dr vivek baliga

Gallbladder Stones – Do I Need Surgery?

Dr Vivek Baliga Abdomen, Dr Vivek Baliga, Liver ,

Gallbladder stones are a common finding on a routine ultrasound scan. Many get concerned about it, but often it is nothing to worry about.

A common question I am asked is whether having gallbladder stones means surgery is needed.

Fortunately, it is not always the case.

Today, I will discuss gallbladder stones with you, and explain what is normally done about them.

What Are Gallbladder Stones?

Gallbladder stones, also called gallstones, are basically small deposits of hardened digestive enzymes inside your gallbladder. The gallbladder is a small balloon-shaped storage organ that is located directly below your liver as is shown in the picture.

It is quite common to find all stones on a routine ultrasound abdomen scan. However, only 1% to 2% of patients develop any complications related to it. Over a 15 year period, 20% of patients will develop a problem.

In the medical world, gallstones are called cholelithiasis.

Interesting trivia

Gallstones have been present in humans over thousands of years. In fact, Egyptian mummies have also been found to have gallbladder stones.

It is a common condition in women who are overweight.

What Causes Gallstones?

The main composition of gallstones is cholesterol, bilirubin (a liver pigment), calcium, proteins and other materials.

There are three different types of gallstones:

  1. Pure cholesterol stones contain around 90% of cholesterol.
  2. Pigment stones contain varying proportions of compounds I have listed earlier. They may be brown or black in color.
  3. 3. Mixed composition stones which contain varying proportions of cholesterol, calcium phosphate and calcium palmitate along with calcium carbonate.

Bile is a compound that is released by the liver in order to dissolve cholesterol. Sometimes though, the liver can produce too much cholesterol and it is not possible for the bile to dissolve this.

As a result, tiny crystals form which eventually become gallstones. In the early stages, these crystals are present in the form of a thick liquid called gallbladder sludge.

Sometimes, certain clinical conditions can lead to the excess production of bilirubin. Bilirubin is a yellow pigment that is formed in the body when the red blood cells break down. Too much bilirubin can eventually lead to gallstone formation.

Finally, if the function of the gallbladder is impaired, the bile can remain within the gallbladder and eventually form stones.

Who Is At Risk?

The risk factors in the development of gallstones include obesity, increasing age, pregnancy, female gender, rapid weight loss and certain medications such as oral contraceptives.

risk for gallbladder stones

As I have mentioned earlier, most patients with gallbladder stones do not have any symptoms and they are found incidentally on an ultrasound scan.

However, on some occasions the stones may pass through the tiny tube coming out of the gallbladder called the cystic duct. When this happens, symptoms may begin.

Sometimes, the stone will have passed through the cystic duct further down digestive tract into the ducts coming out of the pancreas. This can result in a condition called acute pancreatitis which is a serious problem.

Symptoms And Signs of Gallbladder Stones

A majority of patients will remain asymptomatic. This means they will be completely unaware they have gallbladder stones unless they undergo an ultrasound scan of the abdomen.

However, some patients may develop intermittent episodes of very sharp and constant pain just below the lower part of the right side of the cage. Associated with this pain can be nausea and vomiting. Sometimes, the pain can be felt in the right shoulder as well.

gallbladder stones symptoms

This pain is called biliary colic. This occurs because the stone is attempting to come out of the gallbladder through the cystic duct.

On occasion, the gallbladder stone will move back into the gallbladder and the pain relieved.

If you are aware you have gallstones and experience a sudden pain, then make sure you see your doctor.

A common trigger for gallbladder stone pain to occur is the ingestion of a fatty meal. Many times, when food that is full of fat is consumed, pain may begin an hour or so later and can last up to 6 hours. Not everybody will experience this.

If the stone gets stuck, the gallbladder can become distended and inflamed. This can cause severe pain, vomiting and even fever. This is called acute cholecystitis and is a condition that sometimes requires hospitalization.

If the stone is stuck and there is a superadded bacterial infection around the stone, it can lead to jaundice along with fever and abdominal pain. This condition is called cholangitis and requires intravenous antibiotics and surgical removal of the stone.

