How are gallstones treated
Recognize and treat gallstones
Every fifth person in Germany has gallstones. In the case of over 60-year-olds, it is even every second. Gallstone disease (cholelithiasis) occurs two to three times more often in women than in men. Most of those affected have no complaints. Your gallstones are discovered by chance during an ultrasound scan.
VIDEO: Gallstones: when is an operation necessary? (6 min)
Bile: important for the digestion of fat
The gallbladder lies below the liver, above the intestines, and next to the pancreas. It stores the digestive juice formed in the liver and thickens it. The bile mainly consists of water and dissolved substances such as cholesterol, bile acid and bile pigment (bilirubin). Every day the liver produces about half a liter of bile. The gallbladder stores around 50 milliliters of this. When you digest high-fat foods, the gallbladder contracts and pours out the bile through the bile duct into the first part of the small intestine, the duodenum. There, the bile dissolves the smallest droplets of fat from the food and thus enables fat to be digested.
What helps with gallstones?
Gallstones can cause severe pain in the upper abdomen. The surgeon Prof. Stephan M. Freys explains which therapies help. 5 min
Chat protocol: gallstone surgery
Gallstones are not only formed in the gallbladder, but also directly in the bile ducts - an underestimated danger. Gastroenterologist Jürgen Pohl answered questions in the visit chat. more
How gallstones are formed
Most gallstones arise in the gallbladder, less often in the bile duct. If the outflow of bile is disturbed and the fluid stagnates or the proportions of its components are not balanced, crystals can form and grow into stones. There are three types of gallstones:
- Cholesterol stones make up the largest part of gallstones in this country with around 80 percent. They form when the bile produced by the liver contains too much cholesterol. In addition, if the contraction of the gallbladder is disturbed, cholesterol crystals can form in the gallbladder and grow into larger stones within months or years. Studies show that every fourth person affected has a genetic predisposition for it. Obesity and lack of exercise promote the development of gallstones.
- Black pigment stones arise when there is too much of the bile pigment bilirubin. Bilirubin is produced when red blood cells (erythrocytes) break down.
- Brown pigment stones usually form in the bile ducts when bacteria have settled there. They come from the intestine and can be introduced through endoscopic interventions in the bile ducts.
Gallstone colic can become an emergency
Gallstones usually lie in the gallbladder for many years, cause no discomfort and do not require treatment. Only around 20 to 30 percent of those affected will have problems with their gallstones in their lifetime. Biliary colic is an extremely painful consequence. It occurs when a gallstone slips into the bile duct, obstructing the outflow of bile. Cramp-like, severe pain in the upper abdomen, which radiates into the back and shoulders, is typical. They usually last longer than 15 minutes and then subside by themselves or after the administration of anticonvulsant and pain reliever medication.
However, any biliary colic can become an emergency. The danger: if a stone completely blocks the outlet of the gallbladder, the back pressure leads to gallbladder inflammation (cholecystitis). This can cause the tissue to die and the gallbladder to burst.
Gallstones can migrate
If stones get stuck in the bile duct, the bile builds up in the liver and causes dangerous liver inflammation. Typical symptoms are pain in the upper abdomen, fever, and yellowing (jaundice) of the skin and eyes. Doctors speak of the so-called Charcot triad. The liver values in the blood are increased, and the ultrasound shows a thickening of the gallbladder wall.
If the stone blocks the joint opening of the bile duct and the pancreatic duct into the duodenum (papilla), there is a risk of life-threatening inflammation of the pancreas (acute pancreatitis) due to the backflow of bile.
Remove the gallbladder quickly if it is blocked
If gallstones have triggered colic, treatment guidelines advise removing the gallbladder with a laparoscopy. If the bile duct is blocked or the gallbladder is inflamed, the operation must be carried out quickly, preferably within 24 hours, to avoid complications.
Gallstones after removal of the gallbladder
Even if the gallbladder is removed, gallstones in the bile duct can cause discomfort. Sometimes stones in the bile duct are not found during the procedure. However, they can also re-form in the bile duct after the operation, as the bile is constantly being replicated in the liver. Without the gallbladder, there is no storage, but wherever there is bile, gallstones can still develop. If the bile stalls, crystals can form and develop into gallstones that lodge in the bile duct and cause pain.
Remove gallstones using ERCP
To remove gallstones from the bile duct, gastroenterologists use what is known as endoscopic retrograde cholangiopancreatography, or ERCP for short. Under anesthesia, they guide an endoscope through the mouth, esophagus and stomach into the duodenum, as in a gastroscopy. And then through the papilla into the bile duct. Here they release contrast media for the exact representation of the bile duct in the x-ray fluoroscopy in order to find the gallstone. Often this is stuck right in front of the exit of the bile duct to the small intestine.
Big stones are smashed
In order to get the stone out of the bile duct, the sphincter muscle of the papilla is cut. The gallstone is captured with a tiny basket and pulled out with the endoscope.
If a gallstone is too big to be pulled out with the collecting basket, it is shattered directly in the bile duct with the help of shock waves. The fragments can then be removed.
Medication can prevent relapses
If stones keep developing in the bile duct, the doctor can prescribe medication that affects the composition of the bile so that fewer stones are formed. However, the effectiveness is limited and does not work in all patients.
Adventure diagnosis: gallstones
The heavily pregnant Steffi M. suddenly got sharp pain in her stomach and had to vomit. A long search for the cause of the discomfort begins - it is gallstones. 14 min
Experts on the subject
Prof. Dr. Stephan M. Freys
Bremen Belly Center (BBZ)
DIAKO Ev. Diakonie-Krankenhaus non-profit GmbH
Gröpelinger Heerstrasse 406-408
Dr. Fabian Holbe
Specialist in General Medicine
Neuendorfer Weg 8e
Senior Physician Clinic for Internal Medicine
Sana Hanse Clinic Wismar
This topic in the program:
Visit | 07/21/2020 | 8:15 pm
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