Song Tae-jun, professor of gastroenterology at Asan Medical Center in Seoul, said he started experiencing stomach pain 30 minutes after eating… High fever may persist after 3 to 4 hours, but the entire gallbladder is removed, so there is no disruption to daily life… Biliary gallstones raise concerns about serious complications. If bile duct gallstones are left untreated, the risk of biliary tract cancer increases by 10 times… Cholesterol gallstones increase due to Western eating habits
Song Tae-jun, a professor of gastroenterology at Asan Medical Center in Seoul, recommended suspecting gallstones if there is no abnormality in a gastroscopy even though heavy pain continues 30 minutes after a meal. Professor Song emphasized that some gallstones must be treated because they cause serious complications. Provided by Seoul Asan Medical Center
Ms. A, a woman in her mid-50s, ate too much during the Chuseok holiday. In particular, I ate a lot of fatty pancakes. I suddenly felt sick and stuffy, as if I was sick. Even if I took digestive medicine, it didn’t work. Later, her whole body developed a fever.
I went to the hospital 4 to 5 hours after the symptoms appeared. She had acute cholecystitis. The medical staff first removed the pus from the gallbladder and administered antibiotics. After the inflammation subsided, the gallbladder was removed using a laparoscope. Song Tae-jun, a professor of gastroenterology at Asan Medical Center in Seoul, performed the procedure. Will there be any problem if I remove the gallbladder?
● Gallstones, more common in women and the elderly
The gallbladder is adjacent to the liver. In other words, it is called the gallbladder. The liver produces 500 to 1,000 mL of bile (bile juice) every day. This bile disposes of waste products such as cholesterol and bilirubin (depleted hemoglobin) and aids in the digestion and absorption of fat in the duodenum. The gallbladder serves as a temporary storehouse for bile. Bile acids contained in bile change fatty cholesterol to dissolve in water. When less bile acid is secreted by the liver, cholesterol hardens. When gallbladder function declines, it does not contract properly, causing bile to accumulate and harden within the gallbladder. Mucus, calcium, etc. clump together in these hardened crystals and form gallstones.
Depending on the composition of gallstones, they are largely divided into cholesterol gallstones and pigment gallstones. Cholesterol gallstones are literally hardened crystals due to too much cholesterol. Pigmented gallstones are crystals that harden as bilirubin increases and are brown or black in color. Pigmented gallstones can also occur due to bacterial or parasitic infections. Professor Song said, “In the past, more than 60% of gallstone patients had pigmented gallstones, but due to Western eating habits and obesity, cholesterol gallstones are more common these days, at 75-80%.”
There are more female patients than male patients. This is because the female hormone, estrogen, increases the risk of gallstones. If you have given birth multiple times, taken birth control pills, or are taking estrogen hormone medication, it is a good idea to check for gallstones. Gallstones are more commonly found in elderly people than in young people. The cause is a decline in gallbladder function. Professor Song said, “It increases rapidly after people in their 70s, and from then on, the ratio of male and female patients is almost the same.”
● Asymptomatic biliary stones, high risk of complications
Depending on where they occur, they are divided into gallbladder stones and biliary stones.
Gallbladder stones are found in about 1 in 10 adults. In most cases, no symptoms appear. If there are no symptoms, the basic rule is to ‘observe first’. Professor Song said, “Symptoms appear in about 30% of patients with gallbladder stones. “Also, every year, about 2 out of 100 people develop acute symptoms that require treatment,” he said.
When removing gallbladder stones, the gallbladder is usually removed like Mr. A. This is because gallbladder function is in a state of decline, so if left untreated, 50 to 70% of cases will relapse and the likelihood of complications will increase. Professor Song said, “Right after the gallbladder is removed, if you eat fatty foods, you will have diarrhea, but after a few months, the bile ducts will expand and things will get better.”
If gallstones develop in the biliary tract, the passage through which bile flows, treatment methods vary. If biliary gallstones block the entrance to the pancreas, they can cause acute pancreatitis, which can become dangerous after more than 6 hours. Gallstones must be removed within 24 hours at the latest. If bile flows into the blood, symptoms such as abdominal pain, high fever, and jaundice may appear. Professor Song said, “In general, about 20% of patients with biliary gallstones develop complications, so it is best to remove the gallstones as quickly as possible.”
Biliary gallstones can worsen into bile duct cancer. If biliary gallstones are left untreated for a long time, about 10% of them turn into cancer. Additionally, patients with biliary gallstones have a 10-fold higher risk of developing biliary tract cancer. Professor Song said, “For this reason, the rule is to remove biliary gallstones even if they are asymptomatic.”
