GALLBLADDER DISEASE, TREATMENT
Gallbladder is a soft, thin pouchlike organ located under the liver in the right upper quadrant of the abdomen. Liver makes nearly a liter of bile every day, which is continually flowing down to the first part of intestine through a narrow tubular structure called the bile duct. Gallbladder is connected to the bile duct through a narrower tubing called cystic duct. About two tablespoons of bile are stored in the gallbladder. When fatty food reaches the first part of the intestines, a hormone called cholecystokinin stimulates the gallbladder to contract and provides an extra squirt of bile to help digest the fatty food.
Diseases of the gallbladder are relatively common medical problems, affecting 20 million people a year in the United States. Women have twice the number of problems compared to men. Gallstones and associated complications are the most common issues involving gallbladder. Nearly 700,000 people undergo gallbladder surgery a year. The number of gallbladder surgeries have gone up by 80 percent in the last 30 years.
Why do stones form in the gallbladder? Bile is a viscous greenish yellow fluid, with dissolved chemicals held in delicate balance. Three main components are bile salts, bile pigments and cholesterol, along with phospholipids and electrolytes. When the composition is altered for any reason, small crystals begin to form. The bile inside the gallbladder is static. Anytime there is stasis, the small crystals become sediments and grow to become stones.
Risk factors for developing stones include diet consisting of high fat and cholesterol, obesity, pregnancy, rapid loss of weight, starvation, genetic factors, diabetes mellitus, hemolytic anemias, hormone imbalances, prolonged illnesses and post-operative side effects of certain surgeries.
Initial symptoms can be mild digestive discomfort, occasional pain in the right upper abdomen and fatty food intolerance. Later, it worsens to frequent abdominal pain with radiation to the back or right shoulder and nausea. When infection sets in, severe abdominal pain, fever, chills or jaundice occurs. Even more serious complications can be blockage of the bile duct from stones, high fever with bacteria spread throughout body, sepsis, rupture of the gallbladder or abscess formation inside the abdomen. At times, they can cause inflammation of pancreas, otherwise known as biliary pancreatitis.
It is best to consult your primary care physician when persistent abdominal symptoms are noticed. In addition to a full physical examination, several tests are ordered. Blood tests will be done to know the blood count, and liver and pancreatic functions. Often, this is followed by an ultrasound of the abdomen focused on evaluating the gallbladder, bile duct, liver and pancreas. Further tests may be necessary depending on the exact specific scenario. This may include a nuclear scan to evaluate the function of the gallbladder, CAT scan or MRI. If there are suspected bile duct stones, they may recommend an endoscopic test called ERCP.
The exact type of treatment depends on the specific situation of the individual. In general, the best treatment for gallstones is removal of the gallbladder, otherwise called cholecystectomy. Currently vast majority of this operation is done by a laparoscopic method, colloquially called keyhole surgery. The surgery is done through four tiny puncture holes on the abdominal wall, with the help of a camera and magnified visualization on television screens. More recently, robotic assistance is being used along with artificial intelligence support. The benefit is that uncomplicated surgical patients can go home the same day and get back to normal life within a week. Previously, this surgery required an open incision on the upper abdomen necessitating several days of hospital stay and further convalescence.
Dissolution of gall stones by medication is described. However, it is not effective for all types of stones, and the medication must be taken continually without interruption. The stones come back as soon as the medication is stopped. Hence, treatment of gallstones with medication is not a good choice. Another method tried is blasting the stones with high-velocity sound waves as they do for kidney stones. Again, this is not popular also, since it can cause more problems than good with gallstones. One can live a normal life without the gallbladder. Hence, the removal of the diseased gallbladder is the best choice.
If the person is noted to have the stones in the main bile duct, it can be assumed that they moved out of the gallbladder following natural pathway for bile. However, the stones can block the bile duct, resulting in jaundice, fever or sepsis. Then it becomes necessary to clear the bile duct and remove the gallbladder for complete treatment. Clearing the bile duct can be done by a non-surgical method called ERCP, using an endoscope. If unsuccessful, then surgical steps either by laparoscopic method or by open incisional method is resorted to.
Another complication of gallstones is pancreatitis or inflammation of pancreas. This is because the end of the bile duct and pancreatic duct come together as a common entrance into the intestine. When a tiny gallstone blocks this exit spot, it can also block the pancreatic duct, thus irritating the pancreas. Pancreatitis can be unpredictable in its severity. Initial treatment is to give rest to the pancreas by supportive measures and withholding oral feeds. Once the pancreatitis has cooled down, the patient is evaluated for any stones in the gallbladder or inside the bile duct, followed by surgery if necessary.
