The gall of it

People of all ages (even children) often have dyspeptic symptoms - pain in the upper abdomen, burping, indigestion, burning extending up the chest and a feeling of "gas" Treatment is readily available over the counter (OTC) from the friendly neighbourhood pharmacy. You can take a cocktail of antacids, carbonated beverages, and other tablets. The need to consult a physician arises only if there are repeated attacks, there is no symptomatic relief, or the pain extends to the left side of the chest and simulates a heart attack.

By Dr Gita Mathai
  • Published 6.02.17
  •  
Gallstones cause excruciating pain on the right side of the upper 
abdomen, which may extend to the right shoulder or the back

People of all ages (even children) often have dyspeptic symptoms - pain in the upper abdomen, burping, indigestion, burning extending up the chest and a feeling of "gas" Treatment is readily available over the counter (OTC) from the friendly neighbourhood pharmacy. You can take a cocktail of antacids, carbonated beverages, and other tablets. The need to consult a physician arises only if there are repeated attacks, there is no symptomatic relief, or the pain extends to the left side of the chest and simulates a heart attack.

The tests ordered usually include an ultrasound examination. In 60 per cent of symptomatic middle aged women and 40 per cent of men, this may show stones in the gall bladder. These stones may vary in size and be single or multiple. It is easy to blame the stones for symptoms but the dyspepsia is more likely to be due to hyperacidity, GERD (Gastro-Esophageal Reflux Disease), dietary indiscretions, stomach ulcers, irritable bowel, appendicitis, pancreatitis, diverticulosis, or even, rarely, a heart attack.

The gall bladder is filled with bile. During the process of digestion, it periodically contracts and empties the bile into the intestine. The stones present in a gall bladder may be cholesterol stones, pigment stones or mixed. Cholesterol stones are likely to form if there is too much cholesterol in the bile. Pigment stones form when the concentration of bile pigments in bile increases. This occurs if there is haemolytic anaemia (such as sickle cell anaemia), the red blood cells are destroyed in the body, or if the liver is damaged because of cirrhosis. Intravenous nutrition for prolonged periods and drastic dieting may also be the culprits.

Gallstones can cause excruciating pain on the right side of the upper abdomen, which comes and goes. It may extend to the right shoulder or the back. This pain may last for minutes to hours. If there is an accompanying infection of the gall bladder, there may be high fever, chills and jaundice. Blood tests, enzyme studies and scans help to make the diagnosis.

In general, the chance of developing gall stones is greater after the age of 40, in women, during pregnancy, and if there is a family history. Other risk factors are obesity, diabetes and elevated cholesterol. A high-fat low-fibre diet with increased consumption of refined sugars increases the risk. Hormones taken for contraception and as replacement therapy can also increase the chances of stones.

In 80 per cent cases of gallstones, there are no symptoms throughout the life of the person. Stones can, however, produce complications such as infection of the gall bladder or pancreas with high fever and pain. The stone may travel down into the bile duct and block it causing, infection and jaundice. It may perforate the gall bladder. It may pass down into the small intestine and block it.

Once gallstones become symptomatic, the gall bladder - which, just like the appendix, is a not an essential organ - needs to be surgically removed. It is not possible (unlike in the case of kidney stones) to remove the stones alone. The popular way to do this is with laparoscopic surgery. The hospital stay is minimised and there is less chance of infection as the wounds are small.

Frightened by the prospect of surgery, patients may opt for medical treatment available in allopathy and other systems of medicine. In that case ursodeoxycholic acid is used, available as capsules and syrups. About 30 per cent of stones respond to this treatment within 2-3 months if they are less than 5mm in size and do not have calcium deposits.

To prevent gall stones:

• Maintain ideal body weight

• Exercise regularly

• Eat a low-fat high-fibre diet.

Dr Gita Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@ yahoo.co.in