Gallstones in 1 in 10 adults, causes and treatments

'Gallstones' are a common disease that occurs in 1 in 10 adults, what are the symptoms?

 

There are cases where a gastroscopy is performed due to abdominal pain, but there is no particular abnormality. In this case, you should suspect gallstone disease. Cholelithiasis is a disease in which cholesterol in the bile hardens like a stone and accumulates in the liver, gallbladder, or bile ducts, causing pain. It is common in 1 in 10 adults, and the number of cases is constantly increasing due to the aging population and westernization of dietary habits.

 

Pain caused by gallstones, similar to common abdominal pain, is easy to mistake

Depending on the site of occurrence, gallstones are divided into gallbladder gallstones if they occur in the gallbladder (gallbladder), extrahepatic bile duct gallstones (common bile duct gallstones) if they occur in the extrahepatic bile ducts, and intrahepatic gallstones if they occur in the liver, of which gallbladder gallstones are the most common. Symptoms of cholelithiasis range from no symptoms at all to abdominal pain, jaundice, and fever. The most common symptoms are abdominal pain and cramps. Among them, gallbladder stones often last a lifetime without any specific symptoms, and in these cases, no treatment is required. However, if you experience pain caused by gallstones even once, treatment is strongly recommended, as most of the time the symptoms will recur and there is a high probability of serious complications.

 

Most pain caused by gallstones is caused by gallstones blocking the biliary tract. It's usually caused by overeating, but often there's no cause. The location of the pain is most common in the area of the pubic tooth or in the right upper abdomen. Sometimes, the right shoulder blade and the left upper abdomen may ache, and the pain may radiate to the back. The pain occurs relatively suddenly, increases rapidly within a few minutes, and then the pain of the same intensity persists and then decreases gradually. Joo Kwang-ro, a professor of gastroenterology at Kyung Hee University Hospital in Kangdong, said, "When gallstones severely block the biliary tract, the pain is not resolved without painkillers, and fever and jaundice may occur." "If you don't get treatment quickly, your blood pressure will drop and sepsis can lead to death."said.

 

Increased gallstones due to westernization of diet, which can also occur during pregnancy

A diet high in fat, high cholesterol, and low in fiber increases cholesterol in the bile and decreases bile drainage from the gallbladder, increasing the risk of developing cholelithiasis. Large-scale clinical studies have shown that moderate excess weight increases the risk of gallstones. In particular, it is twice as common in women as in men, and gallstones are especially common in women who are obese. Also, when you fast for a long time or have rapid weight loss, gallstones are more likely to form in people over 60.

 

Dr. Joo Sung-sung, a professor of surgery at Kyung Hee University Hospital in Kangdong, said, "In particular, women of childbearing age sometimes come to the hospital with pain caused by gallbladder cholelithiasis during pregnancy, and in this case, there are many difficulties in treatment due to pregnancy." "If you are planning to become pregnant, it is recommended that you have an abdominal ultrasound and other tests to check for gallstones and treat them."said.

    

Treatment methods vary depending on the location of gallstones

Depending on the location of the gallstones, the treatment and treatment of cholelithiasis varies. Surgical cholecystectomy is the only treatment for gallbladder stones, and common bile duct gallstones are removed using an endoscope. Finally, intrahepatic gallstones are usually treated surgically. However, when surgery is not possible, gallstones are removed through biliary endoscopy.

 

Gallbladder stones, in which cases should they be treated?

Gallbladder stones should be treated if they are symptomatic or have complications such as acute cholecystitis or acute pancreatitis. In addition, even if there are no symptoms, preventive treatment may be indicated. First, the gallbladder wall is calcified. Studies have shown that about one-third of these patients develop gallbladder cancer, and if detected, prophylactic cholecystectomy is performed. Second, cholecystectomy may be performed in pediatric patients or patients who are highly concerned about gallbladder cancer. Third, the size of the gallstones is large. Studies have shown that if the size of the gallstones is more than 3 cm, the incidence of gallbladder cancer increases by more than 10 times. Although there is no sufficient evidence of the association between gallstones and gallbladder cancer, prophylactic cholecystectomy is performed for gallstones larger than 2.5~3cm. Fourth, even if gallbladder gallstones are co-occurring with gallbladder polyps or cholecystic adenomyomatosis, prophylactic cholecystectomy should be performed in consideration of the incidence of gallbladder cancer.

    

Bile duct gallstones, an emergency medical condition that can lead to death

Bile duct choleliths (common bile duct cholelithsia) are cholelithiasis that occurs on the path of bile ducts, where bile produced by the liver goes down to the intestines. Gallstones block the flow of bile, which can damage the liver and cause cholangitis. In addition, if it persists for a long time, it can cause cirrhosis of the liver and bile duct cancer, so even if there are no or mild symptoms, it must be treated.

In particular, if gallstones severely block the bile ducts, it is an emergency disease in the medical field that can lead to death if prompt treatment is not provided. In the past, surgical treatment was mainly used, but endoscopic treatment based on endoscopic papillary sphincterotomy, introduced in the mid-1970s, has resolved more than 90% of common bile duct gallstones.

 

A precise examination method that observes the bile ducts, gallbladder, and pancreatic ducts, 'Endoscopic retrograde cholangiopancreatography'

Cholangiogallstones can be cured with endoscopic treatment. Bile duct gallstones do not require surgical treatment. Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure to remove bile duct gallstones. The patient will undergo the procedure under a sleep endoscopy, and the endoscope will be inserted into the duodenum through the mouth in the same way as gastroscopy.

When the endoscope reaches the nipple, which is the entrance to the bile duct in the duodenum, the nipple is incised with an endoscopic knife to create a passage for various instruments to enter the bile duct. Afterwards, use baskets, baluns, and gallstone crushers to crush or remove gallstones. Patients are able to eat and return to their daily routine 24 hours after the endoscopic procedure (ERCP). Endoscopic retrograde cholangiopancreatography is a rather difficult procedure compared to general gastrointestinal endoscopy, and the doctor's abundant experience and excellent technology are essential for success.

 

Laparoscopic cholecystectomy to remove gallbladder stones

Laparoscopic cholecystectomy is performed by making a hole in the abdomen with special equipment such as a laparoscope and a camera-monitor device that can replace the surgeon's eye, a long and elongated surgical instrument designed to be operated in the abdominal cavity through a trocar, unlike conventional surgical instruments used by hand, and a carbon dioxide gas injection device for surgery and visibility.

The only difference is that it does not open the stomach, but the procedure performed in the abdominal cavity is the same as laparotomy. For surgery, carbon dioxide is first injected into the abdominal cavity to create relief.After that, a total of 4 trocars, one each in the navel, right abdomen, pubic tooth, and right abdomen, are inserted and surgery is performed, and laparoscopy is inserted through the navel.

Advances in surgical techniques and instruments have led to advances in cosmetic aspects, from the initial surgery with four trocars, to three trocars in some patients, and to the single-hole surgery through the navel in some young women.

 

Tip: In this case, suspect gallstone disease

• Frequent feeling of exhaustion.

• It is uncomfortable to eat when it gets in.

• Repeated pain in the pubic or right right abdomen.

• Pain radiating to the back and right shoulder.

• Recurrent body aches, such as chills and low-grade fever.

• Repetitively elevated levels of liver function without cause.

• Even though there is nothing wrong with the gastroscopy, the stomach hurts frequently.

[Help-Prof. Kwang-ro Joo, Department of Gastroenterology, Kyung Hee University Hospital, Gangdong, Prof. Sun-Sun Joo, Department of Surgery]