Doss India - Gall Stones, Gall Bladder Surgery Treatment in Pune, Maharashtra

1
GALLSTONES
www.dossindia.com
2
Anatomy of gallbladder and extrahepatic biliary
tree

• Bile
• Helps the body digest fats
• Made in the liver
• Stored in the gallbladder until the body needs it
• Contains
• Water
• Cholesterol
• Bile pigments
• Phospholipids
• Bicarbonate
• Anions of the bile acids
• Concentrations vary - different kinds of stones
  may be formed

www.dossindia.com
3
What are gallstones?

• Small, pebble-like substances
• Multiple or solitary
• May occur anywhere within the biliary tree
• Have different appearance - depending on their
  contents

www.dossindia.com
4
Pigment stones

• Small
• Friable
• Irregular
• Dark
• Made of bilirubin and calcium salts
• Less than 20 of cholesterol
• Risk factors
• Haemolysis
• Liver cirrhosis
• Biliary tract infections
• Ileal resection

www.dossindia.com
5
Cholesterol stones

• Large
• Often solitary
• Yellow, white or green
• Made primarily of cholesterol (gt70)
• Risk factors
• 4 F
• Female
• Forty
• Fertile
• Fat
• Fair (5th F - more prevalent in Caucasians)
• Family history (6th F)

www.dossindia.com
6
Mixed stones

• Multiple
• Faceted
• Consist of
• Calcium salts
• Pigment
• Cholesterol (30 - 70)
• 80 - associated with chronic cholecystitis

www.dossindia.com
7
Complications of gallstones

• In the GB
• Biliary colic
• Acute and chronic cholecystitis
• Empyema
• Mucocoele
• Carcinoma
• In the bile ducts
• Obstructive jaundice
• Pancreatitis
• Cholangitis
• In the gut
• Gallstone ileus

www.dossindia.com
8
Symptoms

• Pain in the RUQ
• Most common and typical symptom
• May last for a few minutes to several hours
• Mostly felt after eating a heavy and high-fat
  meal
• Pain under right shoulder when lifting up arms
• Fever, nausea and vomiting
• Jaundice (obstruction of the bile duct passage)
• Acute pancreatitis (gallstone enters the duct
  leading to pancreas and blocks it)

www.dossindia.com
9
Diagnosis

• Ultrasound
• Most sensitive and specific test for gallstones
• Computerized tomography (CT) scan
• May show gallstones or complications, such as
  infection and rupture of GB or bile ducts

Cholescintigraphy (HIDA scan) Used to diagnose
abnormal contraction of gallbladder or
obstruction of bile ducts

• Endoscopic retrograde cholangiopancreatography
  (ERCP)
• Used to locate and remove stones in bile ducts
• Blood tests
• Performed to look for signs of infection,
  obstruction, pancreatitis, or jaundice

www.dossindia.com
10
Treatment

• Surgery Cholecystectomy (gallbladder removal)
• 5 - 40 of patients develop postcholecystectomy
  syndrome (gastrointestinal distress and
  persistent pain in the RUQ)
• 20 of patients develop chronic diarrhea
• Two surgical options
• Open cholecystectomy
• Laparoscopic cholecystectomy

www.dossindia.com
11
Treatment

• Nonsurgical treatment
• Only in special situations
• When a patient has a serious medical condition
  preventing surgery
• Only for cholesterol stones
• Oral dissolution therapy
• Ursodeoxycholic acid - to dissolve cholesterol
  gallstones
• Months or years of treatment may be necessary
  before all stones dissolve
• Contact dissolution therapy
• Eexperimental procedure
• Iinvolves injecting a drug directly into the
  gallbladder to dissolve cholesterol stones

www.dossindia.com
12
Contact Us
Dr. Satish Pattanshetti M.S ( Gen. Surg ) , F M A
S Fellowship in Bariatric and Metabolic Surgery
(Taiwan) Consulting Laparoscopic General
Surgeon Bariatric Metabolic Surgeon Specialist
in Single port Laparoscopic Surgery
Dr. Neeraj V Rayate Director and Principal
Surgeon Dr Neeraj Rayate is a GI and General
surgeon with expertise is laparoscopic and
robotic surgery for gastro-intestinal diseases
and bariatric surgery. After completing his
medical education in India. He has also completed
a fellowship in Gynecological Endoscopy from the
Giessen School of Endoscopic Surgery in Germany.
Dr. Rayate has special interest in
Hepatopancreatobiliary surgery and
gynecolological oncology.
www.dossindia.com