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| Gallstones, Definition, Symptoms, Causes, Diagnosis, Treatment, Prevention, Complications |
Definition of Gallstones
Gallstone disease or cholelithiasis is a condition characterized by sudden abdominal pain due to the formation of stones in the gallbladder. Gallstone disease can also occur in the bile ducts.
The gallbladder functions to produce and store bile, which plays an important role in the digestive process, including digesting cholesterol from the food consumed. Most gallstones come from cholesterol deposits that harden and form stones.
Cholelithiasis (cholelithiasis) is generally mild and does not require hospitalization. However, if gallstones block the bile ducts, treatment efforts need to be done immediately to prevent complications.
Causes and Symptoms of Gallstone Disease
Gallstones are thought to arise due to deposits of cholesterol and bilirubin in the gallbladder. These deposits occur due to bile not being able to dissolve cholesterol and excess bilirubin produced by the liver.
The main symptom of gallstones is pain in the upper right or middle part of the abdomen that appears suddenly. Abdominal pain can also be accompanied by other symptoms, such as nausea, vomiting, loss of appetite, dark urine, heartburn, and diarrhea.
Immediately consult a doctor if you experience the above symptoms, especially if accompanied by fever, chills, jaundice, or abdominal pain that lasts more than 8 hours.
Gallstone Disease Treatment and Prevention
Treatment methods for gallstones include surgical removal of the gallbladder (cholecystectomy) or medications. However, drug administration is rarely done because it is less effective in treating gallstones.
Cholelithiasis can be prevented by eating foods high in fiber and avoiding coconut milk or oily foods. Other prevention efforts that can be done are limiting the consumption of alcoholic beverages, exercising regularly, increasing fluid consumption, and avoiding diets that are too strict.
Causes of Gallstones
The cause of gallstone disease or cholelithiasis is not known with certainty. However, high levels of cholesterol and bilirubin in the gallbladder are thought to be the main cause of gallstone formation.
This condition occurs because bile cannot dissolve excess cholesterol and bilirubin produced by the liver. As a result, cholesterol and bilirubin are deposited in the gallbladder. Over time, these deposits become crystalline flakes which then form gallstones.
The formation of gallstones is also influenced by several factors, namely:
- Age 40 years and over
- Obesity
- Pregnant women, as well as women who have had children or are undergoing estrogen hormone therapy
- Consumption of high-cholesterol, high-fat and low-fiber foods
- Drastic weight loss
- Family history of gallstones
- Diabetes
- Liver disease, such as cirrhosis
- Blood disorders, such as leukemia or sickle cell anemia
- Digestive disorders, such as Crohn's disease and irritable bowel syndrome
- Taking cholesterol-lowering drugs
Symptoms of Gallstones
Gallstones or cholelithiasis generally do not cause symptoms. However, symptoms may appear if gallstones cause the bile duct to become blocked.
The main symptom of gallstone disease is pain in the upper right or middle part of the abdomen that can spread to other parts of the body, such as the shoulder and shoulder blade. This abdominal pain appears suddenly and can last from a few minutes to hours. Pain can appear and disappear without being affected by any condition.
In addition to abdominal pain, other symptoms can occur if the blockage of the bile duct interferes with the function of other organs, such as the pancreas or small intestine. Symptoms that may appear include:
- Nauseous
- Vomit
- Gastric pains
- Bloated
- Loss of appetite
- Diarrhea
When to go to the doctor
Immediately consult a doctor if you experience abdominal pain suddenly and accompanied by other symptoms that have been mentioned above. Examination by a doctor needs to be done to determine the cause and determine the appropriate treatment method.
Immediately go to the nearest hospital if you have a high fever accompanied by chills, jaundice, and severe abdominal pain that lasts more than 8 hours. In this condition, treatment needs to be given immediately to avoid complications.
