Choledocholithiasis

This is a good article everyone should read if they are more than 50 years old and feel bloated after food intake. This bloatedness can indicate that something is wrong somewhere within the biliary system, and often, there are ready-made gallstones in the gallbladder (they can't be found anywhere else anyway).

Now if I tell you that surgery to remove the gallstones is a quick-fix but a rather expensive affair, what is your immediate response if you were a patient suffering from gallstones? Of course you will want to try "everything else except surgery". What choices are there for the removal of gallstones?

You must have heard and read about "batu karang hempedu". Well, that's gallstones. The Malays call the gallstones "batu karang hempedu" as the "shiny colourful but ugly gall marbles" are bitter, comprising mainly of bitter substances in bile (don't tell me bile is sweet on exams or in viva!!).

We could use some imagination here. Think about how to remove marbles from a bag or from a tube. Well, if all the small marbles are inside the bag, we tie and sever the bag - simple? Yes. What if a marble is down somewhere in the biliary tree (which is a tube system anyway)? How do we get a marble out of a tube? Press it out? Press so hard till it pops out? Maybe an easier way is to tie the tube at 2 locations, immediately before and after the blockage. Then sever the bulge, maybe join the cut ends and get bile to flow freely again as before the blockage? Easier said than done. Surgical removal of the blocked tube is safer, I would think.

Anyway, try to read this article:

Ann Acad Med Singapore. 2010 Feb;39(2):136-42.

Laparoscopic common bile duct exploration: our first 50 cases.
Tan KK, Shelat VG, Liau KH, Chan CY, Ho CK.
Centre for Advanced Laparoscopic Surgery, Digestive Disease Centre, Section of Hepatobiliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore.


Now that you have read the article, and I think you know a little bit more about gallstone removal, you may want to write your comments.

I have put this article up because we have put Professional exam questions on Cholecystectomy, but many students were not able to recall what that big word meant and therefore started answering as if I asked them to make a gallstone punch or something. So, look up that big word, and learn a few things from that article. The topic is important as many (if not all) who reach age 50 start developing problems relating to gallstones.

If you have to know a person's age, these are some clear signs (as I see it):
1) If a person holds/adjusts his/her book/paper at a distant in order to read it - the person is past age 40.
2) If a person says he/she needs her glasses to see something - the person is past age 50.
3) If a person says he/she feels stuffed or bloated after meals - the person is past age 50.
4) If a person says he/she has knee pain - the person is past age 50.
5) If a person says he/she didn't hear you well - the person is past age 50.

So, listen well when you are around people who are much older than you. This is the first lesson in medicine. Knowledge comes second and wisdom is third.

External link:
http://www.healthline.com/health/gallstones#Overview1