Gallstone disease is prevalent in Asia. Stones sometimes pass into the bile ducts, or may form in the gallbladder. They can be divided into pigment stones and cholesterol stones. The formation of pigment gallstones is closely related to insoluble bilirubin, reduced bile salts, gallbladder immobility, biliary tract infection, primary liver disease and hemolytic disease. Cholesterol stones are linked to bile salts, lecithin and low concentrations of bile lipids while cholesterol within the bile presented super-saturation and precipitation that leads to stone formation.

Other common factors include pregnancy, family history of gallstones, obesity, high age, diabetes and chronic use of medications that contain estrogen. Pigment gallstones are more common in Asia. It could be associated with race, metabolism, infection and less commonly congenital structural anomalies or stenosis of the intrahepatic bile duct.

About 60% of people with early gallbladder stones will have no symptoms. Gallstones are sometimes found during regular physical checkup or work up for abdominal surgery. It varies in size and can be sand-like to the size of a coin, and its number can range from a few to dozens. Whatever the amount or size of stones, they can move freely in the gallbladder and carry the risk of impaction in the gallbladder neck and cause symptoms.

 

No gallstone pain requires no treatment?

Gallstones can cause biliary colic in lighter cases and quiescence gallstones or small stones can enter the bile duct from the cystic duct, forming obstructive jaundice or purulent cholangitis and even biliary pancreatitis. Gallstones cause long-term stimulation of the gallbladder wall which can promote tumor formation in the gallbladder wall and chronic inflammation leading to cancer. Even without malignant transformation, more than half of the patients without painful gallstones also experience a series of complications. Once gallstones are diagnosed, and associate with upper abdominal pain or colic symptoms, patients are encouraged to seek advice from surgeons.

Mr. James, 43 years old chef, serves as chief chef in a respectable hotel. He was required to work long hours. Mr. James is an ex-smoker and social drinker. Irregular meal times and inadequate sleep after working long nights had always caused him irritability and stress. He has constipation and abdominal flatulence. He recently experienced right upper abdominal pain, which he took for granted and ignored for weeks. Eventually the pain persistent and had led him to medical attention. After medical assessment, he was found to have gallstone disease and caused symptoms of biliary colic.

Mr. James’ gallstones were once quiescence gallstones with no immediate risk of complication. However, once the symptoms set in, he was required to take regular analgesics. Subsequent follow scan showed that the stone got bigger and was suspected to impact on the gallbladder neck. He felt that gallstones were a great chance of causing infections and complications, so he decided to accept the doctor’s advice and chose to undergo laparoscopic removal of gallbladder. Compared with the big scar from the general “open” surgery, laparoscopic surgery only generates 4 small holes in the abdomen. Due to the beauty of minimally invasive surgery, he was only required to stay in the hospital for 2 days and later resumed normal work one week after the surgery.

 

Gallstone prevention is the most significant

To prevent gallstones, we must first have a healthy diet and lifestyle, and regular hour meals and exercises, which all lead to healthy bile secretion as well as gallbladder mobility. We should avoid high fat, high cholesterol food, which may increase the risk of cholesterol stone formation.

 

Ms. Yung, 49, often refuses to eat breakfast because of her busy work schedule. And she only consumes food which is high fat and calories each day, especially high cholesterol food such as crabs and abalones. Recently, she felt pain in the upper abdomen, sometimes across her back, and even vomiting when she suffered a severe pain. After another binge eating meal, she experienced severe abdominal pain, and was sent to the emergency department. She was diagnosed acute pancreatitis. Clinical examination also found that she had suffered from gallstone disease. The pancreatitis was a result of gallbladder stones falling into the pancreatic duct opening causing obstruction of pancreatic secretion. She required emergency Endoscopic surgery to remove the obstructing gallstones and her pancreatitis was relieved. One month later she received minimally invasive surgery to remove the gallbladder, the source of gallstones, and the pancreatitis never recurred again.

 

Anything changed after removal of gallbladder?

After removal of the gallbladder, Ms. Yung’s body loses the function of storing and regulating bile secretion. In order to adapt to physiological changes caused by cholecystectomy, Ms. Yung needs to pay attention to her diet: she was required to take less high-fat food to maintain normal stool and avoid causing diarrhea. Generally eat light, digestible food, and gradually increase the fat content of the food to ensure a healthy adaptation process after the first few months from surgery.