How Do I Treat Gallstone Pain?

Gallstones are mainly found in adults, more women than men, and the incidence increases with age after age 40. The stones are cholesterol stones or cholesterol-based mixed stones and black bile pigment stones.

Basic Information

English name

cholecystolithiasis

Visiting department

Abdominal surgery

Multiple groups

Women over 40

Common causes

Caused by factors such as obesity, pregnancy, high-fat diet

Common symptoms

Abdominal pain after a full meal or greasy food, with nausea and vomiting

Causes of Gallstones

Gallstones are associated with many factors. Any factor that affects the ratio of cholesterol to bile acid concentration and causes bile stasis can lead to stone formation. Residents of individual regions and races, female hormones, obesity, pregnancy, high-fat diet, long-term parenteral nutrition, diabetes, hyperlipidemia, gastrectomy or gastrointestinal anastomosis, end-ileal disease and post-ileal resection, liver Sclerosis, hemolytic anemia and other factors can cause gallbladder stones. The incidence of gallstones in the northwestern region of China is relatively high, which may be related to dietary habits.

Gallbladder stones clinical manifestations

Most patients are asymptomatic and found only on physical examination and are called resting gallstones. The typical symptom of gallstones in some patients is biliary colic, which manifests as acute or chronic cholecystitis. The main clinical manifestations are as follows:

Biliary colic

Patients often suffer from gallbladder contraction or stone shifting and vagus nerve excitement after full meals, eating greasy food, or changing their posture during sleep. Stones are embedded in the ampulla or neck of the gallbladder. The gallbladder contracts strongly and causes colic. The pain is located in the right upper abdomen or upper abdomen, and is paroxysmal, or the paroxysmal aggravation of persistent pain can be radiated to the right scapula and back, and can be accompanied by nausea and vomiting. Some patients are unable to tell the pain exactly because of the pain. After the first occurrence of biliary colic, approximately 70% of patients will relapse within one year.

2. Right upper abdominal pain

Most patients only feel faint pain in the upper abdomen or right upper abdomen when they overeat, eat high-fat foods, work hard or have a bad rest, or have fullness, discomfort, belching, hiccups, etc., and they are easily misdiagnosed as "gastric disease".

3. Gallbladder fluid

When gallbladder stones incarcerate or block the gallbladder duct for a long time without co-infection, the gallbladder mucosa absorbs bile pigments in the bile. Mucus is secreted to form a gallbladder effusion. The effusion is transparent and colorless, also known as white bile.

4. Other

(1) Partially causes jaundice and is mild;

(2) Small stones can enter the common bile duct through the cystic duct and become common bile duct stones;

(3) Common bile duct stones are incarcerated in the ampulla through Oddi sphincter and cause pancreatitis, which is called biliary pancreatitis;

(4) Gallstone inflammation and chronic perforation due to stone compression can cause gallbladder duodenal fistula or gallbladder colon fistula. Large stones enter the intestine through the fistula and cause intestinal obstruction, which is called gallstone intestinal obstruction;

(5) Gallstones and long-term inflammation can induce gallbladder cancer.

5.Mirizzi syndrome

Mirizzi syndrome is a special type of gallbladder stones. Due to the long length of the gallbladder and common hepatic ducts or the low position of the confluence of the gallbladder and common hepatic ducts, the continual incarnation in the neck of the gallbladder and larger gallbladder stones compress the common duct Causes common hepatic duct stenosis, repeated gallbladder common duct fistula, gallbladder duct disappeared, stones partially or totally blocked the common hepatic duct. The clinical manifestations are recurrent cholecystitis and cholangitis, and obvious obstructive jaundice. Biliary imaging showed that the gallbladder may be enlarged, the common hepatic duct is dilated, and the common bile duct is normal.

Gallstone diagnosis

Based on a typical clinical history of colic, imaging can confirm the diagnosis. B-ultrasound is the first choice. It can be seen that there is a strong echo group in the gallbladder, which moves with the change of body position, and then there is sound shadow to diagnose the gallbladder stones. Only 10% to 15% of the gallbladder stones contain calcium, the abdominal X-ray can be diagnosed, and the lateral photograph can be distinguished from the right kidney stone. CT and MRI can also show gallbladder stones. But not as a routine check.

Gallstone Treatment

1. Laparoscopic cholecystectomy is preferred

Compared with the classic open cholecystectomy, the injury is less and the effect is exact. Asymptomatic gallbladder stones generally do not require active surgery and can be observed and followed up, but surgery should be considered in the following cases:

(1) Stone diameter 3cm;

(2) Combined surgery requiring laparotomy;

(3) polyps with gallbladder> 1cm;

(4) Thickening of the gallbladder wall;

(5) Calcification of gallbladder wall or porcelain gallbladder;

(6) Gallstones in children;

(7) Combined with diabetes;

(8) Cardiopulmonary dysfunction;

(9) Field workers in remote or underdeveloped areas;

(10) Gallbladder stones have been found for more than 10 years.

2. When performing cholecystectomy, common bile duct exploration should be performed in the following cases

(1) Preoperative medical history, clinical manifestations or imaging examinations confirm or highly suspect common bile duct obstruction, including obstructive jaundice, common bile duct stones, recurrent bile colic, cholangitis, and pancreatitis.

(2) The common bile duct is confirmed to have lesions during the operation, such as intraoperative biliary angiography or stones, tapeworms, and lumps in the common bile duct, and the common bile duct has a diameter of more than 1 cm, and the bile duct wall is significantly thickened. Thing. A bile duct puncture removes purulent, bloody bile, or silt-like bile pigment particles.

(3) Gallstones are small and may enter the common bile duct through the gallbladder duct. In order to avoid blind biliary exploration and unnecessary complications, cholangiography or choledochoscopy can be performed during surgery. Common bile duct exploration usually requires T-tube drainage, with certain complications.