![Gastro New.png](https://static.wixstatic.com/media/95e422_f33ef2dd545e45f5a793d1d57088b5bb~mv2.png/v1/fill/w_274,h_245,al_c,q_85,usm_0.66_1.00_0.01,enc_auto/Gastro%20New.png)
Dr. Aravind P.S.
MBBS, MS (General Surgery), M.Ch. (Surgical Gastroenterology), FMAS, FIAGES
Consultant Surgical Gastroenterologist
Laparoscopic Surgeon
Laser Surgeon
GI & HPB OncoSurgeon
Gall bladder & cbd stones
![jaundice20210502_165135.png](https://static.wixstatic.com/media/95e422_0a8c7d2feb774537a3fd5e47ed37d632~mv2.png/v1/fill/w_193,h_193,al_c,q_85,usm_0.66_1.00_0.01,enc_auto/jaundice20210502_165135.png)
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Gall bladder is a pear shaped organ, situated below the liver
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Gall Bladder concentrates the bile and releases into the duodenum at the time of food intake, which helps in fat digestion
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Cystic duct of the gallbladder joins the common hepatic duct to form common bile duct (CBD)
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CBD joins the pancreatic duct at the lower end to finally enter into the 2nd part of duodenum
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Gallbladder and CBD stones are the common benign biliary tract disorders
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Gallbladder stones can be cholesterol stones, pigment stones or mixed stones
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CBD stones can be primary or secondary (passed down stones from gallbladder)
Cholelithiasis v/s Choledocholithiasis
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Gallbladder stones are also known as cholelithiasis
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CBD stones are also known as choledocholithiasis
Why stones are formed in gallbladder?
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Stones are formed in gallbladder whenever there is
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Increased cholesterol, bilirubin or calcium in bile
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Decreased bile salts in bile (which helps in stone dissolution)
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Gallbladder stasis or dysmotility ( prolonged bile stasis in gallbladder results in stone/sludge formation)
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What is incidental gall stone disease?
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When gall stones are detected (without symptoms) by imaging done for other reasons
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For eg.- detection of gallstones by ultrasonography (USG) done for kidney evaluation
What are the symptoms of Gall stone disease?
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Pain in right upper quadrant of abdomen which may radiate to back
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Nausea/vomiting
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Fever
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Jaundice ( due to complications)
Symptomatic v/s Asymptomatic Cholelithiasis
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Gallstones with symptoms is called as "symptomatic cholelithiasis"
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Gallstones without symptoms is called as "asymptomatic cholelithiasis"
I have incidentally detected gall bladder stones on USG. What should I do?
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Not all incidentally detected or asymptomatic gallstones require treatment
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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?
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Age > 40 years
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Females ( 2 to 3 times higher than males)
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Obesity
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Sedentary life style etc.
Can gallstones be treated by medications?
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No
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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?
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Cholecystectomy ( Surgical removal of gallbladder )
Laparoscopic or open cholecystectomy?
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Laparoscopic cholecystectomy is the standard of care at present with the added advantages of laparoscopic surgery
![IMG_20200225_130248_edited_edited_edited](https://static.wixstatic.com/media/95e422_0fc4519ec338442d94ec065849d7a787~mv2.jpg/v1/fill/w_176,h_135,al_c,q_80,usm_0.66_1.00_0.01,enc_auto/IMG_20200225_130248_edited_edited_edited.jpg)
What are the commonly done tests for Gall bladder/CBD stones?
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Blood test - LFT ( Bilirubin, albumin, AST, ALT, ALP, GGT) , PT/INR
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Imaging -
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Ultrasonography
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MRI scan
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EUS (Endoscopic Ultrasonography)
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CT scan
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![IMG20180628125716_edited_edited.jpg](https://static.wixstatic.com/media/95e422_9c10481a0e07410aa56ef967a9d65916~mv2.jpg/v1/fill/w_136,h_187,al_c,q_80,usm_0.66_1.00_0.01,enc_auto/IMG20180628125716_edited_edited.jpg)
In which conditions patients with asymptomatic gall stone disease need to undergo surgery?
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Sickle cell disease
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Prolonged Total parental nutrition requirement
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Chronic immunosuppression
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No immediate access to health care facilities (e.g. military personnel etc)
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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
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Cholecystitis - inflammation of gall bladder
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Gangrenous cholecystitis - gangrenous changes in the wall of gall bladder
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Perforation of gall bladder
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CBD stones & cholangitis - Gall bladder stones may spill into the CBD and cause obstruction resulting in pain, fever & jaundice
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Biliary pancreatitis- stone spillage into the lower end of CBD causing obstruction of pancreatic duct
![shutterstock_536786626.jpg](https://static.wixstatic.com/media/95e422_0b46acd56f8f4dfcaba944ecb296f19d~mv2.jpg/v1/fill/w_268,h_221,al_c,q_80,usm_0.66_1.00_0.01,enc_auto/shutterstock_536786626.jpg)
What are the symptoms of CBD stones?
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Pain
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Fever
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Jaundice
![2019-08-09-22-55-28.jpg](https://static.wixstatic.com/media/95e422_7aff7fb145fd4cca9abdcd1c84d2c260~mv2.jpg/v1/fill/w_209,h_128,al_c,q_80,usm_0.66_1.00_0.01,enc_auto/2019-08-09-22-55-28.jpg)
Does asymptomatic CBD stone require treatment?
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Yes. Unlike asymptomatic gall stone disease all CBD stones require treatment
What are the treatment options for CBD stones?
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Endoscopic removal (ERCP)
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Surgery ( Laparoscopic or open)