Diagnosis Of Gallbladder Stones

Initial diagnosis can be made through blood tests which include a liver function test. Often the alkaline phosphatase and bilirubin levels are elevated on the blood report. A complete blood count may show an increase in the total white blood cell count which is indicative of an active infection. ESR and CRP may also be elevated.

A simple diagnostic tool in determining whether the patient has got gallbladder stones is an ultrasound scan. This is a painless procedure and can be done in just a few minutes. While gallbladder stones can be visualized fairly easily, the presence of thickening of the gallbladder wall and fluid around the gallbladder indicates acute cholecystitis or gallbladder infection.

Additional imaging of the gallbladder is rarely required.

However, if there is concern or if further information is required, a test called a magnetic retrograde cholangiopancreatography, or MRCP, will be performed. This is essentially an MRI scan.

In individuals in whom the gallbladder stone is stuck, a procedure called an endoscopic retrograde cholangiopancreatography, or ERCP, may be performed. This is a test where an endoscope is inserted through the oral cavity all the way into the stomach up until the opening of the gallbladder into the digestive tract. Once a stone is removed, a stent is usually placed to keep the cystic duct and common bile duct open to allow free flow of bile from the gallbladder.

Gallstones Treatment

Patients who have gallstones and do not have any symptoms do not require any treatment.

Lifestyle changes

Dietary advice in the form of a low fat diet (avoid fried foods, ghee and sweets) and regular exercise will be provided.

If you are attempting to lose weight, don’t crash diet and lose weight too quickly.

Increase the fiber intake in your diet. Green leafy vegetables, green beans, oats etc have a lot of fiber. There are also high fiber supplements available as well.

Medical treatment

As such, there is not much in terms of medical treatment of gallstones.

If the patient has cholesterol stones, then treatment with a medicine called ursodeoxycholic acid may be offered. This tends to be useful in only 50% of cases and in stones that are less than 1 cm. The treatment can take up months to reach some degree of benefit.

If the tablet is stopped, gallbladder stones can recur.

Surgical treatment

However, if biliary colic i.e. abdominal pain is a problem, then elective surgery to remove the gallbladder along with the gallstones will be advised. Surgeries are now done laparoscopically and rarely are open surgeries required.

In children who have gallbladder stones, symptoms will inevitably develop. In such cases, gallbladder removal will be advised as a preventative treatment.

In patients who are undergoing weight loss surgery, the gallbladder is often removed simultaneously.

Those who have long-standing gallbladder stones more than 3 cm in diameter and calcification of the wall of the gallbladder (porcelain gallbladder) will be advised gallbladder removal as well.

Conclusion

Gallbladder stones are a common problem but is often nothing to worry about. Surgery is not needed in all patients but in only those who have made a risk factors or symptoms from the stones.

At Baliga diagnostics, we commonly come across patients who have gallbladder stones and manage them medically, sometimes offering surgical corrections. Visit our clinic today if you wish to learn more.


Urine Infection? Causes, Treatment & Prevention

Dr Vivek Baliga Dr Vivek Baliga, Urine , , , ,

Today, I will talk about urine infections.

One of the commonest reasons why patients come to our general medical clinic is fever.

On questioning, many of them have a high fever for a day or two, that is associated with burning sensation when they pass urine. It is likely that the patient is suffering from an infection in the urine, commonly called UTI, or urinary tract infection.

Given how common this is, we thought we should briefly touch upon what a UTI is, and how it is treated.

What Is A Urine Infection?

A urinary tract infection, also called a urine infection, refers to an infection that has affected the bladder or any other part of the urinary system.

It is commoner in women when compared to men, and is often seen in older individuals.

Before we dive into urine infections and how they are managed, here is a brief look at the urinary tract, or your urinary excretory system.

The Urinary Tract

The urinary tract consists of the following –

bigstock-Urinary-System-35562683

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Vitamin D – All You Need To Know

Dr Vivek Baliga Bones, Dr Vivek Baliga, General , , , , ,

Our body requires a number of different nutrients to function normally. Vitamin D is one such nutrient that has a variety of different functions in the body. Women (and men) in India are surprisingly low in Vitamin D levels. This can have detrimental effects on the body, and can affect your health in the long term.

