Gallstones: Symptoms, Risks, and When to Consider Surgery

Gallstones

Dear Dr.
Huang,
I would like to ask you about a health check I had in April 2003, where I was diagnosed with gallstones, the largest being approximately 1.8 cm.
Some people have suggested surgery, stating that a 1.8 cm stone is quite large.
Can gallstones grow larger over time?
Recently, I have been experiencing intermittent abdominal pain that varies in intensity; sometimes it is quite noticeable, while other times it feels more like a dull ache.
Initially, the pain was severe, and I thought it might be due to diarrhea since I had two episodes of loose stools at the onset of the pain.
I am unsure if this could be a gallstone attack, as I am still feeling abdominal pain while writing to you.

How can I determine if my abdominal pain is caused by gallstones? Could my symptoms indicate a gallstone attack? Thank you! Given my 1.8 cm stone, what is the likelihood of an attack occurring? Is it possible for it to remain asymptomatic?
Best regards.

vivi, 30~39 year old female. Ask Date: 2004/05/18

Dr. Huang Zhihui reply Surgery

The main symptom of gallstones is pain in the upper right abdomen, especially after consuming fatty foods.
Sometimes, the pain may radiate to the right side of the back.
A small number of individuals may be misdiagnosed with gastric pain.
If the inflammation of the gallbladder is severe, it can even lead to sepsis, accompanied by fever and chills, which is a serious condition.
The severity of symptoms is not related to the size of the stones.
Generally, if a person has experienced symptoms before, doctors will recommend surgical treatment to prevent severe gallbladder inflammation.
The current treatment method is laparoscopic cholecystectomy, which is a minimally invasive surgery.
As for whether you are currently experiencing symptoms, it is difficult to assess without a face-to-face examination, so it is advisable to consult a gastroenterology specialist promptly to avoid any delay in treatment.

Reply Date: 2004/05/18

More Info

Understanding gallstones is crucial for managing symptoms and determining the appropriate treatment options. Gallstones are hardened deposits of digestive fluid that can form in the gallbladder, and they can vary in size, with some being as small as a grain of sand and others as large as a golf ball. In your case, you mentioned having a gallstone measuring approximately 1.8 cm, which is indeed considered significant.

Symptoms of Gallstones
The primary symptom of gallstones is biliary colic, which typically presents as intense pain in the right upper abdomen, often after eating fatty meals. This pain can radiate to the back or right shoulder blade. Other symptoms may include nausea, vomiting, and in some cases, fever if there is an associated infection or inflammation, such as cholecystitis (inflammation of the gallbladder).

From your description, it sounds like you are experiencing intermittent abdominal pain, which could indeed be related to your gallstones. The fact that the pain is sometimes severe and associated with gastrointestinal symptoms like diarrhea suggests that your gallstones may be causing intermittent obstruction or irritation of the gallbladder or bile ducts.

Risks and Complications
Gallstones can lead to several complications if left untreated. These include:
1. Cholecystitis: Inflammation of the gallbladder, which can occur if a gallstone blocks the cystic duct. This condition can cause severe pain, fever, and may require emergency surgery.

2. Pancreatitis: If a gallstone blocks the pancreatic duct, it can lead to inflammation of the pancreas, which is a serious condition requiring immediate medical attention.

3. Biliary Obstruction: Gallstones can block the bile duct, leading to jaundice and potential liver damage.

4. Infection: Blockages can lead to infections in the bile duct or gallbladder, which can be life-threatening.

When to Consider Surgery
The decision to undergo surgery, typically laparoscopic cholecystectomy, is often based on the presence of symptoms and the risk of complications. Given that you have experienced significant abdominal pain and have a gallstone of considerable size, it is advisable to consider surgical intervention. The general recommendation is that if a patient has symptomatic gallstones, surgery should be performed to prevent future complications.

Will Gallstones Get Bigger?
Gallstones can indeed grow larger over time, especially if they are composed primarily of cholesterol. The growth rate can vary, and while some stones may remain stable in size, others may increase, leading to a higher risk of complications. Regular monitoring through ultrasound can help assess any changes in size.

Conclusion
In summary, your symptoms are consistent with gallstone-related issues, and the size of your gallstone does warrant consideration for surgical intervention. It is crucial to consult with a healthcare provider, preferably a gastroenterologist or a surgeon specializing in gallbladder diseases, to discuss your symptoms, the risks of surgery, and the potential benefits of removing the gallbladder. Early intervention can prevent more severe complications down the line. If surgery is deemed necessary, laparoscopic cholecystectomy is the standard approach and is generally associated with a quick recovery and minimal complications.

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