ARTICLE ABOUT DIGESTIVE SYSTEM

“Gallstone”

Disusun Oleh :

1. Maharani Indriana Koli P1337420215081

2. Dicky Syarif Hidayat P1337420215089

Tingkat III C

KEMENTRIAN KESEHATAN REPUBLIK INDONESIA

POLITEKNIK KESEHATAN KEMENTRIAN KESEHATAN SEMARANG

PRODI DIII KEPERAWATAN PURWOKERTO

2017
 Gallstone Disease

Gallstone disease is a common medical condition in Malaysia. This is associated with the
increasing consumption of fatty food. With advances in radiological services, more patients are
diagnosed with Gallstones. It is unique disease as it involves 3 organs namely the liver,
gallbladder and pancreas. The clinical presentation varies depending on whether the bile flow is
obstructed. Laparoscopic surgery offers a faster recovery and return to daily activities.

What is gallbladder and its function

The gallbladder is an organ located under the liver It functions as a store for bile produced by the
liver. Bile is essential for the absorption and digestion of fat. When the semi-digested food
passes the upper part of the small intestine called duodenum, a hormone called Cholecystokinin
is released which stimulates bile release.

Bile contains water, cholesterol, fats, bile salts, proteins, and bilirubin. Bilirubin is considered an
end product of red blood cells. Cholesterol, bile salts and bilirubin are the three main
components that determine the formation of gallstones.

What is Gallstone

Gallstones are stone like formations that develop in the gallbladder and found in many shapes,
colour and consistency. It is formed when one of the three main components in the bile
(cholesterol, bile salts and bilirubin) is in excess causing imbalance in its liquidity. Over time
these stones enlarge in size or number. Gallstones may get trapped along the cystic or common
bile duct as they expelled from the gallbladder. Stones may also occur primarily in the liver,
hepatic ducts or the common bile duct. Stones are classified according to their chemical
components into cholesterol stones, pigment stones and mixed stones. The majority are mixed
stones.
There are several factors that may influence the formation of bile stone or gallstones. They are :

1. Sex. Women are at higher risk, twice as likely as men. This is caused by the higher amount
of hormone oestrogen found in women. Certain conditions among women expose them to an
even higher amount of oestrogen such as pregnancy, hormone replacement therapy and birth
control pills. Excess oestrogen increases cholesterol level in bile thus disrupting the
equilibrium in bile liquidity. Excess oestrogen also decreases gallbladder contractility leading
to bile stasis and gallstones formation.
2. Weight. Obesity is another risk factor due to higher cholesterol levels in the blood.
3. Diet. Diet high in fats and cholesterol.
4. Age. Elderly individuals above the age of 60 have higher incidence of Gallstones.
5. Diabetes. Individuals with diabetes mellitus carry higher amount of fatty acids namely
triglyceride and cholesterol in their blood circulation.
6. Cholesterol-lowering drugs. Drugs that lower cholesterol levels in the blood also increase
the amount of cholesterol secreted into bile.

Haemolytic anaemia. A condition where the red blood cells are destroyed due to an underlying
problem. Heme, a by-product of red blood cells destruction is metabolized into bilirubin.

What are the symptoms of bile stones or gallstone disease

Majority of gallstones (bile stones in the gallbladder) do not cause any symptoms. It may be
found as an incidental finding during a routine investigation. A small percentage of gallstones
may cause symptoms such as pain called gallstone colic at the right upper quadrant of the
abdomen, lasting for several minutes. Gallstone colic is commonly accompanied by nausea and
vomiting. It is usually self-remitting but it may recur intermittently. Inflammation of the
gallbladder or infection of the static bile is termed acute cholecystitis and it may produce fever.

If the stone blocks the central passage of bile flow from the liver to duodenum, it will cause
congestion of the liver with excess bile. This excess bile will spill over into the systemic
circulation causing jaundice or yellowish discolouration of the eye, skin and mucous membrane.
In severe cases excess bilirubin deposition in the skin causes itchiness. The other common
symptoms are described above such as colicky pain, nausea and vomiting. Infection of the static
bile presents with fever and is termed Ascending Cholangitis. If left untreated it may be fatal.

