Diagnosis of gallstones

The diagnosis of gallstones can be made by the blood laboratory, among others. An increase in direct bilirubin in the serum may indicate an obstruction of the bile duct. Whether the liver has also been affected can be determined from the laboratory liver values (e.g. GOT).

Liver damage results in increased liver values. Inflammation parameters (e.g. CRP) also provide information. Ultrasound (sonography) is the fastest and most sensitive method of detecting gallstones.

Due to their lime content, stones can be recognized as white patches with a corresponding acoustic shadow. The detection of gallstones can be problematic. If the gallstones are freshly formed, they cannot be detected with the examination method of the first choice, namely ultrasound.

With the typical clinical signs (colicky pain radiating into the right shoulder, fatty stools, aversion to fatty food, jaundice), it is nevertheless almost certain that a stone disease has developed.Only when the gallstones have triggered an inflammatory reaction of the walls of the gall bladder (cholecytitis) or the bile ducts (cholangitis), and the inflammatory reaction has led to calcification of the gallstone, can the gallstones also be detected by ultrasound. Gallstones can also be detected in an X-ray image. Without the administration of contrast medium, however, only the calcified stones can be detected.

Stones that contain little calcium can be seen through recesses after the administration of contrast medium. Due to the side effects of contrast medium, this examination is only performed if the following method has not yielded any results. Another method of detection is endoscopic bile duct imaging (ERCP). For this purpose, an endoscope is advanced through the esophagus, stomach and duodenum to the exit point of the bile duct. By penetrating the bile duct, stones can be detected and removed if necessary.

Therapy of gallstones

Gallstones are only treated if the patient has symptoms. The following options are available for the treatment of gallstones: Pain relief is achieved by means of analgesics (Metamizol = e.g. Novalgin ®) and/or spasmolytic drugs to relieve biliary spasms (Buscopan®). Shockwave therapy attempts to cause the spontaneous loss of gallstones by fragmentation.

As a rule, drug litholysis (stone dissolution) is started about 2 weeks beforehand. An increased concentration of bile acids is provided to dissolve the cholesterol from the gallstones. MTBE (methyl-tert-butyl-ether) is a cholesterol-solving ether and is used in the form of flushing drains in the gall bladder.

The flushing time depends on the respective stone volume. Cholecystectomy (removal of the gallbladder) is the most common form of therapy for gallstone disease. For this purpose, laparoscopy is mainly performed with an endoscope.

With this minimally invasive operation, the recovery of the patient is correspondingly fast. Through an ERCP, gallstones can be found and removed with the help of an endoscope. The therapy of gallstone disease depends on the position of the stone: Usually the stone remains stuck at the narrow point where the bile duct opens into the small intestine.

Since the bile duct and the excretory duct of the pancreas open into the duodenum together, the cocktail of digestive proteins from the pancreas also accumulates. This can then in turn trigger an acute inflammation of the pancreas (pancreatitis). You can find more information on this topic at: Therapy of gallstones Homeopathic approaches to therapy can also be found under Homeopathy for gallstones

Fragmentation of gallstones due to shock waves
In 50% of the patients the disease recurs.
Dissolution (lysis) of the stones by MTBE (endogenous ether)
Drug dissolution of the stones (litholysis)
If it obstructs the exit of the gallbladder (the most common position), this is now treated by a complete removal of the gallbladder (cholecystectomy).
After all, the gallbladder only has storage functions that are not vital, which is why the body can manage without it. The earlier therapeutic approach of destruction by means of sound waves (shock wave therapy) has proven to be permanently useless, as it led to the regular recurrence of gallstones.
If gallstones obstruct the direct channel between the liver and the small intestine, another option must be considered, since the channel cannot be removed. In this case, an attempt is usually made to enter the bile ducts through the mouth, stomach and small intestine with the help of an endoscope (ERCP, see above) in order to remove the stone virtually on site.
Pain relief (analgesia) for biliary colic through medication
Non-surgical gallstone removal by fragmentation of gallstones through shock waves 50% of patients relapse.
Dissolution (lysis) of the stones by MTBE (endogenous ether) Drug dissolution of the stones (litholysis)
Fragmentation of gallstones due to shock waves
In 50% of the patients the disease recurs.
Dissolution (lysis) of the stones by MTBE (endogenous ether)
Drug dissolution of the stones (litholysis)
Removal of the gall bladder (cholecystectomy)
ERCP

Surgical removal of gallstones is especially considered when the affected person is symptomatic, i.e. has pain. Surgery can be planned if the affected person is in a stable condition, or it can be performed immediately in an emergency. If there are no symptoms, surgery can still be considered if the following characteristics of the stones are present: there are several stones, the gallstone is particularly large so that it fills the entire gallbladder, or there is a porcelain gallbladder, which carries a certain risk of degeneration.

