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Gallstones

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WHAT ARE THEY?

Abstract

VOL: 99, ISSUE: 44, PAGE NO: 25

 

WHAT ARE THEY?

 

- Gallstones are lumps of solid material in the gallbladder.

- They can be as small as grains of sand or as large as pebbles.
- Most are made up of cholesterol; others consist of calcium, chalk and red blood cells.

 

INCIDENCE

- One in 10 people develop gallstones or a gallbladder disease.

 

- Incidence is highest in the following groups (British Liver Trust, 2002):

 

- Overweight women;

 

- Women who have been pregnant;

 

- People who have recently lost weight.

 

SYMPTOMS

- Pain can vary from mild to severe; persistent pain felt just below the right ribs can spread to the side and shoulder blade. It may begin after a fatty meal or at night and may be relieved by walking.

 

- Jaundice develops when the bile duct is blocked by a stone. The skin and whites of the eyes become yellow and eventually the urine darkens and stools become pale.

 

- A sudden chill with severe shivering and a high temperature similar to flu is a sign of infection and requires urgent medical attention.

 

DIAGNOSIS

- Initial examinations include palpation of the abdomen to check for swelling of the liver or tenderness of the gallbladder, and a urine sample to check for signs of jaundice.

- Most stones can be seen clearly on an ultrasound scan.

 

- Endoscopic retrograde cholangiopancreatography (ECRP) gives a detailed X-ray of the pancreas and bile ducts.

 

- Oral cholecystogram involves swallowing tablets that contain a contrast dye that will show up in the gallbladder. An X-ray will then show any gallstones and indicate whether the gallbladder is functioning properly.

 

- Cholescintigraphy (HIDA scan) uses an injection of a minute dose of radioactive material to highlight gallstones or other structures.

 

COMPLICATIONS

- Smaller stones can lodge in the outlet of the gallbladder, causing painful biliary colic. Frequent attacks can cause cholecystitis (inflammation and scarring of the gallbladder).

 

- If gallstones enter the bile duct and block the flow of bile they may cause jaundice and cholangitis (inflammation of the bile ducts).

 

- If stones pass into the intestine they can temporarily obstruct the flow of digestive juices from the pancreas, resulting in acute pancreatitis, which can be life-threatening.


 

TREATMENT
- Asymptomatic gallstones are often left untreated.

 

- Laparoscopic removal of the gallbladder (cholecystectomy) is the most usual treatment for symptomatic gallstones.

 

- Stones that have passed into the bile duct and cause infection or jaundice are sometimes removed during an ERCP examination by using diathermy to widen the opening to the bile duct. The stones are removed or left to pass into the intestine. Sometimes a temporary or permanent stent is left in the bile duct to help drain bile.


- Other treatments such as dissolving stones with drugs or breaking them up with shock-wave treatment are now used only occasionally.

 


 

 

 

 

 

FURTHER READING
Hallett, A. (2000)Patients requiring gastrointestinal surgery. In: Punder, R. (ed) Nursing the Surgical Patient. Edinburgh: Bailli[ap10]re Tindall.

Hibberts, F., Barnes, E. (2003)The use of endoscopic retrograde cholangio pancreatography. Nursing Times; 99: 20, 26-27.

 

 

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