Managing Gallstones: What You Need to Know About Treatment Options

What should I do about gallstones?

Hello Dr.
Liu, I have been experiencing (suspected) stomach pain for many years due to work-related stress and irregular eating habits.
About ten years ago, I suddenly had upper abdominal pain that radiated to my back, and each episode lasted at least 3 to 5 hours.
Antacids were ineffective.
After visiting the emergency room, the doctor ordered blood and urine tests, and an X-ray revealed fecal impaction.
After undergoing bowel clearance, the pain slightly alleviated, but an ultrasound showed a high-density round object in my gallbladder.
The doctor initially suspected it was a polyp.
Later, during an outpatient visit, a gastroscopy revealed ulcers in both my esophagus and stomach.
Another ultrasound confirmed gallstones with inflammation, and I also have fatty liver disease.
There is suspicion of pancreatitis, and a CT scan needs to be arranged.
Given my overall health issues, including being a carrier of hepatitis B, anemia, and having uterine fibroids, I am concerned about whether my gallbladder will need to be removed.
Is it possible to only remove the stones? If the gallbladder is removed, will it affect my daily life, especially since my job requires physical exertion? Additionally, based on my conditions, which other organs should I be particularly cautious about? Thank you, Dr.
Liu.

Miss Huang, 30~39 year old female. Ask Date: 2006/08/07

Dr. Liu Nanshan reply Gastroenterology and Hepatology

Although upper abdominal pain is more indicative of a gastric or duodenal ulcer, your symptoms radiating to the back suggest that it may be caused by gallstones or cholecystitis.
Additionally, duodenal ulcers are more common in younger individuals, so your gastric ulcer is likely a stress ulcer resulting from cholecystitis.
Once cholecystitis has occurred, or if gallstones have led to pancreatitis, it is advisable to remove the gallbladder.
Most patients can undergo laparoscopic surgery, requiring a hospital stay of 3-5 days, with very few complications.
Some individuals may experience diarrhea postoperatively, but the incidence is low and does not significantly affect normal life.
Gallstones must be removed along with the gallbladder.
Patients with hepatitis B should have abdominal ultrasounds and liver function tests every six months.
If there are any abnormalities in liver function, it is important to discuss the necessity of treatment with the attending physician.

Reply Date: 2006/08/07

More Info

Managing gallstones can be a complex issue, especially when there are additional health concerns involved. Based on your history and the symptoms you've described, it seems that you are dealing with multiple gastrointestinal issues, including gallstones, potential pancreatitis, and ulcers. Here’s a comprehensive overview of gallstone management and treatment options, along with considerations for your specific situation.

Understanding Gallstones
Gallstones are solid particles that form in the gallbladder, often composed of cholesterol or bilirubin. They can vary in size and may be asymptomatic or cause significant discomfort. Symptoms typically include abdominal pain, especially in the right upper quadrant, nausea, vomiting, and sometimes fever if an infection occurs.

Treatment Options
1. Observation: If gallstones are asymptomatic, many doctors recommend a watchful waiting approach. However, given your history of abdominal pain and the recent diagnosis of gallbladder inflammation, this may not be the best option for you.

2. Medications: There are medications like Ursodiol that can help dissolve cholesterol gallstones, but they are generally less effective for pigment stones, which are more common in certain populations. Additionally, these medications require long-term use and may not be a viable solution for everyone.

3. Surgical Intervention: The most common and effective treatment for symptomatic gallstones is cholecystectomy, the surgical removal of the gallbladder. This can be performed laparoscopically or through open surgery, depending on the complexity of the case. Given your symptoms and the inflammation, surgery may be necessary to prevent further complications, such as acute cholecystitis or pancreatitis.

Risks and Considerations
- Surgery Risks: As with any surgical procedure, there are risks involved, including bleeding, infection, and injury to surrounding organs. However, these risks are generally low, especially when performed by an experienced surgeon. Post-operative complications can include digestive issues, such as diarrhea or difficulty digesting fatty foods, but these often resolve over time.

- Impact on Lifestyle: After gallbladder removal, most people can return to their normal activities, including work, within a few weeks. However, some may need to adjust their diet, particularly in the initial recovery phase. It’s important to gradually reintroduce foods and monitor how your body reacts.

Additional Health Considerations
Given your history of hepatitis B, anemia, and uterine fibroids, it's crucial to manage these conditions alongside your gallbladder issues. Here are some points to consider:
- Liver Health: Since you are a hepatitis B carrier, maintaining liver health is essential. Regular monitoring of liver function tests and following your healthcare provider's recommendations for managing hepatitis is vital.

- Anemia Management: Addressing the underlying cause of your anemia is important. This may involve dietary changes, supplements, or other treatments as advised by your healthcare provider.

- Monitoring for Pancreatitis: If there is suspicion of pancreatitis, it’s crucial to avoid triggers such as alcohol and high-fat meals. Follow-up imaging studies, like a CT scan, may be necessary to assess the pancreas and surrounding structures.

Conclusion
In summary, while gallstones can often be managed conservatively, your symptoms and the presence of inflammation suggest that surgical intervention may be warranted. It’s essential to have a detailed discussion with your healthcare provider about the risks and benefits of surgery, considering your overall health status. They can provide personalized recommendations based on your specific situation, including whether gallbladder removal is necessary or if there are alternative approaches that could be considered. Always prioritize open communication with your medical team to ensure that all aspects of your health are taken into account.

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