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Gallstones in the bladder treatments and signs
The gallbladder is a reservoir in which bile accumulates, which is required, for example, when eating large amounts of fatty meat so that the food can be digested. However, gallstones can form in the gallbladder, which can sometimes migrate into the bile duct and block it. As a result, it can cause jaundice, extremely painful colic, and bile pain. If this happens, doctors recommend removing the entire gallbladder.
Gallstones - an overview
- The gallbladder is probably a relic from the times of hunters and gatherers. It stores bile so that it is available when consuming large amounts of high-fat food to speed up digestion.
- So-called gallstones can form in the gallbladder, which some people go unnoticed, but there is a risk that these stones can migrate out of the bile. If they get stuck in the bile ducts or other parts of the abdomen, this can lead to cramp-like pain - so-called colic.
- If gallstones have formed and / or have already caused colic, medicine advises the immediate surgical removal of the gallbladder.
- If the organ is not inflamed, this operation is now minimally invasive, which is extremely safe and now routine. In the case of severe inflammation of the gallbladder, on the other hand, only conventional surgery with a long cut across the abdominal wall will help. This requires a longer stay in the hospital and longer-term wound healing.
Function of the gallbladder
The gallbladder does not produce bile, but stores it, which is evolutionarily understandable. Our ancestors lived as hunters and gatherers for tens of thousands of years. If the hunt was successful, a lot of meat was ready to eat at once, if the hunt failed, there was hardly any meat for several weeks. The body needs a lot of bile, especially when a lot of fat meat has to be digested. It was important, therefore, if the hunters swallowed kilos of deer, bison or wild boar, not just having to produce the bile, but having it in stock.
Today people can do without the organ. If gallstones appear, the diet must be adjusted to avoid colic and jaundice. So there is no compelling reason to remove the gallbladder to remove the danger from the world.
Stones in the gallbladder
So-called stones can form in the gallbladder, as in the kidney. The size of the "semolina" ranges from the size of grains of sand to brownish lumps the size of chickpeas. Some people do not notice anything at all, but they penetrate these structures from the gallbladder and block vessels or transport routes in the body, triggering severe cramp-like pain, so-called colic. For those affected, this triggers the feeling of not being able to breathe. In addition, the pain migrates into the upper abdomen and the right shoulder. In this case, it is important to see a doctor immediately so that he can remove the gallbladder promptly.
According to studies, such gallstones are 25% genetic. Previous theories that gallstones arise from psychological stress and / or from a high-fat diet and lack of exercise have been scientifically refuted. Young slim women who eat a low-calorie diet, do not smoke and do not drink alcohol get gallstones just like old men with overweight who suffer from alcoholism and hardly get off the sofa.
Outdated theories about the supposed causes can even be dangerous. For example, a woman who suffered from recurrent colic in the 1980s and therefore went to the doctor several times reported that she told the doctor that she suspected her pain was due to gallstones. The doctor shook his head and said that a woman of the age and weight could not get gallstones. Months later she came to the emergency room with extreme cramp-like pain. The gallbladder had become dangerously inflamed, and only performing an emergency operation saved her life.
Bile acid and lecithin usually balance the water-soluble bile and the non-water-soluble cholesterol. Gallstones can also be caused by keeping extreme diets as the balance is disturbed and a cholesterol stone can form. Too little fluid intake, on the other hand, plays no role in the formation of gallstones, just like alcohol (in contrast to kidney stones).
When do gallstones become a problem?
Smaller stones can migrate into the bile duct, get stuck there and cause an infection. They have to be removed endoscopically from the intestine. When stones block the exit of the gallbladder, they usually cause colic with cramp-like pain that can radiate into the upper abdomen and even up to the right shoulder. Those affected should be taken to the doctor immediately so that the stones can be smashed as part of a biliary examination. In such cases, medicine advises to remove the gallbladder immediately.
Accumulated bile causes a so-called jaundice - symptoms of jaundice. Those affected are chronically exhausted, the white in the eyes turns yellow, as does the skin. Now there is a risk that the gallbladder becomes inflamed, which can quickly become dangerous.
Inflammation of the gallbladder
If the gallstones block the bile and cause inflammation, a clinic must be visited immediately. Symptoms for this are chronic signs of exhaustion and the said yellowing of the skin and eyes. Go to a hospital emergency room immediately if you experience these symptoms as sepsis can develop within a few days, which often goes unnoticed. Your skin continues to turn yellow, you become more and more exhausted, but you usually do not suffer from pain, but death occurs after a short time.
Initially, the immune system can still fix the inflammation by "bombarding" it with white blood cells. An abscess is formed from dead leukocytes. However, if the inflammatory values increase, the immune system can no longer limit the inflammation, causing sepsis in the abdomen. Today, such blood poisoning can be combated with high-dose antibiotics in the early stages, but in the progressive stage it leads to death. Immediate conventional surgery to drain the abscess and remove the gallbladder is necessary.
