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The highly skilled and well-trained general surgeons at Cedars-Sinai Marina del Rey Hospital care for patients with gallstones by providing an individualized treatment advice for each patient. They can choose from the various conservative and surgical treatment methods available.
The gallbladder is an organ situated just underneath the liver. It appears to be in the shape of a pear, and its major function is the storage of bile, which is produced by the liver, and is essential for the digestion of fats. During the process of digestion of our food, the gallbladder slowly releases bile through a tube called the common bile duct that connects the liver and gallbladder to the small intestine.
Gallstones develop when the substances in the bile become hard like a stone. A gallstone causes problems when it obstructs the passage of bile through the bile ducts. The symptoms of gallstones most commonly appear after a meal. Generally, most people remain unaware of their gallstones until they experience pain as a result of an obstructed bile duct. The size of a gallstone varies, and may be small as a sand grain or as big as a golf ball.
Most of the times, patients with gallstones require surgical treatment to get rid of their problem. The surgical removal of the gallbladder is called cholecystectomy, and it is the treatment of choice for gallstones. The surgical procedures followed by surgeons at Cedars-Sinai Marina del Rey Hospital include:
Laparoscopic cholecystectomy: In this procedure, the surgeon makes tiny incisions in the abdominal wall through which specialized instruments and a tube with a camera attached to its end is passed to reach the inner portion of the abdomen. The surgeon is able to visualize the internal organs on a video monitor. Laparoscopic cholecystectomy results in lesser pain and minimal downtime.
Robot-assisted laparoscopic surgery produces three-dimensional images of the internal structures.
Open cholecystectomy: The surgery is performed through a large incision made in the abdomen to remove the gallbladder. This results in more discomfort during healing and requires a longer stay in the hospital.
Sphincterotomy: This procedure is indicated in conditions where the gallstone gets caught within the hepatic or common bile ducts. It involves making a cut in the muscles of the common bile duct using an electrosurgical instrument at the place where it joins the duodenum to allow better access to the common bile duct. Then, the instruments that can grab and extract the gallstone may be passed into the hepatic and common bile ducts. Sometimes, a lithotripsy tool that makes use of high-frequency sound waves to crush the gallstone may be passed through the endoscope.
Gallstones are classified into the following types:
Usually, there will be no signs or symptoms until it is discovered on imaging tests done for other reason. If you do notice the symptoms, it may include:
As few symptoms of gallstones are similar to the symptoms of heart attack, it is important to derive an accurate diagnosis. The diagnostic tests that may be ordered to confirm the diagnosis of gallstones include:
Blood test: Helps to determine the signs of obstruction or an infection. It can also preclude other conditions.
Ultrasound examination: This involves trans-abdominal ultrasonography, and is one of the best diagnostic examinations to detect gallstones.
CT scan: These allow your doctor to see detailed images of the internal organs of your body, including your gallbladder.
Magnetic resonance cholangiopancreatography (MRCP): This test involves the use of a magnetic field and pulses of radio waves to create pictures of the internal organs of your body, including the liver and the gallbladder.
Cholescintigraphy (HIDA scan): This test is performed to check whether the gallbladder functions correctly or not. A harmless radioactive material is injected into the bloodstream, which then travels to reach the organ. The movement of this dye is then observed.
Endoscopic ultrasound: This test is a combination of ultrasound examination and endoscopy, and is done to check for gallstones.
Endoscopic retrograde cholangiopancreatography (ERCP): During this test, gallstones that have moved into the ducts can be removed. It involves insertion of an endoscope through your mouth and passing it further down to reach the small intestine. A special dye is injected that allows visualization of the bile ducts.
Oral Cholecystogram (OCG): In preparation for this test, you will be advised to take iodine-containing pills for one night or two continuously. The iodine gets absorbed from the intestine into the blood circulation. The liver removes iodine from the blood and excretes into the bile. The iodine along with the bile is present in higher concentration in the gallbladder. Iodine is used in this test as it is a dense, radio-opaque material, and helps outline the gallstones that are usually invisible on X-rays.
Intravenous Cholangiogram (IVC): In this test, an iodine-containing dye is injected into your bloodstream through your veins. Your liver will separate the dye from your blood and excretes it through the bile. The iodine is very much concentrated as it gets secreted into the bile, without requiring further concentration by the gallbladder in order to outline the bile ducts or to find any gallstones.
The following factors can increase the risk of developing gallstones:
Being obese: Obesity can lead to increased levels of cholesterol in your body, and decreased emptying of your gallbladder, which further accentuates your risk of developing gallstones.
