Gallstones (cholelithiasis)

Understanding
Gallstone disease or kolelitiasis is a health problem where there is a stone in the bladder or bile ducts. In some cases, stones may be present in both organs. This stone is the result of bile liquid that solidifies into hard particles resembling pieces of stone - like gravel.

Bile itself is the only pathway that works to remove excess cholesterol from the body-either as free cholesterol or as bile salts. While the gallbladder is a sac that serves to store bile before it is released into the intestine. The location of the gallbladder is under the liver.

If gallstones enter the bile ducts, blockage and infection of the bile ducts (cholangitis) may occur. The blockage that occurs in the bile ducts will make the bacteria grow and develop. As a result, there is infection in the channel. The bacteria can also spread through the bloodstream and cause infection in other parts of the body.

Gallstones can be divided into three types, namely gallstones cholesterol, pigment gall stones, and gallstone mixture. As the name implies, cholesterol gallstones are formed from cholesterol. Gallstones are usually yellow or green.

Furthermore gallstones pigment / bilirubin, formed from too much bilirubinat calcium in bile. Gallstones this one is usually dark, like black or brown. The last is a gallstone mixture which is a mixture of cholesterol and bilirubin.

Diagnosis 
In diagnosing gallstones, the physician will collect accurate information and physical examination of the patient. More than half of people with gallstones usually do not feel any symptoms. Complaints that may arise are bloated that sometimes accompanied by discomfort in the body when eating fatty foods.

In addition to gathering information, your doctor will also advise you to undergo a support. Investigations that can be done include ultrasonography or ultrasound examination. This is a standard examination to confirm the diagnosis of gallstones. Ultrasound examination has a very high accuracy, which reaches 95%.

In addition to ultrasound, another examination that can also be done is a CT scan. A CT scan is performed when the stone is in the bile ducts. In addition there is also an MRI (Magnetic Resonance Imaging). This examination is necessary if there is a yellow pain complication. 

Symptoms 
Gallstones in general do not cause complaints in patients - during the stone does not enter the bile ducts. But if a stone enters the end of the bile ducts, you may feel a certain complaint.
When small, there is the possibility of a rock easily pass through the bile ducts and enter the duodenum. Gallstones may not cause symptoms for decades.
Significant symptoms of gallstones disorder are severe tenderness and persistence in the bile ducts. The pain arises if the bile ducts are blocked by the stone. It can also lead to severe abdominal pain that radiates to the back or shoulders. Nausea and vomiting are often associated with this pain attack.
Other symptoms that can also appear is fever, pain throughout the surface of the abdomen, stomach feels twisted, and the stomach feels bloated. Severe pain may last more than 15 minutes and disappear a few hours later.
The onset of pain often progresses slowly. But 30% of cases, the pain arises suddenly. Pain due to bile duct stones usually persists and gets worse when breathing in. 

Treatment
Treatment of gallstones should be adapted to the development of the stone and its impact on you. Because, basically gall stones have different effects and influence between each person.
There are several steps of gallstone treatment: 

• Early stage  

As mentioned earlier, gallstones do not always cause symptoms. If gallstones do not cause any symptoms, doctors usually will not take special medical action. However, the doctor will ensure in advance that there is no possibility of complications that will occur. But if there is a possibility of complications or other diseases that increase the risk of complications, then further treatment is needed. 

• Advanced Stage

At this stage, it is necessary to see the severity that occurs. If the symptoms of pain that you feel is still relatively mild and rarely appear, then the consumption of drugs is enough. Usually the necessary medication is the type of painkiller medicine. In addition, you should also change your diet to be healthier.
But if the pain that arises-especially in the abdominal area-feels so great, then there is a need for further medical action. Especially if the pain appears quite often. Possible operative action is required. 

Operative Action 
This medical action is necessary only when the symptoms you feel are severe and severe. The worst possibility is your gallbladder should be removed. There are several operative measures that can be done to deal with gallstone problems.

• Laparoscopic cholecystectomy

This is the most commonly recommended operative action because it produces a very minimal incision. This action is also known as keyhole surgery because of the size of a very small incision -in a keyhole. The recovery period you need lasts for 1-2 weeks. 

• Open cholecystectomy 

This action is necessary if the size of gallstones is large enough not to be removed by keyhole surgery. Or it could be done if your condition is not possible to undergo laparoscopic cholecystectomy. The cause can vary - such as the location of the gall bladder is suli dijangkai or in case of obese people. The recovery period is long enough, that is 1-1.5 months.

• ERCP (Endoscopic Retrograde Cholangiopancreatography)

To deal with blockage problems in the bile ducts due to gallstones can also be done through ERCP procedures. This procedure is performed without removing the gallbladder.

• ESWL (Extracorporeal Shock Wave Lithotripsy) 

This is a rock breaking procedure by using sound waves. A few years ago, the use of ESWL procedures was very popular. However, this procedure is only limited to patients who have actually considered to undergo this therapy 

Cause
Previously it was explained that there are three types of gallstones. Each is formed and has different content. Gallstones cholesterol contains at least 70% cholesterol and the rest are calcium carbonate, calcium palmitite, and calcium bilirubinate. The shape is more varied than the pigment stone shape.
Gallstones are almost always formed in the gallbladder. Its surface is slippery, round, prickly, and sometimes there is something similar like a mulberry fruit. Gallstones cholesterol occurs due to the concentration of cholesterol in the high bile. This happens as a result of high blood cholesterol.

High cholesterol in the gallbladder can trigger deposition that gradually turns into stone. Another cause is the emptying of bile in the gallbladder is less than perfect. The remaining bile in the bag after the bile pumping process can also cause precipitation.
In contrast to gallstones pigment. Appearance of calcium bilirubinat stone, also called mudstone or pigment stone, does not vary much. Often found irregularly shaped, small in size, with color variations between brown, reddish, to black, and sometimes large amounts.
It looks like mud or fragile soil. Pigment stones occur because bilirubin is difficult to dissolve in water. It is also due to the deposition of salt bilirubin calcium or due to infectious diseases.
Further gallstones mixture. This is the most common type of gallstones - even 80%. Gallstones of this one is formed from cholesterol, bile pigment, and various calcium salts. Usually multiple and slightly contain calcium "

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