Removing the gallbladder - traditional methods
The older methods of removing the gallbladder are a surgical procedure - through a large incision in the skin, which is known as a "cholecystectomy". The second method is the "laparoscopic cholecystectomy" and requires many smaller skin incisions. An endoscope is used as a tool and both operations are performed under general anesthesia.
The second method has the advantage that the recovery phase is much shorter and patients can leave the hospital faster. However, this method is not suitable for all people, especially those who have already had an operation on the abdomen.
In the open procedure, the skin of the upper abdomen is incised so that the abdominal cavity can be reached to remove the bile. X-rays are sometimes examined to determine whether stones are “hiding” in the main bile duct. If this is the case, the passage is opened and the stones are removed. The bile flows out through a catheter, which is only removed days or weeks after the operation.
During a laparoscopic procedure, medical personnel release a certain gas into the abdominal cavity. Subsequently, various interventions can be undertaken with the endoscope, which was previously inserted through a single cut. The gallbladder is separated from the bile duct with the endoscope and removed. Stones in the main bile duct can also be removed with the laparoscopic instruments.
Risks and complications
Both methods are very safe. Risks such as Strokes Kidney failure, pneumonia and leg thrombosis usually occur with general anesthesia. Every surgical procedure has typical risks associated with penetration into the body. These include possible infections in the abdominal cavity or at the incision on the abdomen. In such a case, those affected have to take antibiotics over a long period of time or even have to be operated on again.
In the course of possible bleeding, it may be necessary to administer blood transfusions or to have surgery. In extremely rare cases, the liver, intestine and stomach as well as the bile duct can be damaged. The need for further surgery can also be triggered by abdominal wall perforations, in which the intestine presses against the weak inner abdominal wall.
What happens after the procedure?
Once the bile is removed, you will come to the recovery room and later to a normal room. Until you are able to eat and drink again on your own, the food is administered via an infusion. To prevent thrombosis, patients (together with clinic staff) should walk around the hospital as soon as they are able to do so. The discharge takes place after a few days. You should see your doctor immediately if you experience the following symptoms: fever, severe abdominal pain (a slight pulling or scratching after the procedure is normal), weakness, swelling or infection.
Abdominal mirroring is "gold standard"
The doctor Konstantinos Zarras describes the removal of the gallbladder by means of an abdominal mirroring as the gold standard today. In Germany, this intervention takes place 170,000 times a year. The cuts through which the tokars are inserted are tiny. The laparoscope, the largest token, has a diameter of just twelve millimeters and is inserted (for aesthetic reasons) over the umbilical cavity. The patient's abdominal cavity is inflated with carbon dioxide via the access in the navel and a camera with lighting is inserted using Tovar. The surgeons can now see exactly where the surgical instruments have to be placed on the camera image. These need a maximum of five mm thick locks. The stones are removed, the gallbladder is broken up and automatically inserted into the recovery bag.
Diet without a gallbladder
There is a conditional all-clear beforehand: Removing a gallbladder does not in any way put essential functions of the digestive system out of action, so that sufferers like diabetics are only allowed to eat certain things for a lifetime, otherwise they put their lives in danger. It is not so. Medicine today no longer makes any general recommendations as to which diet is suitable for living without a gallbladder. Some sufferers do not notice any change at all and others are sensitive to certain food that they could previously eat without any problems.
Since the organ is a reservoir that stores bile to be available when it is needed in large quantities to process plenty of fatty food, you should pay attention to this with French fries, gyros, grilled knuckle, grilled chicken and the like how you tolerate what you eat. Some sufferers report that they have to use the toilet faster and more frequently than before when eating such food.
So the body may no longer be able to digest extremely large amounts of food that is rich in fat and carbohydrates and on top of that, it takes longer. In this respect, according to the Greek menu with gyros and lamb chops, you do not have to reckon with cramps on the floor, but it may take longer for digestion than people who immediately replenish bile juice have in store. (Dr. Utz Anhalt)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- German Society for Gastroenterology, Digestive and Metabolic Diseases e.V. (DGVS): S3 guideline diagnosis and therapy of gallstones, as of November 2017, detailed guideline view
- Professional association of German internists e.V .: What are gallstones, their causes & risk factors? (Accessed: June 25, 2019), internisten-im-netz.de
- Institute for Quality and Efficiency in Health Care (IQWiG): Gallstones (accessed: June 25, 2019), gesundheitsinformation.de
- Herold, Gerd, Internal Medicine 2019, self-published, 2018
- German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS): Diagnostics and Therapy of Gallstone Disease, as of April 2018, dgvs.de
- German Society for Combating Diseases of the Gastrointestinal and Liver and Disorders of Metabolism and Nutrition (Gastro-Liga) e. V .: Guide to gallstones, as of January 2017, gastro-liga.de
ICD codes for this disease: K80ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.