Let’s take a brief look at why this vitamin is essential, and how low levels can affect your health.

What Is Vitamin D?

Our body requires vitamins and minerals that ensure normal functioning of all the cells in the body.

Vitamin D is what is called a ‘fat soluble’ vitamin, and forms an essential component of our bones. It plays an important role in the regulation of calcium and phosphate levels in the blood, and these are primary components of bones and teeth.

Once vitamin D is synthesized in the body, it is converting into an active hormone in order to exert its benefits.

What Are The Sources?

Vitamin D is primarily obtained from sunlight. Our skin absorbs the sunlight, and a series of different chemical reactions occur which ultimately results in the production of vitamin D. While a detailed discussion regarding how this occurs is out of the scope of this article, we thought we would include a diagram that illustrates this for those who love science!

vitamin D

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Here’s How You Can Keep Your Eyes Shining Bright

bgbaliga Dr Vivek Baliga ,

Your eyesight is a precious commodity.

If you are looking to keep your eyes healthy, then there are certain things that you need to do to ensure that. Here are a few ways you can do so.

  1. Eat healthy foods, especially ones that are colored orange. They are rich in vitamin A that is essential for good eyesight.
  2. Stop staring at the computer for too long
  3. Give your eyes some rest
  4. Sleep well

There are many more ways that you can keep your eyes healthy. Rather than go into the specifics, I would like to draw your attention to an article Dr Vivek Baliga published on how to keep your eyes healthy.

Take a look at it when you get a chance.


How Thick Are Your Bones? Dr Vivek Baliga Presentation

Dr Vivek Baliga Bones, Dr Vivek Baliga , ,

Our bones get thinner as we get older. Osteoporosis is a common problem that is faced by many, especially women in the post menopausal age group.

In this presentation, Dr Vivek Baliga discusses a simple test that helps determine the thickness of bones and whether they are prone to fracturing.

Take a look at the presentation below.

As is very evident from the presentation, bone thickness can be affected due to a number of reasons. Dr Vivek Baliga clearly explains what can be done to keep the bones healthy. In addition to this, he also talks about how a bone mineral density test is done and how useful it is in determining whether the bones are of normal thickness or whether they are thin and weak.
Bone fractures can be very painful, and Dr Vivek clearly describes how the BMD test can help detect bone thinning early. This will help you start treatment sooner rather than later.


Congenital Birth Defects – Dr Vivek Baliga Article

Dr Vivek Baliga Heart disease , ,

The development of the human body is a work of wonder. Starting out from tiny cell, it divides rapidly over a period of 9 months, finally emerging out of the womb as a bundle of joy.

The birth of a child is amazing, and the first look that we as parents have of the fetus in the womb on the ultrasound scan is nothing but memorable.

The primary purpose of these scans is to pick up any defects early on during development, so that appropriate action can be taken if needed.

While the process of development of a foetus in the womb is probably the most organised process in the world, it is not uncommon for things to go wrong sometimes.

Defects that occur in the structure of the tissues during foetal development are called congenital defects.

Studies have shown that in India, 70 out of 1000 live births have birth defects. There are many kinds of congenital defects, some of which we have discussed below.

Risk Factors

What are the risk factors that can lead to an increased chance of the fetus developing congenital defects?

The common ones include –

  • Increased maternal age – Women who have babies over the age of 35 years are at increased risk
  • Poor planning of pregnancies
  • Improper antenatal care – This refers to care taken prior to and just after conception.
  • Pre-existing medical conditions in the mother such as diabetes, high blood pressure and epilepsy
  • Consanguineous marriages – This refers to marriages between close relatives. This is more common in south India.
  • Poor maternal nutrition – This includes consumption of alcohol and smoking during pregnancy
  • Low socioeconomic conditions

Common Congenital Disorders

Heart defects

These are probably the most worrying to all parents.

A congenital heart defect is often regarded as a simple hole in the heart, but it is a lot more than that.

