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Do Gallstones Always Require Treatment?

Do Gallstones Always Require Treatment?

Gallstones are common, and when they are discovered incidentally, such as at the time of a CAT scan or ultrasound, they are often asymptomatic. If you find you have gallstones and there is any question as to whether to treat them, your doctor will most likely want to conduct some simple blood tests. Gallstones can do serious harm without causing symptoms. Your doctor may want the opinion of a general surgeon, the specialist best equipped to determine this possibility. However, truly asymptomatic gallstones can typically be left untreated.

Symptoms attributable to gallstones include pain almost anywhere in the torso. The most common location is just under the right rib cage, but pain can also be felt in the upper part of the mid-abdomen, behind the sternum, in the back, right shoulder, or between the shoulder blades. Mostly, this pain comes in episodes, usually at night, and is intense. It may last only a few minutes or could remain for hours. It tends to occur after eating a heavy or rich meal, but the time frame after eating is variable. However, some people have only mild pain, or more nausea and indigestion, sometimes diarrhea, rather than pain. Still, others have no discomfort at all, but their family or friends notice that their eyes or skin seem to be turning yellow (jaundice), and their urine takes on an unusual amber, almost fluorescent appearance. Since the symptoms caused by gallstones can be varied and misleading, a physician experienced in diagnosing and treating gallstone disease should judge whether or not you need treatment.

For those who do need treatment, the best way to deal with gallstones is to remove the gallbladder. This obviously requires an operation. Modern gallbladder surgery (laparoscopic cholecystectomy) is one of the most common operations performed around the world and is extremely safe. The operation almost always cures the condition permanently, and healing is usually very quick. Alternative forms of treatment include dietary restriction (low fat), watchful waiting, wearing a drainage tube, having an internal opening (papillotomy) made in the bile duct (sometimes with an internal drainage tube) to reduce the risk of stones lodging and plugging the bile duct, and taking medication that dissolves gallstones. However, none of these alternatives work as effectively as having the gallbladder removed.

The consequences of untreated gallstones can be very serious, even life-threatening. These include gallbladder inflammation and infection, pancreatitis, bile duct, and liver infection, jaundice, and gallbladder cancer. Even if your doctor or surgeon determines that your gallstones do not require treatment, you should consider this recommendation to be temporary. Gallstone disease that is treated without gallbladder removal should be reevaluated at least once a year.


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