DR. GORKEM OZGEN

The patient's complaints play an important role in determining the problems in the gallbladder. Although the pains in the upper right part of the abdomen lead the way in this respect, ambiguous complaints (pains in the upper part of the abdomen that cannot be determined exactly, indigestion, nausea, etc.) may also be seen, which can be confused with many other ailments from time to time. These ambiguous complaints can also be seen in conditions such as stomach or duodenal ulcer, reflux, gastritis. When the patient applies to the helium, problems in the gallbladder, if any, can be easily detected with an ultrasonography examination to be performed for this reason. From time to time, a problem with the gallbladder may be suspected in blood tests performed for different reasons, or there may be stones in the gallbladder, etc., in screening tests performed for complete control purposes. diseases can be detected.

 

When stones are detected in the gallbladder, this does not necessarily mean that the patient will be offered surgery. In order for surgery to occur, certain conditions must be met:

1. If the stone present in the gallbladder causes any symptoms in the patient and makes its presence felt there, the gallbladder is no longer functioning and is considered as a candidate to cause problems. The treatment for this condition is removal of the gallbladder. In summary, the symptomatic gallbladder is surgically removed.    _fcc781905-5cde-3194_badc5b

2. The main problem is what to do in the presence of asymptomatic and incidentally detected stones or polyps. There are some trends here in the world of surgery, although there is no complete consensus. The criteria we base our decision on:

   1. The stones in the gallbladder are larger than 2 cm or the presence of millimetric (very small) stones that fill the entire gallbladder,

   2. The patient has diabetes. In the presence of diabetes, the signs and symptoms of inflammatory conditions that may occur in the gallbladder may be masked by diabetes, therefore, surgery is planned in order not to put the patient at risk. 

 

When surgery is required for gallstones, the reason for surgical removal of the gallbladder is four bad scenarios:

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1. The gallbladder is a large and expandable organ like a bag. Bile produced in the liver fills the gallbladder with very tiny ducts (Luschka ducts) that extend from the liver surface to the gallbladder. The sac drains its contents from a very narrow (1.5 – 2 mm) duct (cystic duct) to the main bile duct according to its volume and has no other option to empty it. If the stones formed in the gallbladder block the outlet at the junction of this small duct with the gallbladder, the contents of the gallbladder cannot be emptied. In the first stage, he will want to empty the contents of the gallbladder wall by contracting it at certain intervals. These contractions are reflected in the patient as cramp-like pains that get worse from time to time and then pass, and this situation is called biliary colic. If the stone blocking the outlet is dislodged (body movement, etc.) and the passageway is opened, the gallbladder is emptied and the problem disappears. To a large extent, this is how events unfold. Patients apply to the hospital with the pain described above, and then their complaints go away with the supportive treatment (serum, etc.) given in the hospital. At this stage, most likely ultrasonographic examination is also performed and the stone in the gallbladder is detected. Once the stone in the gallbladder is detected after such a complaint, it is not expected to regress and surgery is required. Biliary colic is the best scenario among the problems that may develop due to gallstones. The necessity of surgery has occurred, but emergency surgery is not necessary. After the patient's complaints have passed, he can adjust his own conditions and plan the surgery at the most appropriate time  -on the condition of not delaying it too long.

2. In the biliary colic scenario described above, the stone blocking the outlet moves after a while, opens the outlet, and the patient relaxes. In the absence of this, the process prolongs, the patient's complaint does not go away, and some changes begin to occur in the gallbladder due to the inability to empty the bile. Although the bile does not contain any bacteria while it is fluid under normal conditions, it tends to become inflamed with bacteria when it cannot be discharged and becomes stagnant. If the obstruction is prolonged, this inflammation occurs and this also affects the gallbladder. Just like in other inflamed organs, the wall swells and fluid accumulates around it. This is called gallbladder inflammation (acute cholecystitis). Once the inflammation has developed, it is very difficult to reverse it. Due to the presence of bacteria, antibiotic treatment is required in the hospital, but it is not sufficient. Since the gallbladder is the source of inflammation, it must be eliminated, that is, surgically removed. This surgery should preferably be performed as soon as gallbladder inflammation is detected. If it is delayed, surgery can be performed after a period of 4-6 weeks for the safety of the surgery, which makes the operation technically more difficult, and the risk of other problems that may develop in this 4-6 week period is taken unnecessarily._cc781905-5cde-3194- bb3b-136bad5cf58d_    _cc781905-5cde-1331359bbad5cf58d__cc781905

3. The problems that may be caused by stones that may occur in the gallbladder are defined in the first two articles. Sometimes the stones formed in the gallbladder do not stay in the gallbladder, but move into the common bile duct. This condition blocks the passageway of bile produced from the liver and flows into the intestine and causes jaundice (obstructive jaundice). This type of jaundice is not a microbial (Hepatitis viruses) and contagious jaundice, but it should be corrected as it will cause a slowdown in the flow of bile fluid and therefore inflammation of the biliary tract. Inflammation of the biliary tract is called cholangitis and if left untreated, it can lead to very serious consequences such as general body infection (sepsis), admission to the intensive care unit, and even death. When obstructive jaundice occurs in this way, the biliary tract must be cleared of stones before the gallbladder is removed.    

4. Behind the stomach, very close to the duodenum, is an organ called the pancreas. The pancreas provides the secretion of substances that play a role in protein and fat digestion into the intestine through the secretion channel it contains. Since these substances take part in the breakdown of proteins, they are harmful to all tissues except the inside of the intestine. The pancreatic duct merges with the common bile duct at a point very close to the duodenum and opens into the intestine. If the stone that has fallen from the gallbladder to the biliary tract goes down to this level, it clogs the pancreatic duct along with the bile duct. A blockage in the pancreatic duct prevents pancreatic enzymes from emptying into the intestine, and since these enzymes will be trapped in the pancreas, they begin to destroy the pancreas' own tissue. This condition is called inflammation of the pancreas (pancreatitis) and is a very serious disease. It can be life-threatening at times, and its treatment usually requires long-term hospitalization.