Sometimes, the blood vessels that emerge from the heart may develop in a ‘reverse direction’, resulting in oxygen poor blood getting circulated through the body.

Babies with these defects may have breathing difficulties, rapid heart beating, problems with feeding, bluish skin and even swelling in the legs.

These defects usually need some form of surgical correction. Some may need pacemakers.

Modern technology now permits detection of heart defects in the very early stages of foetal development. This way, action can be taken sooner rather than later.

Down syndrome

This is a well recognised birth defect amongst the general public.

It is seen in 1 in 800 births, and children typically have features such as small, slanted eyes, a small mouth, folded ears, large tongue, flattened nose and small hands and fingers.

Around 50% of children with this condition have hearing difficulties, and heart defects may also be present.

There is some degree of mental retardation; however a large number of these children still have the essential skills needed to live a normal life.

Cleft lip and palate

This is another common condition, that these days are detected when the baby is in the womb.

It is not clear what the cause of this condition is. Children with cleft lip and palate have a slit present in the upper lip that can extend into the nose and the palate in severe cases.

The cleft is a result of failure of fusion of the left and the right sides of the lip and palate during embryonic development.

Children with this condition may have difficulty feeding and difficulty speaking.

However, surgical correction of the defect is possible around 3 months of age for cleft lip, and between 6 months to a year for cleft palate. Scarring is minimal and quality of life is normal after repair.

Club foot

This condition is common in boys, and occurs in 1 in 400 births worldwide.

It is a deformity of the feet and ankles, resulting in the foot getting ‘folded inwards’ to look like the end of a club.

Mild cases are usually painless, but severe club foot can be quite painful.

Once detected, treatment usually involves gentle correction of the defect using different manoeuvres and exercises.

Severe cases may require plaster casts or special shoes that have to worn up to 6 months of age.

Spina Bifida

This is an uncommon condition and is characterised by the presence of defect in the lower part of the spinal column.

Spina bifida is described as a neural tube defect. A neural tube is a precursor in the development of the spinal column, and defects in this structure can now be detected sooner through fetal ultrasound scans that are performed during pregnancy.

The condition may be harmless, though some children may have problems with bowel and bladder control.

Surgical correction may be performed within the first 2 days of birth, and physical therapy may be needed in the future to allow for normal mobility.

What To Do As A Parent

If your child has a birth defect, do not panic.

Modern treatments have made it possible for children with birth defects to have completely normal lives.

Make sure you get the advice you need from a pediatrician who will guide you regarding the future and prepare you for any situations you may encounter.

It is important for all pregnant women to get their ultrasound scans done as scheduled as these can pick up serious problems even before the baby is born.


For more academic articles by Dr Vivek Baliga, click here.


Chest Pain – It’s Not Always Due To Heart Disease

Dr Vivek Baliga Chest pain, Dr Vivek Baliga, General , , , , ,

Chest pain is a common reason for patients to visit their doctor. Many a time they worry what might be the cause of the pain, and in particular worry whether it may be a heart attack.

This worry and anxiety is natural. It may be reassuring to know that not all chest pain is due to the heart, and there are a number of other causes as well. This sort of pain is called non cardiac chest pain. However, if you do suffer from chest pain, rather than think it could be due to these other causes, we STRONGLY RECOMMEND you see your doctor straight away for further advice.

Here are some points on how to manage acute chest pain.

Right, so lets see what the other causes for chest pain are. We will not be talking about heart attacks or heart related pain here.

1. Gastro-Esophageal Reflux Disease (GERD)

heartburnGastro-esophageal reflux disease (gastro = stomach, esophagus = food pipe), also called GERD, heartburn or acid reflux disease is the most common cause of non cardiac chest pain seen in clinical practice. Millions of people all over India and in the South Asian countries suffer from this condition. This is well recognised as one of the commonest causes of non-cardiac chest pain.

Patients with GERD often complain of chest pain behind the breast bone. The pain is typically ‘burning’ in nature, and patients state that they experience increased episodes of burping and ‘acid in the mouth’. Patients also tend to salivate more. The symptoms are worse after a heavy meal and when lying down flat. This history is fairly classic of this condition. Read more