Gallbladder Stones: Does Size Matter?

An addiction to spicy and fatty foods can play a trick on gourmets. Mistakes in nutrition can lead to a formidable disease of the gastrointestinal tract – cholelithiasis. How does the disease manifest itself and is it possible to ignore such a typical problem for many as gastric colic? Are there pills for gallstones or is the only chance to regain health is surgery? Is it true that the gallbladder should be removed only if the stones have become large? This was reported on the air of MK general practitioner “Open Clinic” Svetlana Vlasova and surgeon “CDC on Presnya” Vyacheslav Cheremisin.

“People have known about stones in the gallbladder since ancient times,” said Svetlana Vlasova. – Information has reached our days that stones were even used in religious ceremonies as decorations. A description of gallstone disease can be found in the writings of Hippocrates and Avicenna. In the middle of the 19th century, scientists identified two theories of the onset of the disease. Some associated the disease with disorders of the biliary system. Others – with the presence of foci of inflammation in the body. It was the second version that the famous Russian doctor Botkin adhered to.

– By what symptoms can a modern person suspect cholelithiasis?

– The patient may experience nausea after eating, pulling pain in the right hypochondrium. This can especially occur after taking fatty and fried foods and after overeating. Such pains can be stopped with antispasmodics and “let go” for a while, explains Svetlana Vlasova.

In addition, a patient with gallstones may experience stool disorders, flatulence, and bloating. But the main symptom is pain in the right hypochondrium. There is a much more formidable sign of the disease – yellowing of the skin. In this case, the patient needs emergency medical care.

– Meanwhile, gallstone disease is shrouded in a mass of myths. For example, some patients believe that in this disease the gallbladder itself can not be removed, but only crushed and removed stones.

– This myth exists because stones in a person in the body are formed not only in the gallbladder, but also in the kidneys. Stones are crushed in them, and they come out on their own. Unfortunately, this is not possible in the gallbladder, since the bile ducts are very small in diameter and have a developed character. Therefore, even if the stones are crushed, their movement can cause blockage of the channels and the disease will be aggravated by complications or jaundice. Crushing stones can lead not to a cure, but, on the contrary, to the progression of the disease, – commented on the failure of the popular myth, surgeon Vyacheslav Cheremisin.

Another popular myth is “has had an operation, so it’s healthy.” Unfortunately, this is not the case, doctors say. After the removal of the gallbladder, the body needs time to rebuild and begin to function normally in the new “configuration”. Therefore, after the surgeon, the patient is sent to a gastroenterologist, who leads him for some time after the operation.

– Many patients who have undergone gallbladder surgery are haunted by the fear of gallstones forming in the bile ducts. It sounds logical: if the stones accumulated in the bladder, what prevents them from appearing in the conducting channels through which bile flows?

– One of the reasons for the formation of stones is the stagnation of bile, which occurs in the bladder. When constrictions occur, deformations occur when the gallbladder is squeezed by other organs. This often happens in pregnant women. When the bladder is removed, the ducts that carry bile from the liver to the intestine allow bile to flow freely. The formation of stones in the ducts is extremely rare. This is due to a violation of anatomy, – explains Vyacheslav Cheremisin.

Svetlana Vlasova adds that at an increased risk for the formation of stones are women taking hormonal contraceptives and people with high cholesterol. It also causes thickening of bile. Therefore, even after removal of the gallbladder, risk factors remain in some patients. Doctors advise such people to monitor the level of cholesterol in the blood and take drugs that will be prescribed by the attending doctor.

– Is it possible to do without surgery at all and make the stones simply dissolve? Indeed, advertising on TV regularly presents to the attention of viewers a variety of drugs that are supposedly able to normalize the functioning of the gallbladder.

Vyacheslav Cheremisin emphasizes that not all stones can be dissolved. It all depends on what kind of stones you are dealing with:

– Stones in the gallbladder are cholesterol and pigment. Cholesterol stones are soft, not so dense, do not give a clear clinical picture. Small cholesterol stones can be tried to dissolve with drugs. True, this happens extremely rarely and only with stones of small sizes. Scientific studies have revealed that only stones with a size of 2-3 mm, single and cholesterol in composition, can be dissolved with drugs.

– If there are stones in the gallbladder, most likely, you will have to go to the operation. But can it even be delayed? For example, wait until the “pebbles” grow? And if so, how many “carats” should the stone gain in order not to turn into a threat to the life of the patient? Doctors say that everything is individual here.

“For some, even 0.5 cm is a big stone, and for someone, even 2-3 cm is a small stone,” says Vyacheslav Cheremisin. – I had a patient whose stones grew up to 3 cm. She told me that she had heard in some program that if a stone is larger than 3 cm, then it must be removed. If less, you can live with it. The fact is that the size of the calculus does not matter. And a small pebble that will block the ducts will cause so many problems that you can’t wait for a large calculus that stands still. It also happens that the entire gallbladder is occupied by one stone. Therefore, it is wrong to talk about what should be removed only when the stones are large, and which stones are considered large. A stone of any size can cause a problem.