GALLSTONESGALLSTONES

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Anatomy of gallbladder and Anatomy of gallbladder and extrahepatic biliary treeextrahepatic biliary tree

Bile Helps the body digest fats Made in the liver Stored in the gallbladder

until the body needs it Contains:

Water Cholesterol Bile pigments Phospholipids Bicarbonate Anions of the bile acids

Concentrations vary - different kinds of stones may be formed

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What are gallstones?What are gallstones? Small, pebble-like substances Multiple or solitary May occur anywhere within the biliary tree Have different appearance - depending on their

contents

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Pigment stonesPigment stones Small Friable Irregular Dark Made of bilirubin and

calcium salts Less than 20% of

cholesterol Risk factors:

Haemolysis Liver cirrhosis Biliary tract infections Ileal resection

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Cholesterol stonesCholesterol stones Large Often solitary Yellow, white or green Made primarily of cholesterol

(>70%) Risk factors:

4 “F” : Female Forty Fertile Fat

Fair (5th “F” - more prevalent in Caucasians)

Family history (6th “F”)

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Mixed stonesMixed stones

Multiple Faceted Consist of:

Calcium salts Pigment Cholesterol (30% - 70%)

80% - associated with chronic cholecystitis

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Complications of Complications of gallstonesgallstones

In the GB: Biliary colic Acute and chronic

cholecystitis Empyema Mucocoele Carcinoma

In the bile ducts: Obstructive jaundice Pancreatitis Cholangitis

In the gut: Gallstone ileus

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SymptomsSymptoms Pain in the RUQ

Most common and typical symptom May last for a few minutes to several hours Mostly felt after eating a heavy and high-fat meal

Pain under right shoulder when lifting up arms Fever, nausea and vomiting Jaundice (obstruction of the bile duct passage) Acute pancreatitis (gallstone enters the duct leading to

pancreas and blocks it)

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DiagnosisDiagnosis Ultrasound

Most sensitive and specific test for gallstones

Computerized tomography (CT) scan May show gallstones or complications, such as infection

and rupture of GB or bile ducts

Endoscopic retrograde cholangiopancreatography (ERCP) Used to locate and remove stones in bile ducts

Blood testsPerformed to look for signs of infection, obstruction, pancreatitis, or jaundice

Cholescintigraphy (HIDA scan) Used to diagnose abnormal contraction of gallbladder or obstruction of bile ducts

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TreatmentTreatment Surgery: Cholecystectomy (gallbladder removal)

5 - 40% of patients develop postcholecystectomy syndrome (gastrointestinal distress and persistent pain in the RUQ)

20% of patients develop chronic diarrhea Two surgical options

Open cholecystectomy Laparoscopic cholecystectomy

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Nonsurgical treatment: Only in special situations

When a patient has a serious medical condition preventing surgery

Only for cholesterol stones

Oral dissolution therapy Ursodeoxycholic acid - to dissolve cholesterol gallstones Months or years of treatment may be necessary before

all stones dissolve

Contact dissolution therapy Eexperimental procedure Iinvolves injecting a drug directly into the gallbladder to

dissolve cholesterol stones

TreatmentTreatment

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Contact UsContact UsDr. Satish PattanshettiM.S ( Gen. Surg ) , F M A SFellowship in Bariatric and Metabolic Surgery (Taiwan)Consulting Laparoscopic & General SurgeonBariatric & Metabolic SurgeonSpecialist in Single port Laparoscopic Surgery

Dr. Neeraj V RayateDirector and Principal SurgeonDr Neeraj Rayate is a GI and General surgeon with expertise is laparoscopic and robotic surgery for gastro-intestinal diseases and bariatric surgery. After completing his medical education in India. He has also completed a fellowship in Gynecological Endoscopy from the Giessen School of Endoscopic Surgery in Germany. Dr. Rayate has special interest in Hepatopancreatobiliary surgery and gynecolological oncology.

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