"Batu Hempedu" a.k.a Gallstones...

Introduction 

Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. In most cases they do not cause any symptoms and do not need to be treated.

However, if a gallstone becomes trapped in a duct (opening) inside the gallbladder it can trigger a sudden intense abdominal pain that usually lasts between one and five hours. This type of abdominal pain is known as biliary colic.

The medical term for symptoms and complications related to gallstones is gallstone disease or cholelithiasis.

Gallstone disease can also cause inflammation of the gallbladder (cholecystitis). This can cause persistent pain, jaundice and a high temperature (fever) of 38°C or above.

In some cases, a gallstone can move into the pancreas, causing it to become irritated and inflamed. This is known as acute pancreatitis and causes abdominal pain that gets progressively worse, and sometimes life threatening.

The gallbladder

The gallbladder is a small, pouch-like organ situated underneath the liver. The main purpose of the gallbladder is to store and concentrate bile.

Bile is a liquid produced by the liver, which helps digest fats. It is passed from the liver through a series of channels, known as bile ducts, into the gallbladder.

The bile is stored in the gallbladder and over time it becomes more concentrated, which makes it better at digesting fats. The gallbladder is able to release bile into the digestive system when it is needed.

What causes gallstones

It is thought that gallstones develop because of an imbalance in the chemical make-up of bile inside the gallbladder. In most cases the levels of cholesterol in bile become too high and the excess cholesterol forms into stones.

Gallstones are very common. It is estimated that more than one in every 10 adults has gallstones, although only a minority of people will develop symptoms.

Gallstones are particularly more common in the following groups:

•women, particularly those who have had children

•overweight or obese people – people who are overweight with a body mass index (BMI) of 25 or above

•people aged 40 years or older (the older you are, the more likely you are to develop gallstones)

•people with cirrhosis (scarring of the liver)

•people with the digestive disorders Crohn’s disease and irritable bowel syndrome (IBS)

• patient with haemolytic blood disorders

•people with a family history of gallstones (around a third of people with gallstones have a close family member who has also had gallstones)

•people who have recently lost weight, either as a result of dieting or weight-loss surgery such as gastric banding, gastric bypass or sleeve gastrectomy.

•people who are taking a medication called ceftriaxone, which is an antibiotic used to treat a range of infections, including pneumonia, meningitis and gonorrhoea

 Women who are taking the combined oral contraceptive pill or undergoing high-dose oestrogen therapy (which is sometimes used to treat osteoporosis, breast cancer and the menopause) also have an increased risk of developing gallstones.

What Are the Symptoms of Gallstones?

Gallstones often don't cause symptoms. Those that don't are called "silent stones." A person usually learns he or she has gallstones while being examined for another illness.

When symptoms do appear, they may include:

• Pain in the upper abdomen and upper back; the pain may last for several hours.
• Nausea
• Vomiting
• Other gastrointestinal problems, including bloating, indigestion and heartburn, and gas

Continue reading below...How Are Gallstones Diagnosed?

If your doctor suspects you have gallstones, he or she will do a physical exam and may perform various other tests, including the following:

• Blood tests: Blood tests may be given to check for signs of infection or obstruction and/or to rule out other conditions.
• Ultrasound: This procedure produces images of various parts of the body and can be used to identify gallstones.
• CAT scan: This test uses specialized X-rays to create cross-section images of organs and body tissues.
• Magnetic resonance cholangiopancreatography (MRCP): This test uses a magnetic field and pulses of radio wave energy to get pictures of structures inside the body, including the liver and the gallbladder. 
• Endoscopic ultrasound: This test combines ultrasound and endoscopy to look for gallstones.
• Endoscopic retrograde cholangiopancreatography (ERCP): The doctor inserts an endoscope through the patient's mouth down to the small intestine and injects a dye to allow the bile ducts to be seen. The doctor can often then remove any gallstones that have moved into the duct

  Treating gallstones

Treatment is usually only necessary if gallstones are causing symptoms, such as abdominal pain, infections or acute pancreatitis.

In these cases, keyhole surgery to remove the gallbladder may be recommended. This procedure, known as a laparoscopic cholecystectomy, is relatively simple to perform and has a low risk of complications.

During this procedure, instruments, a light, and a camera are passed through several small incisions in the abdomen. The surgeon views the inside of the body by looking at a video monitor. This procedure is used in of the majority of gallbladder removals. After the surgery, the patient spends the night in the hospital, or sometimes patient can be allowed home on the same day.

 

You can lead a perfectly normal life without a gallbladder. The organ can be useful but it is not essential. Your liver will still produce bile to digest food, but the bile will just drip continuously into the small intestine, rather than build up in the gallbladder.

Outlook

Most cases of gallstone disease are easily treated with surgery. Very severe cases can be life-threatening, especially in people who are already in poor health, but deaths are rare.

Open cholecystectomy wound

"keyhole" cholecystectomy wound