As mentioned earlier, obesity is one of the triggering factors for cholelithiasis. If you are overweight, discuss with your nutritionist about diet to lose weight. You are also advised to exercise regularly to get the ideal body weight.
Gallstone Diagnosis
At the initial stage of the examination, the doctor will ask the symptoms that appear and perform a physical examination of the patient. During a physical examination, the doctor will ask the patient to take a deep breath, then press on the right upper abdomen. If it hurts, the patient is suspected of having inflammation in the gallbladder.
The doctor will also check for signs of jaundice by looking for yellowing of the eyes and skin. After that, to determine the severity of gallstones, the doctor will perform a follow-up examination, namely with the following scans:
- abdominal ultrasound
- CT scan
- MRI
- Endoscopic retrograde cholangio-pancreatography (ERCP)
In addition to scans, blood tests can also be done to detect possible diseases caused by gallstones, such as pancreatitis.
Gallstones Treatment
Treatment of gallstones depends on the presence or absence of symptoms. In patients who do not experience symptoms, medical treatment is not necessary because gallstones can pass along with the urine. However, the doctor will still monitor the progress of the patient's symptoms.
If symptoms appear, especially pain in the upper right part of the abdomen, the doctor will take action to manage the symptoms and prevent complications. Treatment methods include:
Operation
The doctor will perform surgery to remove the gallbladder. This operation is known as a cholecystectomy procedure (cholecystectomy).
Cholecystectomy is divided into two types, namely laparoscopic cholecystectomy and open cholecystectomy.
- Laparoscopic cholecystectomy
- This method of removing the gallbladder is done using a laparoscope, which is a thin tube equipped with a camera and light. This method is also known as 'keyhole surgery'.
- Open cholecystectomy
- An open cholecystectomy is performed if the laparoscopic method cannot remove the gallbladder, for example because the patient is pregnant, obese, or because the gallbladder is difficult to reach.
During a cholecystectomy, the surgeon may also explore the bile ducts to see which stones are blocking the bile ducts.
Although they no longer have a gallbladder, the patient can still function normally. This is because removal of the gallbladder will not affect the body's ability to digest food. Patients will only urinate more often and experience mild diarrhea for some time.
Drugs
Medications are used if the gallstones are small and the patient has mild symptoms, or if the patient's condition is unlikely to undergo surgery, for example due to morbid obesity.
The drug most often given is ursodeoxycholic acid. This medication helps dissolve gallstones through urine. However, drug administration is rarely done for the following reasons:
- It takes about 6-12 months to dissolve most gallstones
- Gallstones can reappear if the drug is stopped
- The drug can only be used for gallstones caused by cholesterol
- Medication can cause mild diarrhea
Gallstone Complications
If not treated immediately, gallstones can block the bile duct and trigger inflammation or infection of the gallbladder. This condition is known as acute cholecystitis or acute inflammation of the gallbladder.
Several other complications can also occur if gallstones are not treated immediately, namely:
- Cholangitis or inflammation of the bile ducts
- Acute pancreatitis or acute inflammation of the pancreas
- Gallstone ileus or intestinal blockage due to gallstones
- Sepsis
Gallstone Prevention
The best way to prevent gallstones or cholelithiasis is to adopt a healthy and balanced diet. Eat high-fiber foods and increase your fluid intake, at least 6-8 glasses per day. Eating small portions but regularly also helps the body digest food more easily.
You are also advised to avoid or limit the consumption of certain types of food, especially foods with high levels of saturated fat, such as:
- Coconut milk foods, such as rendang and vegetable ketupat
- Oily foods, such as fried foods
- Foods with peanuts, such as satay
- Butter-containing foods, such as cakes and biscuits
In addition to maintaining a healthy diet, the following steps can also be taken to prevent gallstones:
- Limiting consumption of alcoholic beverages
- Exercise regularly to prevent obesity
- Do not go on a diet that is too restrictive, because drastic weight loss can increase the risk of gallstones
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