Gallstone Disease in Bariatric Surgery Patients

Introduction

Gallstones are common in older individuals due to poor food intake or less water consumption. They are hardened masses that obstruct the ducts, essential for the flow of digestive juices. This may result in pancreatitis or infections if left untreated.

What Is Gallstone?

When the digestive fluids are hardened, they form a gallstone stone in the gallbladder. The gallbladder is a small organ situated on the right side of the abdomen, below the liver. It primarily holds digestive fluids, which get released into the small intestine.

Generally, when an individual consumes food, the gallbladder contracts and empties the bile fluids into the small intestine. The gallstones are due to the bile produced in the gallbladder. Gallstones appear in different sizes. Sometimes there could be just one gallstone, whereas there could be multiple gallstones at other times. Usually, if the gallstones are asymptomatic, they do not require treatment. A few symptoms of gallstones are mentioned below:

• Sudden pain in the right portion of the abdomen.

• Back pain between the shoulder blades.

• Nausea.

• Vomiting.

It is important to seek immediate medical attention if the abdominal pain is extremely intense.

What Causes Gallstone?

The exact cause of gallstones is yet to be determined. Gallstones are most likely to occur due to one of the following reasons:

• If the bile contains an excess of cholesterol, an individual may be affected by gallstones. Usually, the bile is made of enough chemicals to dissolve the excess cholesterol from the liver. But if the liver is made of more cholesterol, it may eventually crystallize and result in gallstones.

• Sometimes, the bile contains excess bilirubin. Bilirubin is a chemical that is produced in the body as a by-product of red cell breakdown. Certain conditions are responsible for excessive bilirubin. Examples of such conditions include biliary tract infections and blood disorders. This excess bilirubin is the cause of gallstones.

• If the gallbladder cannot empty properly, it may result in gallstones. This is because the bile gets concentrated, resulting in the formation of gallstones.

There are different types of gallstones found in the body. They are:

• Pigment Gallstone - These are dark brown stones formed when the bile contains an excess of bilirubin.

• Cholesterol Gallstones - It is a very common type of gallstone that is usually yellow in color. They compromise many undissolved cholesterol and other components.

The risk factors of gallstones are mentioned below:

• Individuals above the age of 40 years.

• Being overweight.

• Consuming a high-fat diet.

• Eating a low-fiber diet.

• Diabetes.

• Certain blood disorders.

• Taking certain medications.

• Losing weight constantly.

• Liver diseases.

• Family history of gallstones.

Gallstones may present with various complications, some of which are mentioned below:

• If the gallstone gets lodged in the gallbladder, it can cause severe inflammation, resulting in cholecystitis. Cholecystitis can cause severe pain and fever.

• Gallstones can block the ducts through which the bile flows from the gallbladder to the liver. This may result in severe pain, jaundice, and bile duct infection.

• Sometimes, bile stones obstruct the pancreatic duct, which joins the common bile duct. These juices aid in digestion and flow through the pancreas, which gets obstructed and infected by gallstones.

• People with a history of gallstones have an increased risk of cancer.

How Is Gallstone Prevented?

In order to prevent gallstones, it is important to follow the below-mentioned measures:

• It is important to stick to regular meal times every day and avoid skipping meals. This is because rapid weight loss can increase the risk of gallstones.

• Eating food rich in fiber content, like fruits and vegetables, can help to prevent gallstones.

• Obesity and being overweight can increase the risk of gallstones.

What Is Bariatric Surgery?

Gastric bypass, also known as bariatric surgery, involves making changes in the digestive system for weight loss. It is done when dieting and exercising have not successfully reduced an individual’s weight. The surgery limits the ability of the individuals to meet. Alternatively, it can also inhibit nutrient absorption from the body. There are various types of bariatric surgery. They are:

• Sleeve gastrectomy.

• Gastric bypass.

• Biliopancreatic diversion.

Bariatric surgery is usually done to aid in losing excess weight from the body and reducing the risk of potentially life-threatening diseases. The health problems include:

• Heart diseases.

• Stroke.

• Nonalcoholic fatty liver disease.

• Sleep apnea.

• Type 2 diabetes.

Bariatric surgery cannot be performed for all individuals who are overweight. To perform bariatric surgery, an individual has to meet certain guidelines that qualify for weight loss. A few risks associated with the surgery are mentioned below:

• Infection.

• Excessive bleeding.

• Blood clots.

• Breathing difficulty.

• Leaks in the gastrointestinal system.

The surgery is usually done in the hospital under the influence of general anesthesia. The surgery may vary for each individual depending on the type of weight loss surgery. After the surgery, the individual is usually restricted to eating certain types of food for a couple of days. The diet usually begins as a liquid diet and slowly progresses to a soft diet. There may be a lot of restrictions on eating and drinking.

What Is Gallstone Disease in Bariatric Surgery Patients?

Some patients are known to present with gallstones post-bariatric surgery. Obesity has been identified as the independent risk factor for gallstones. Post-bariatric surgery, as individuals may experience rapid weight loss, they are highly prone to gallstone disease. Usually, gallstone is detected incidentally during other diagnostic tests. Once it reaches a large size, it blocks the gallbladder, which is primarily responsible for producing bile. It eventually results in acute pain lasting anywhere between 30 minutes to several hours. Sometimes it is accompanied by nausea and vomiting. The treatment for this involves removing the gallbladder. The gallbladder is not a vital organ anymore, as the fat intake is substantially less. So individuals are capable of performing daily activities without the gallbladder.

Conclusion

Gallstones usually occur due to a fat-rich diet or a diet with less fiber intake. It is usually asymptomatic and is found accidentally. The treatment involves removing the gallbladder. Bariatric surgery is usually performed to aid with weight loss in individuals. Sometimes post-surgery individuals may have gallstones due to rapid weight loss. Identifying the condition plays a vital role in treating gallstones.