Gallstones: I could not dress, go to the hospital

Richard Kavita started feeling excruciating pain in his abdomen but could not dress himself to go to hospital. That was in 2019. “I had zero symptoms, it just came abruptly in the middle of the night. At first I thought it was normal abdominal pain but it persisted for like an hour and I had to be taken to the hospital,” recalls Kavita, who lives in Machakos County.

A CT scan revealed that he had gallstones. He was admitted immediately awaiting a surgical procedure which did not happen because gallstones - hard stone-like structures that form in the gallbladder - can be dissolved medically. 

Dr Ancent Kituku, a consultant surgical pathologist and also the Machakos County Health Executive, explains that the gallbladder is connected to the liver and the small intestines and its main function is to store bile.  “Bile is produced in the liver and it is concentrated in the gallbladder and later released as the need arises into the small intestines mainly for digestion of fat,” Dr  Kituku explains.

When the bile is too concentrated, it may form gallstones if it contains excess cholesterol, bilirubin or less bile salts. Gallstones also form if the gallbladder does not empty completely or often enough.

There are two types of gallstones including cholesterol stones which, Dr Kituku says, have more than 70 per cent cholesterol. The second type are pigmented stones, made up of bilirubin and blue salts. Bilirubin is a yellowish pigment made during the normal breakdown of red blood cells.

“There are other mixed stones which are formed when levels of cholesterol in bile become too high and the excess cholesterol forms into stones,” adds Dr Kituku.

Dr Ngami Mutwa, a physician at Machakos Level 5 Hospital, says patients who report with gallstones have high fever, acute abdominal pain especially on the upper right side where the liver sits, yellowness of the skin and eyes (jaundice) and others may have nausea and vomiting.

The medic further explains that since the gall bladder connects with the liver and the small intestines, there is a duct that connects the two and when the stones form, they can lodge in either of the ducts, causing blockage and making the patient get severe pain in the abdomen.

“Some may get irritation in the gallbladder and may present with inflammation of the gallbladder called cholecystitis,” offers Dr Ngami.

Gallstones are more common in females than in males due to the estrogen hormone found in females which is responsible for the formation of gallstones.

And there are certain risk factors that expose one to gallstones, including advanced age especially for those above 40, fertility, being overweight or obese, a sedentary lifestyle or pregnancy, which induces changes in hormones. Other factors include consumption of high-fat and high cholesterol diet, a low fiber diet, diabetes or abrupt weight loss.

“We say that obese people are more likely to get stones and that lean people are less likely, but when one loses weight abruptly, they will be at a risk of getting these stones,” says Dr Mutwa.

Certain medications that contain estrogens, such as oral contraceptives or hormonal drugs, can also trigger gallstones, while having certain disorders like sickle cell disease or leukemia may also trigger the formation of gallstones.

Dr Ngami singles out avoiding fatty and high cholesterol foods as the best form of management but that some factors are uncontrollable, like old age and gender.

In treatment, Dr Ngami notes “we start by running some tests on the patient mostly imaging or blood tests to determine if it is hard or soft and if it should be treated non-surgically or surgically.”  

On his part, Dr Kituku explains that most gallstones can be removed surgically if medication given to dissolve them does not work effectively. However, “dissolving the stones can take long so most doctors will recommend surgical removal.”

The doctors also advise people to reduce the risks of gallstones by losing weight slowly, eating more high-fiber foods which include fruits and vegetables and whole grains, and maintaining a healthy weight.