   These kind of drugs work best for cholesterol based gallbladder stones.  When to go back to the emergency department?
  1.  if the abdominal pain cannot be controlled with over-the-counter pain medications with the prescriptions given to you in the emergency department.
  2.   If there is persistent nausea and vomiting and you are unable to keep fluids down.
  3.  if you have developed fever, chills or sweats.
  4.   If your skin has changed color (jaundice) yellow
If you were seen in the emergency department diagnosed with gallstones it is very important that he follow up with your primary care physician and a referral to a general surgeon be obtained as soon as possible. In the following video we will discuss what to eat or NOT eat if you have been diagnoses with gallbladder stones. Behaving well and avoiding these things can cause less gallbladder attacks and therefore less need for pain medications and repeat visits to the ER. When the gallbladder itself gets swollen, obstructed or infected it can develop into CHOLECYSTITIS. In the following video we talk about this clinical entity, diagnosis, treatment options, surgery, etc. dr oller cartoon holds iPad     Dr. Carlo Oller Board Certified Emergency Physician    

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