When removing gallstones through surgery, there are different methods to choose from, which are used depending on the patient’s condition and assessment of the gallstones. On the one hand, laparoscopic surgery, i.e. using the keyhole technique, with removal of the entire gallbladder, can be performed. In this procedure, the instruments for the operation are introduced into the abdominal cavity through usually four small incisions in the abdominal wall, and can thus still completely remove the gallbladder despite minimal access routes.

As an alternative to the access routes of classic laparoscopic surgery, the surgical instruments, the so-called trocars, can also be introduced into the abdomen through the vagina in women, which then leave no scars on the abdominal wall. In the case of more complicated gallstones, such as very large diameter stones, open surgery may be necessary in some cases. The approach can be chosen either on the right costal arch or on the longitudinal midline of the abdomen.

Here again, the complete gallbladder including the stones is removed. Common to all methods is that they are performed under general anesthesia. If the stones are still small and are already causing symptoms in the patient, the gallstones can also be caught and removed in this way by splitting the ring muscle of the gallbladder in the course of a so-called ERCP (endoscopic retrograde cholangiopancreaticography) examination, in which the bile duct can also be reached with the endoscope.

However, the classic and most commonly used surgical procedure for gallstones is still laparoscopic surgery. As with any surgery, there are certain complications, such as bleeding, injury to surrounding soft tissue, inflammation and wound healing disorder. However, these are all very rare.

The prognosis after the operation is good, patients usually stay in hospital for a week after the operation. For the treatment of symptomatic gallstones, the disintegration of these by means of targeted extracorporeal shock wave therapy can be considered. However, some criteria must be fulfilled for the disintegration therapy to have the desired effect.

Firstly, the stones should be free of calcium and should not exceed a certain volume and a number of three stones. On the other hand, after the stones are shattered, the stone remains are removed, which can only take place if the gallbladder has efficient peristalsis, i.e. contracts and relaxes in a wave-like manner. Furthermore, it should be ensured that the gallbladder is not inflamed.

When the gallstones are shattered, a number of 2000 to 3000 shock waves are emitted from the outside of the body within one hour, targeted at the stones, which ideally causes them to break up into small individual pieces. No anesthesia is necessary for this, at best a pain therapy. Subsequently, drugs such as bile acid can be given to promote the dissolution of gallstones.

Otherwise, the shattered gallstones are eliminated naturally with the urine via the urinary tract. The prognosis is normally very good, although the formation of new stones should be expected in about 10%. If gallstones have been detected in the gallbladder, it is possible to dissolve them with medication or to shatter them with so-called extracorporeal shock wave therapy (abbreviated: ESWT).

Drug-based dissolution is always an option if the gallstones are very small and not calcified. Bile acids are then taken orally (= through the mouth), resulting in an excess of bile acids in the body. Due to the increased excretion of bile acids, the ratio of bile acids and the cholesterol that forms stones changes in favor of the bile acids.

This therapy must be carried out for about 6 months to be successful. A fragmentation is possible for gallstones with a maximum diameter of 3 cm.In addition, these may not be more than three pieces and must be lime-free in composition. ESWT is always performed in combination with drug dissolution to eliminate stone debris as effectively as possible.

ESWT must not be performed in the case of an existing pregnancy, inflammation in the area of the gall bladder and gall ducts, or blood clotting disorders. The risk of recurrence is relatively high for both the drug-based dissolution of gallstones and fragmentation: up to 15% of people treated with ESWT regain gallstones within one year, while with drug therapy new stones form in almost half of those treated within the next five years. For this reason, the dissolution of gallstones is now used less frequently than mechanical or surgical removal of the gallbladder.

The best home remedy against gallstones is probably a low-cholesterol and low-fat diet, which can prevent the development of gallstones. Regular consumption of fruit and vegetables also contributes to prevention. An often recommended household remedy is the daily use of apple vinegar: Two tablespoons of vinegar are added to two glasses of water and drunk. This stimulates the flow of bile and the excess fats have less time to accumulate in the gall bladder to form stones. Pear juice, vegetable juices and peppermint tea have a similar effect.