This is the case of Ms. B, a woman in her early 70s diagnosed with cirrhosis of the liver, who left asymptomatic biliary gallstones and worsened them. Professor Song said, “It is assumed that biliary gallstones were the starting point of cirrhosis.” Mr. B lived near the river. She has always eaten a lot of freshwater fish raw. She said parasites stuck to her liver, causing gallstones, and these gallstones caused ongoing inflammation, leading to cirrhosis. Professor Song said, “There are quite a few cases like this among elderly people living near the river. “Even if you don’t have symptoms, it’s a good idea to get tested for gallstones,” she said.
● The pattern of abdominal pain must be closely examined.
Gallstones block the flow of bile. At this time, the pressure on the gallbladder and bile ducts increases, causing abdominal pain. However, even if a gastroscopy is performed, the problem cannot be found. Professor Song said, “The abdominal pain of gallstones has its own characteristics.” First, if you have gallstones, abdominal pain usually appears about 30 minutes after eating. Bile is secreted in large quantities when ingested food reaches the duodenum. This is around 30 minutes after eating.
Second, the area where abdominal pain appears is limited. Pain mainly occurs in the upper right part of the abdomen, where the gallbladder and bile ducts are located. In severe cases, abdominal pain spreads to surrounding areas. In this case, pain may extend to the right shoulder.
Third, stabbing-type abdominal pain rarely occurs. It is often abdominal pain that feels like it is suddenly blocked. If symptoms of nausea and indigestion appear frequently, and no problems are found in digestive tests, you need to suspect gallstones.
Fourth, abdominal pain caused by cholelithiasis lasts from at least 30 minutes to as long as 3 to 4 hours. When the area blocked by gallstones is released, abdominal pain disappears. If the blockage does not improve, abdominal pain may continue thereafter. In this case, bacterial infection occurs and the bile turns into pus. This can worsen into acute cholecystitis or cholangitis. Professor Song said, “The most common complication of cholelithiasis is acute cholecystitis. So, it is better to go to the hospital quickly before the symptoms worsen.”
Fifth, if gallstones become severe and complications occur, symptoms such as shortness of breath and fever may appear. Professor Song said that the worst case scenario is when gallstones block the bile duct. He urged prompt treatment, saying, “In this case, the bacterial infection can spread throughout the body and even lead to sepsis.”
● Excessive dieting – fasting should be avoided
It is best to be careful in your daily life to prevent gallstones from forming. First of all, it is best to avoid foods high in saturated fat or foods high in fructose. High-fat and high-calorie foods produce more cholesterol, which increases the chance of developing gallstones. It is best to eat regularly. In this way, the gallbladder contracts periodically and releases bile. If this system works properly, the risk of developing gallstones decreases.
Obesity is a favorable environment for gallstones to form. This is because when you gain weight, cholesterol secretion into bile increases and gallbladder function decreases. The flow of bile slows, and more mucus-like substances are secreted from the gallbladder. This creates an environment where bile hardens more easily. Therefore, exercise is essential. If you exercise frequently, bile is discharged smoothly and cholesterol is reduced.
However, excessive and drastic dieting is prohibited. Losing weight in a short period of time or fasting for a long time can make gallstones more likely to form. If you diet drastically, the liver secretes more cholesterol and mucus when secreting bile, and gallbladder function deteriorates. Research has shown that one in four people who follow this type of diet develop cholesterol gallstones. Additionally, because the gallbladder does not contract while fasting, the risk of developing gallstones increases.
In addition, hyperlipidemia and diabetes are also causes of gallstones. If you drink too much on a regular basis, the chance of developing pigmented gallstones increases. If you receive female hormone treatment, the chance of developing gallstones doubles. Therefore, it is a good idea to get tested for gallstones regularly.
90% of gallbladder stones can be detected through abdominal ultrasound. Biliary gallstones can also be discovered through ultrasound, but areas that are difficult to observe require magnetic resonance imaging (MRI).
Lifestyle rules to prevent gallstones 1. Eat less high-fat, high-calorie foods.
2. Develop the habit of eating regularly.
3. Manage to avoid becoming obese.
4. Do appropriate exercise on a daily basis.
5. Avoid excessive dieting or fasting.
6. Prevents hyperlipidemia and diabetes.
7. Excessive drinking is prohibited. Drink as much as possible.
8. Consult your doctor when using female hormone preparations.
Source: Taejun Song, Professor of Gastroenterology, Asan Medical Center, Seoul
Reporter Kim Sang-hoon corekim@donga.com
2023-11-03 16:40:00
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