Gallstones: the silence that can bring misery

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They're often called "˜silent' stones as they remain unnoticed in the bile ducts until detected by stabbing pain or through a routine ultrasound examination

A woman who just had gallstones removed at a Ho Chi Minh City hospital. Photo by Thanh Tung   A diagram of gallbladder and gallstones. PHOTO: WEBMD

Tuoi Tre (Youth) newspaper late last month published a story by Dr. Nguyen Quang Huy, director of People's Hospital 115's General Surgery Department, about an old man who has lived with recurring gallstones since he was 52 years old.

The man first reported acute pain in the upper right part of the abdomen beneath the ribs, before it spread to the right shoulder and eventually throughout the abdomen.

It was most noticeable when he was moving or lying on his right side. He thought he had stomach pain and treated it at home, until his skin turned yellow some time later.

Doctors in the surgical department diagnosed the man with gallstones lodged in the common bile duct, which carries bile from the gallbladder into the small intestine.

They used endoscopic retrograde cholangio-pancreatography (ERCP) to put an endoscope into the common bile duct and to find and remove or break apart the gallstones.

The patient seemed to get over the disease but it came back three more times between five years and eighteen months ago, so the doctors used the ERCP again.

More than a month ago, he returned to the hospital for more ERCP but the stones were too big and hard to break, so open surgery was performed to take them out. 

Gallstone disease, or cholelithiasis, is one of the most common digestive disorders in the world; and despite its silent progress, it can lead to life-threatening complications to the gallbladder, common bile duct and even liver without timely treatment, doctors warn.

The stones emerge when the bile produced by the liver and stored in the small and pear-shaped gallbladder solidify into crystals. Bile is a fluid released by the gallbladder through the common bile duct into the small intestine to help digest fat.

The stones can be as small as a grain of sand or as big as a golf ball, hard or soft, smooth or jagged.

When they form in the gallbladder, they probably do not hurt in that organ. The problem is that they can migrate and clog the common bile duct, the cystic duct through which the gallbladder passes bile into the common bile duct, and hepatic ducts which carry bile from the liver to the gallbladder, causing abdominal pain when the gallbladder contracts against the stones.

The obstructions can also cause the ducts to get inflamed and even infected. Other symptoms include fever, jaundice and indigestion. 

Women are more likely to develop the disease than men as estrogen, a hormone produced in the ovaries, raises the level of cholesterol in the bile. The chances of developing gallstones also increase by age and they are more common among people over 60.

Also at risk are those who have obesity, diabetes, rapid weight loss or women who have given birth several times, take hormone replacement therapy or birth control pills as these increase the cholesterol in bile and reduce the gallbladder's movement.

Their prevalence also varies among countries and peoples, doctors say.

Huy from People's Hospital 115 in Ho Chi Minh City added that sedentary office workers, those who undergo stomach or intestine-removal surgery, are infected with worms (which sometimes migrate from the intestines to the biliary system), and those who eat at night, have irregular meals or meals with too much fat, are at risk of developing gallstones.

According to doctors, 80 percent of gallstones are made of cholesterol while the rest are pigment stones.

Dr. Ho Van Cung, who used to work for a committee responsible for the physical welfare and security of government workers in Long An Province, said cholesterol stones form when cholesterol concentration in the bile is too high for the bile salts to dissolve, and the excessive cholesterol crystalizes. This type of gallstone is pale yellow, often stays separately and does not block X-rays.

Cung said cholesterol stones are often connected with aging, or caused by food with high cholesterol content like animal fat, multiple pregnancies, complications from certain digestive disorders, or excessive use of some certain medicines.

Pigment stones, on the other hand, form as bilirubin (a substance produced in the liver) in the bile increases, or if a bile duct is infected, he said. They are dark in color, often cluster together, and block X-rays.

He said gallstones make bile stagnant, prevent the small intestine from getting enough bile to digest food properly, and generally weaken the digestive system. They also damage the bile ducts.

Cung said a scientific diet with enough meals and sufficient nutrition can help prevent gallstones.

People should limit fat in their diet as it causes poor and irregular supply of bile to the intestine, stimulates the gallbladder to contract strongly, and contains much cholesterol. Indeed, they should go easy on food rich in cholesterol such as egg yolk, heart, liver and brains.

Instead they should eat fruit and vegetables to supply the body with fiber and vitamins B and C to aid digestion and prevent constipation, and eat bile-boosting food like turmeric and lime leaves.

Lots of protein is also recommended as it aids the regeneration of damaged liver cells and wards off hepatocyte steatosis. 

So that the gallbladder contracts gently, daily food intake should include easily digestible fats like butter, chicken and duck fat. Raw herbal oil is fine too.

Exercise is also a good idea as it helps reduce bile stagnancy, improve digestion, and thus reduce the likelihood of gallstones considerably, Cung said.

Many doctors say gallstones should be treated only when the symptoms arise. If they keep recurring, the best treatment is to surgically remove the gallbladder as the liver can take over its functions if necessary.

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