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ABDOMEN THE MAGIC BOX - II (January, 2004)

Abdomen, the Magic Box ! (partII)
The sleeping tiger inside?
The abdomen contains large variety of organs and each of them have their duties cut out for them. Any one or more of them may be affected by some disease or other at some time or other. In spite of all the experience and skills of the examining doctor and even with all the latest investigative methods currently available, time and again "man proposes a diagnosis and God disposes off this". It is not infrequent that an experienced doctor/surgeon or gastroenterologist comes to a final conclusion as to what particular patient is suffering from. But later at a surgical operation and maybe subsequent pathological examination of whatever tissue or organ has been cut out (Biopsy), the "Final Diagnosis" may turn out to be completely different. That is why the abdomen is considered a magic box.

The Ultrasound scan picks up a "Tiger" inside! The US Scan is now extensively used for almost any abdominal problem, displacing X-ray. It is not uncommon to find some surprise in the scan. One of them is stones in the gallbladder. Whether the gallstones are the cause of the abdominal symptoms that the patient has is not always clear. In fact, sometimes the surgeon is quite sure that the gallstones are not responsible for symptoms. Such a condition is called as "silent Gallstone". This is the "SLEEPING TIGER" inside the abdomen of quite a few people.

Gallstones produce various symptoms like severe abdominal colic, indigestion / abdominal distension or discomfort of varying extent, particularly after taking fat rich diet, and many more symptoms. The stone blocking the exit from the gallbladder produces a complication resulting in severe distension of gallbladder causing severe pain. Infection in this distended gallbladder ("mucocele") may in fact convert into a bag of pus, called "pyocele". This condition often needs a surgical operation, possibly as an emergency. A small stone may get out of the gallbladder exit, but get caught lower down in the bile duct system. This block to the free flow of bile results in not only severe pain but also jaundice and back pressure effects on the liver. The liver gets damaged and if infection sets in, as it often does, severe impairment of liver function and damage to the liver occurs. In this emergency situation, interventional procedures and even emergency surgery may be essential, sometimes as life saving measure.

The bile duct opens into and drains bile into the initial part of small intestines called "duodenum". The secretion of another organ called "Pancreas" also drains into duodenum at the same spot either separately side by side, but often after joining each other. If the gallstone coming out of the gallbladder gets impacted at this common exit into duodenum, it affects liver, produces jaundice etc. but also produces blockage, infection, stone formation and many serious diseases affecting the pancreas - called "Pancreatitis". "Pancreatic stones" "Diabetes" (because pancreas contains insulin producing cells) and some more.

And, even if it does not produce any of these problems till late old age, there is one more serious complication - cancer of the gallbladder, believed to be due to long standing mechanical irritation by the rough stone is possible.

Any of the symptoms or complications may set in anytime and without any provocation. This "sleeping tiger" - the silent gallstone, also called as "cholelithiasis" may sleep, or may wakeup anytime. Once it is symptomatic, treatment, often surgical will be needed.

Is surgery indicated?
Should you tackle the sleeping tiger - the silent gallstone or wait till it wakes up and starts creating problems is a highly debated matter, even among experts. As always, no two doctors agree fully, just like their counterparts in the legal profession!

Probably a good option would be to tackle the silent gallstone - remove it by the presently available patient friendly technique of Laproscopic Cholecystectomy in relatively younger patients or those who are otherwise medically fit to undergo surgery. But older subjects and those who have associated medical diseases like diabetes, high BP, heart disease etc which pose serious risks to life if subjected to anaesthesia and surgery are not advised surgery. In them, we leave the sleeping tiger to sleep, and hope that it does not wake up!

Let us see some more into the magicbox, the abdomen, in some of our future newsletters.
Be healthy, Be happy!


Dr. M.Mohan Rao, MBBS,MS,FICS,MCH,

M.D. & Chief Surgeon, Dr. U Mohan Rau Memorial Hospital.
E-mail: mmr@mohanraohospital.com


Additional Comments (July, 2009)
Controversy – “ To do or Not to Do” surgery for silent gallstones continues. But Laparoscopic Cholecystectomy has tilted the scales in favour of removing the silent gallstones.


 

  

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