Advice from Dr. Zhukova
How does cholelithiasis present and what should we do after a cholecystectomy?
O. Voropaev, Minsk
Cholelithiasis is a disease whereby gallstones are formed in the gallbladder or in bile passages.Cholelithiasis is quite common, affecting mostly adults (especially women aged 40-50 who carry extra weight). However, even teenagers may suffer. In Europe and America, a third of women and a quarter of men are recorded as suffering, with occurrences rising dramatically for those aged over 70 years (affecting over 30 percent of the population).
Two basic factors cause gallstones: cholestasia in the gallbladder and an increased concentration of salts in bile, due to metabolic derangement.
The following factors may provoke occurrence of cholelithiasis:
over-eating, starvation, or irregular eating;
a sedentary life style;
pregnancy;
taking hormonal contraceptives;
obesity; and
biliary dyskinesia (bile not moving through the digestive system efficiently).
Gallstones form in the gallbladder as a result of sedimentation of solid particles of bile. Most comprise cholesterol, bilirubin (bile pigment) and calcium salts. They hinder the normal work of the gallbladder, which is a reservoir for bile.
When gallstones remain calmly in the gallbladder, people may not know there is a problem. Diagnosis is likely only during ultrasonic investigation of the abdominal cavity. The World Gastroenterology Organisation (WGO) notes that surgery is not performed in cases of asymptomatic gallstones, although there are exceptions. You should consult a doctor if gallstones are evident in the gallbladder.
The first warning signs of cholelithiasis are a feeling of heaviness in the right hypochondrium (upper abdomen), the taste of bile, vomiting, and discomfort, especially after eating fatty/greasy foods. Jolting, overeating or other factors may move a gallstone into the ostium of the bile duct, creating a blockage. As a result, bile cannot escape the gallbladder, and the walls are forced to distend, bringing on ‘gallstone colic’: an acute pain in the right hypochondrium (upper abdomen). This may cause pain in the clavicle, right hand or back, and there may be a noticeable bile taste, nausea and vomiting, without sense of relief. This may result in inflammation of the gallbladder, known as acute cholecystitis. Inflammation may also extend to neighbouring organs: the pancreas, duodenum and/or stomach.
In such cases, surgery (cholecystectomy) is performed.
After surgery, patients may still have discomfort in their stomach and other disorders. There are many reasons for Post-cholecystectomy Syndrome but it tends to occur where the illness has been long endured before surgery.
In order to behave correctly after surgery and eat healthily, you should keep an eye on pain, with the help of your doctor. Patients should understand that, after surgery, bile flow is compromised. Try to eat small amounts 4-5 times a day, at regular times, to promote bile flow, and prevent retention.
Overeating, especially binge-eating, may result in pain and other disorders. In this case, try to eat as above, to avoid overworking your system. The eating of too many fatty or spicy foods, as well as cold dishes or carbonated drinks, may provoke an attack.
Tatiana Zhukova,
Doctor of higher category,
D.M. Ph.D.
