How serious are gallstones

When "stones" cause severe pain

Recognize and treat gallstone disease

08/24/17 (ams). Gallstones, the most common gallbladder disease, are common. Most stones are "dumb", which means that they do not cause pain to their "owners". They are found by chance during a routine ultrasound scan of the upper abdomen. "As long as the stones aren't causing any discomfort, no treatment is necessary," says Dr. Eike Eymers, doctor in the AOK Federal Association. The Institute for Quality and Efficiency in Health Care (IQWiG) estimates that around two to four out of 100 people with gallstones have noticeable problems within a year.
The bile produced in the liver flows through bile ducts into the small intestine, where it supports fat digestion. When the body is not digesting food, it stores the bile in the gallbladder, a pear-shaped hollow organ below the liver. The bile consists of water and various substances. When these substances clump together, gallstones are formed, most of which contain cholesterol. The so-called pigment stones, which consist of calcium and the bile pigment bilirubin, are less common. The solid, crystal-like deposits usually form in the gallbladder, less often directly in the biliary tract.
The risk of developing gallstones increases significantly from the age of 40. Women are affected more often than men. Other risk factors include a genetic predisposition, pregnancy, taking the contraceptive pill or estrogen tablets during menopause, diabetes mellitus, being very overweight and lack of exercise.
Gallstones are often initially noticeable with unspecific signs that are similar to those of other diseases.

Ready-to-broadcast radio o-tones with Dr. Eike Eymers, doctor in the AOK Federal Association

If, after eating high-fat foods, there is a feeling of fullness and pressure in the upper abdomen, accompanied by flatulence and nausea, this can indicate gallstones. It may also be that those affected no longer tolerate certain foods as well, such as coffee or fried foods.

A typical sign of gallstone disease is biliary colic. It occurs when the gallbladder contracts to release bile into the intestine, but stones block the exit. The result is violent, cramp-like pain in the upper abdomen, which occurs in waves and can radiate to the back and right shoulder. Often there are also nausea and vomiting. Jaundice (jaundice) can also develop when the bile builds up in the liver. The skin and the whites of the eyes turn yellow, the urine dark, while the stool becomes light. The patients also often suffer from fever and chills. Another complication is the development of inflammation of the pancreas (pancreatitis) due to a stone in the main bile duct that blocks the joint outlet of the gallbladder and pancreas. This causes the digestive juices formed by the pancreas to build up and attack the pancreas. Inflammation of the pancreas causes severe pain in the upper abdomen, nausea, vomiting, and fever. To avoid complications, symptoms of gallstones should be taken seriously and a doctor should be consulted. Because the stones can permanently irritate the gallbladder, which can lead to inflammation or bursting of the organ. Doctors can diagnose stones in the gallbladder with a physical exam and an ultrasound scan of the abdomen. Laboratory tests of the blood are also used for the assessment. If the doctor suspects stones in the bile duct, endoscopic retrograde cholangiography (ERC) can be useful, as these stones are not always easy to see on the ultrasound image. The doctor guides an examination instrument (endoscope) over the esophagus and stomach into the duodenum to the mouth of the bile duct. There he injects a contrast agent that makes the passage visible in the X-ray image. On this occasion, the doctor can remove the stones right away.

Treatment is based on complaints

The treatment depends on the severity of the symptoms caused by the gallstones. In the case of acute biliary colic, the doctor first prescribes pain reliever and anticonvulsant medication. Ailments such as bloating or nausea can also be treated with medication. The only way to permanently prevent pain is to remove the gallbladder. Most surgeons remove the gallbladder during a laparoscopy. Thin tubes are inserted through three to four small incisions in the abdominal wall, through which the surgeons can push very fine surgical instruments up to the gallbladder. A large abdominal incision is rarely necessary, for example in the case of complications or adhesions in the abdomen. Stones in the bile duct can also be removed during a laparoscopy or with an abdominal incision.

Information on treatment quality

Patients can use the AOK hospital navigator to find a suitable hospital for gallbladder removal for gallstones. The nationwide online offer provides information on how often the procedure is carried out in different clinics. In addition, the portal for this operation contains information on the quality of treatment according to QSR, which stands for "quality assurance with routine data". The QSR procedure not only records complications during the hospital stay, but also during the subsequent outpatient treatment. Even without a gallbladder, patients can usually live well. Some have more frequent bowel movements than before and softer stools after the procedure. A special diet is usually not necessary. In general, patients should eat what is good for them. It is difficult to prevent gallstones from forming. However, a balanced diet can reduce the risk of gallstone disease. It makes sense to eat a low-fat, high-fiber diet and watch your weight. Obesity should be avoided as well as losing weight too quickly. It is also advisable to have your blood lipid levels checked regularly, especially your cholesterol.

To the ams guide 08/17

© 2016 AOK Federal Association