Hormone replacement therapy or use of oral contraceptive pills for menopausal symptoms: A higher level of estrogen can increase the amount of cholesterol, and slow down the emptying of your gallbladder.
Conditions such as diabetes: Diabetic individuals may have higher levels of triglycerides, which can increase your risk of developing gallstones.
Medicines to lower your cholesterol: Some of these drugs may increase the concentration of cholesterol in the bile, which in turn increases your chances of forming cholesterol stones.
Rapid weight loss: This makes your liver produce extra cholesterol, which in turn may lead to gallstones.
The risk of developing gallstones is greater among women, people with a family history of gallstones, and in some ethnic backgrounds such as Native Americans, Mexican Americans.
There are several factors that play an important role in the etiology of gallstones, which include:
The composition of the bile can be a partial reason as your body requires bile, but when it has higher amounts of cholesterol in it, gallstones are more likely develop.
Acupuncture may be especially helpful in reducing your pain, spasm, aiding the easy flow of the bile, and restoration of proper liver and gallbladder function.
Certain clinical studies have shown the effectiveness of specific homeopathic remedies in the treatment of gallstones. A professional homeopathic doctor may recommend one or more of the following treatments for gallbladder disease depending on their knowledge and clinical experience. To suggest a remedy, homeopaths consider a person's constitutional type - your physical, emotional, and intellectual makeup. All these factors are assessed before prescribing the most appropriate remedy.
Some of the most common remedies include:
There is no defined method to prevent gallstones. However, you may reduce your risk of developing gallstones by taking the following precautionary measures:
Maintain a healthy weight: Always try to be close to normal weight, and if you want to lose weight, do it gradually over a period of time. Regain of lost weight increases your risk of gallstones. A favorable weight loss is 1lb (0.5 kg) to 1.5lb (0.7 kg) a week.
Eat regular, balanced meals: Eat at regular intervals, and avoid skipping meals. Meals should ideally have some amount of fat that eases gallbladder emptying, which can help prevent gallstones. Include lots of whole grains, vegetables containing fiber, and milk products in your daily diet.
Regular exercise: In addition to a healthy diet, regular exercise helps you maintain a normal weight, and lower your cholesterol and triglyceride levels. These measures in turn help in reducing your risk of gallstones.
Avoid medications that can increase your risk of forming gallstones: Some cholesterol-lowering drugs such as gemfibrozil and fenofibrate can increase your risk of developing gallstones. These medications will enhance the release of cholesterol in the bile, which leads to gallstone formation. If you are on such medications, your doctor will consider prescribing an alternate cholesterol-lowering medication.
Avoid hormone therapy such as estrogen following menopause and high-dose birth control pills as it increases a woman's risk of developing gallstones.
Dietary modifications: Here is some advice on dietary changes that could help you reduce the risk of developing gallstones:
Fat: Not all types of fats are bad. Monounsaturated fats such as olive oil and canola oil, and omega-3 fatty acids that are abundant in fish oils, flaxseeds, avocados, may decrease your risk of developing gallstones. Fish oil is very helpful in people with high levels of triglycerides as it helps in gallbladder emptying. Avoid the intake of saturated fats predominantly found in butter, fatty meats, and other animal products. These fats increase your chances of developing high cholesterol and gallstones. If you do want animal products included in your diet, you can choose low-fat alternatives such as low-fat yoghurt and lean chicken.
Fiber: Fiber is abundantly found in cereals, whole-grain bread, and certain vegetables. Dietary fibers help in losing weight and preventing gallstones.
Fruits and vegetables: Consumption of plenty of fruits and vegetables help in prevention of gallstones.
Nuts: Eating peanuts and other tree nuts (almonds and walnuts) is a healthy way to control hunger, which in turn helps lose weight and prevent gallstones.
Sugar: Avoid eating large amounts of sugar or choose low-sugar food alternates whenever possible.
Carbohydrates: Reduce your intake of carbohydrates as these get transformed into sugar in your body. A daily diet filled with higher amounts of pasta, white bread, and other foods rich in carbohydrates can increase your risk of forming gallstones.
Alcohol and coffee: Some studies suggest that drinking alcohol and coffee in moderate amounts may prevent gallstones.
If you believe that you are truly struggling with managing your weight and have problems with your gallbladder, talk to our general surgeons at Cedars-Sinai Marina del Rey Hospital. They will advise you about what can be done and guide you along through your path to good health.
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