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Gall bladder & cbd stones

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  • Gall bladder is a pear shaped organ, situated below the liver

  • Gall Bladder concentrates the bile and releases into the duodenum at the time of food intake, which helps in fat digestion

  • Cystic duct of the gallbladder joins the common hepatic duct to form common bile duct (CBD)

  • CBD joins the pancreatic duct at the lower end to finally enter into the 2nd part of duodenum

  • Gallbladder and CBD stones are the common benign biliary tract disorders 

  • Gallbladder stones can be cholesterol stones, pigment stones or mixed stones

  • CBD stones can be primary or secondary (passed down stones from gallbladder)

Cholelithiasis v/s Choledocholithiasis

  • Gallbladder stones are also known as cholelithiasis 

  • CBD stones are also known as choledocholithiasis

Why stones are formed in gallbladder?

  • Stones are formed in gallbladder whenever there is 

    • Increased cholesterol, bilirubin or calcium in bile

    • Decreased bile salts in bile (which helps in stone dissolution)

    • Gallbladder stasis or dysmotility ( prolonged bile stasis in gallbladder results in stone/sludge formation)

What is incidental gall stone disease?

  • When gall stones are detected (without symptoms) by imaging done for other reasons 

  • For eg.- detection of gallstones by ultrasonography (USG) done for kidney evaluation

What are the symptoms of Gall stone disease?

  • Pain in right upper quadrant of abdomen which may radiate to back

  • Nausea/vomiting

  • Fever

  • Jaundice ( due to complications)

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Symptomatic v/s Asymptomatic Cholelithiasis

  •  Gallstones with symptoms is called as "symptomatic cholelithiasis"

  • Gallstones without symptoms is called as "asymptomatic cholelithiasis"

I have incidentally detected gall bladder stones on USG. What should I do?

  • Not all incidentally detected or asymptomatic gallstones require treatment

  • However, there are some conditions which needs treatment even in the absence of symptoms

What are the risk factors for the development of gall stones?

  • Age > 40 years

  • Females ( 2 to 3 times higher than males)

  • Obesity

  • Sedentary life style etc.

Can gallstones be treated by medications?

  • No

  • Certain stone dissolving drugs which are used are associated with high incidence of side effects and recurrence of stones after stoppage

What is the treatment of symptomatic gallstone disease?

  • Cholecystectomy ( Surgical removal of gallbladder ) 

Laparoscopic or open cholecystectomy?

  • Laparoscopic cholecystectomy is the standard of care at present with the added advantages of laparoscopic surgery

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What are the commonly done  tests for Gall bladder/CBD stones?

  • Blood test - LFT ( Bilirubin, albumin, AST, ALT, ALP, GGT) , PT/INR

  • Imaging -

    • Ultrasonography

    • MRI scan

    • EUS (Endoscopic Ultrasonography)

    • CT scan

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In which conditions patients with asymptomatic gall stone disease need to undergo surgery?

  • Sickle cell disease

  • Prolonged Total parental nutrition requirement

  • Chronic immunosuppression

  • No immediate access to health care facilities (e.g. military personnel etc)

  • At the time of abdominal surgery for other conditions

What are the complications of gall bladder stones?

Patients with gall stones especially if symptomatic are prone for complications 

  • Cholecystitis - inflammation of gall bladder​

  • Gangrenous cholecystitis - gangrenous changes in the wall of gall bladder

  • Perforation of gall bladder

  • CBD stones & cholangitis - Gall bladder stones may spill into the CBD and cause obstruction resulting in pain, fever & jaundice

  • Biliary pancreatitis- stone spillage into the lower end of CBD causing obstruction of pancreatic duct

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What are the symptoms of CBD stones?

  • Pain

  • Fever

  • Jaundice

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Does asymptomatic CBD stone require treatment?

  • Yes. Unlike asymptomatic gall stone disease all CBD stones require treatment

What are the treatment options for CBD stones?

  • Endoscopic removal (ERCP)

  • Surgery ( Laparoscopic or open)

​Photo Gallery 

Discussion 

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