A stone at the distal end of the common bile duct will also obstruct the flow of pancreatic
enzymes from the pancreas as common bile duct and pancreatic duct share a common outflow
passage into the duodenum called the Ampulla of Vater. Blockage to the flow of pancreatic
enzymes will eventually cause inflammation of the pancreas, a condition called Acute
Pancreatitis. It causes severe pain at the central upper part of the abdomen that may radiate to the
back.

How to diagnose bile stones or gallstones disease

If an individual presents with symptoms mentioned above, the usual method confirming the
disease are as follows

1. Blood tests. These are essential investigations to determine the status of illness. Specific
blood investigations such as the while cell counts, liver function tests and serum amylase are
particularly important to confirm infection, obstruction and pancreatitis.
2. Abdominal X-Ray. Ten percent of bile stones are radio-opaque, meaning that they can be
seen on plain x-ray. They are usually incidental findings on tests done for other purposes. X-
Rays are not important diagnostic tools for this disease.
3. Ultrasound. This is a simple and fast non-invasive imaging technique that is commonly used
to diagnose gallstone disease. It can also determine if there is obstruction to the flow of bile.
However small stones may pose difficulty in diagnosis especially if the ducts are obscured by
the air in the bowel.
4. Computerized tomography scan or CT scan. This is also a non-invasive imaging
technique that uses x-ray to produce cross-section images of the body. CT scan will
definitely help to determine inconclusive ultrasound results especially in evaluating distal
common bile duct obstruction.
5. Endoscopic retrograde cholangio-pancreatography or ERCP. This is an endoscopic
procedure with additional use of fluoroscopy or contrast media injected through the bile
ducts and images are visualized by X-Ray. Its role as a diagnostic tool has lessened with the
 availability of non-invasive imaging technique. The current usa of ERCP is mainly
therapeutic to remove stones in the bile ducts

Treatment of bile stones or gallstone disease

Treatment for bile stones or gallstone disease depends on the symptoms and its location. The
majority of asymptomatic gallstones do not require treatment. However surgery may be
necessary in certain situations. Discussion with a surgeon would be advised in such
circumstances.
Symptomatic gallstones are treated by admission to ward and treatment with pain killer, anti-
spasmodic medication and antibiotics if there are signs of infection. Upon symptom resolution,
patients are offered to remove the gallbladder, a procedure called cholecystectomy, which is
done on a planned admission. This surgery is done mainly through a laparoscopic approach or
key-hole surgery. Camera and surgical instruments are inserted into the abdominal cavity
through 3 or 4 small 0.5 cm – 1.0 cm incision on the abdomen. Laparoscopic surgery causes less
post-operative pain with faster recovery and return to normal activities. Occasionally
cholecystectomy is performed via a conventional open method especially during emergency or
when the surgeon encounters difficulties during laparoscopic surgery.
When a patient presents with jaundice associated with biliary obstruction, they are treated in a
similar manner as symptomatic gallstones.However soon after the infection and colic has
resolved, they will undergo ERCP to remove the biliary stones. It is usually this is done during
the same admission. ERCP may also be done as an emergency procedure if the patient does not
show any improvement with antibiotic or too ill for surgery. In this situation a plastic stent is
inserted to relieve the obstruction and ensure that the bile flow into the duodenum.
Cholecystectomy can be performed once the patient improves.
Occasionally the obstructed biliary stone is removed during open Cholecystectomy. However
this involves surgically opening up the bile duct. Hence to ensure that the bile duct heals without
surgical stricture or stenosis, a rubber T-shape tube is placed into the common bile duct. This
tube will be removed after 6 weeks.
Non-surgical approach or medication may also be used to treat gallstone disease. The usage of
such medication or oral dissolution therapy have limited role due to its low effectiveness and
high recurrence rate. It is only used in situations where the patient has a high surgical or
anaesthetic risk.

Reference

http://www.myhealth.gov.my/en/gallstone-disease/