Besides gallstones, there can be other diseases of the gallbladder. Cancer of gallbladder is a known entity, but fortunately it is not common. Polyps can arise inside the gallbladder. Some patients can have dysfunction of the gallbladder known as biliary dyskinesia. These patients experience recurrent episodes of upper abdominal pain, dyspepsia and nausea, especially after a fatty meal. All usual tests come back are normal, and no stones are seen inside the gallbladder. Nuclear scan shows poorly functioning gallbladder. All these patients will benefit from surgical removal of the gallbladder. At times, a situation arises where the patient has no gallstones, but the gallbladder is severely inflamed resulting in fever and abdominal pain. It is called acalculous cholecystitis. Some of these patients are sick due to other serious medical problems such as heart attacks. They need antibiotic therapy and drainage of the gallbladder to the exterior using a percutaneously placed tube.
It behooves everyone to go for medical checkups and have blood and urine tests, especially when experiencing recurrent abdominal pain. Sonogram is an easy noninvasive test to diagnose gallstones. Planned elective surgery to remove the gallbladder is much safer than postponing the care until it becomes complicatedEYE CARE
The Eyes of Love: How Vision Shapes Connection and Life
By Dr. ARUN GULANI
February is the month of love – a time to celebrate relationships, connections and the beauty of seeing the world clearly, both literally and metaphorically. Yet, how often do we stop to consider how our vision impacts the way we experience life and the people we love?
From the first glance that sparks a connection to the shared joy of watching a sunset or admiring a loved one’s smile, clear vision is at the heart of our most cherished moments. Vision doesn’t just help us see; it allows us to feel deeply, connect meaningfully, and live fully.
As an eye surgeon with a worldwide patient clientele of practically every culture, I’ve had the honor of witnessing how life changes when vision improves.
They may have come to me to get rid of their glasses and contact lenses due to their astigmatism, nearsightedness, farsightedness and even reading glasses or cataracts, and my patients often share stories that are more than medical – they’re deeply personal. One patient who traveled to me from Switzerland recently described the profound emotion of seeing their partner clearly for the first time in years: “It was like falling in love all over again.” Another patient from India talked about the simple but life-changing experience of reading their grandchild’s handmade Valentine – every heart, every word glowing with love.
These stories aren’t unique. For countless individuals, vision is a key part of how they experience the world and express their emotions. Yet, many of us take our eyesight for granted. We adapt to blurry vision or live with discomfort, not realizing how much of life’s vibrancy we’re missing.
Seeing Beyond the Surface
Vision, in many ways, is a metaphor for life. It’s not just about clarity; it’s about perspective. When I work with patients, I see how their journey toward better vision mirrors a journey of rediscovery. Whether they’re regaining the ability to read, drive or simply recognize the faces of their loved ones, the change is profound.
But vision is not just about overcoming problems; it’s also about thriving. In this season of love, consider what it means to truly see – to take in the details, the colors, the expressions and the moments that make life beautiful.
Here are a few tips to keep your vision – and your connection – strong:
- Protect Your Eyes: Whether it’s wearing sunglasses to shield against UV rays, using safety goggles during activities, or ensuring proper lighting when reading, small preventive measures can make a big difference.
- Stay Hydrated and Moisturized: Winter’s dry air can irritate your eyes. Use humidifiers at home and artificial tears to maintain comfort and eye health.
- Prioritize Your Vision: Regular checkups with an eye doctor can catch issues early, preventing them from escalating into more complex problems. Don’t wait until something feels wrong – our eyes deserve proactive care.
- Embrace Modern Advancements: Today’s technologies, such as those I have pioneered, can not only correct vision problems from cataract or glasses prescriptions, but even bad outcomes from Lasik or cataract surgery. From laser surgery to personalized solutions for extreme cases, the possibilities for clear vision are remarkable.
The Gift of Sight: A Love Letter to Yourself
Imagine what you could see, feel and experience if your vision weren’t holding you back. Whether it’s reading the fine print on a love letter, watching your favorite film, or seeing the details in your loved one’s face, clarity can transform the way you experience life’s most meaningful moments.
As someone who has spent over three decades helping people achieve this transformation, I can confidently say that clear vision isn’t just a medical outcome – it’s a gift. It’s the difference between living in the shadows and stepping into the light, between missing moments and cherishing them.
This Valentine’s season, as you celebrate love in all its forms, take a moment to consider the gift of sight. Whether for yourself or a loved one, clear vision is an investment in life, love and connection. After all, life is best lived with open eyes and an open heart.