Gallbladder Stones

Once, a young lady from a group of young visitors to our hospital had volunteered to lie on the couch to have me demonstrate how an ultrasound machine works. When I put the probe on her abdomen intending to show them what normal organs in the abdomen looked like, I was surprised to find that her gallbladder was packed with multiple stones. On repeated questioning however she denied ever having had pain.

Stones form quite commonly in the gallbladder. Of every 100 adults walking on the streets in northern India, stones will show up in the gallbladder in atleast 5 of them if they are all subjected to an ultrasound test. This figure goes up to around 15 in Western Europe and America. Highest prevalence of gallstones has been reported in a tribe of Pima Indians (native Americans), 75% of whom are affected by the age of 35.

Why stones form in the gallbladder of some individuals is still not clearly. Medical students are often taught the risks of 6 Fs: fat, females, forty, fair, fertile and those having a family history. Though females are more often affected than their male counterparts, and fatty people indeed more often have stones, they need not have to be fair anymore to qualify for having them!

Gallstones usually appear yellowish or whitish and are composed of cholesterol. They form due to excess amounts of this sludgy material that the liver excretes in the bile. Around 15% of stones however are black in colour, and consist of a black pigment formed from the breakdown of bilirubin.

Medical scientists distinguish 2 types of stones: the naught ones that come to attention by causing severe pain, and the silent ones that are picked up incidentally. The “painful” ones are likely to cause pain repeatedly, and are best removed by surgery.

Doctors seem divided in their opinion about how to deal with “silent” gallstones. Dr Gracie had followed up a group of 200 Americans with silent stones for several years in the 1980s, and found that only 18% developed pain in their lifetime. In other words, 82% went through life harbouring stones without any problems. The conservative group therefore feels that silent stones are best left alone, unless they start giving trouble.

The aggressive group on the other hand, composed mainly of itchy-handed surgeons, recommend that stones are best removed before they get to cause trouble. They site rates of potentially serious complications such as pancreatitis (1%) and cancer (0.6%) and argue that the benefit of laparoscopic surgery in modern time far outweigh its risk. Why live with the constant worry that the stone may slip one day or the gallbladder may turn cancerous?

A senior lady doctor who had sought my consultation for silent gallstones a few years ago finally underwent surgery and got her gallbladder with stones removed. “I don’t have to worry about them everyday anymore”, she told me when she met me at a party!

As published in HT City ( Hindustan Times) dated 15th July, 2012.