Wednesday 20 November 2019

Ask the GP: Decrease the risk of gallstones

If you have increasing bouts of abdominal pain its worth getting a surgeon's opinion
If you have increasing bouts of abdominal pain its worth getting a surgeon's opinion

Nina Byrnes

Expert advice from our GP on gallstones and facial thread veins.

Question: My doctor sent me for an ultrasound recently because I had some abdominal bloating. I was told the ultrasound was OK but that I have gallstones. My GP said I don't need any surgery.

Dr Nina replies: The gallbladder is a pear-shaped gland that sits below the liver in the right side of the abdomen. It stores a substance called bile which helps us digest fats in our diet. Gallstones form when liquid stored in the gallbladder hardens into pebble-like material. They can vary in size from small bits of grit to as large as a golf ball. People may have one or several gallstones. Gallstones are very common and are thought to occur in 10 to 15pc of the adult population.

There are two main types of gallstones. Cholesterol stones are the most common. Bile is normally able to break down cholesterol excreted by the liver. However if there is excess cholesterol excreted this may crystallise and form stones. These stones are normally yellow green.

The second type of stone is a pigment stone. These occur when there is too much bilirubin in bile. Bilirubin is produced from the break down of red blood cells. Other conditions such as cirrhosis, certain infections and blood disorders may lead to increased bilirubin.

Gallstones may also occur when the gallbladder doesn't empty correctly. Bile may become very concentrated and then stones may be more likely to form.

Women are twice as likely to develop gallstones as men. They are more common in those over 60. High oestrogen conditions such as pregnancy, the contraceptive pill or using hormone replacement therapy increase the risk. Obesity is a major risk factor for gallstones as is a diet high in fat and low in fibre. Conversely fasting and rapid weight loss can also increase the risk. Gallstones may run in families and are more common in those with diabetes.

Despite the fact that so many people have gallstones it is estimated that every year only about one to 4pc of these will develop symptoms related to them. When gallstones act up they cause pain usually in the upper abdomen. This may be felt in the back or in the shoulder also. These attacks often follow fatty meals.

If there is a blockage or infection in the gallbladder the pain may last longer. There may be a fever, nausea and vomiting, pale-coloured stool and jaundice (yellowish colouring of the skin and eyes) may occur. These symptoms usually require admission to hospital. Gallstones only require treatment if they are symptomatic.

If gallbladder attacks have been occurring it is usually advised to have the gallbladder removed. This is normally done once the infection or attack has settled down. Today most gallbladder operations are done via keyhole surgery and you can leave the hospital within 24 hours.

Traditional surgery involving a larger wound is still occasionally required. You will still be able to digest food normally after gallbladder surgery. Bile is simply passed directly into the bowel through ducts from the liver. There are some people who develop loose or more frequent bowel motions after a gallbladder operation.

If you have been diagnosed with gallstones and you have no symptoms related to them it is reasonable to do nothing.

However if you are having increasing bouts of abdominal pain it may be worth getting a surgeon's opinion. Surgery is not for everyone as there are risks involved. A face-to-face consultation with a surgeon will give you the best options for you.

Question: I am a 42-year-old male in great health but somehow have thread veins on my cheeks. I would be grateful if you could advise me how best to treat these as they have affected my confidence.

Dr Nina replies: Thread veins are tiny blood vessels that are visible just below the surface of the skin. They are blue or red and often have a web-like or lattice pattern. The medical term is telangiectasia.

Telangiectasia are more common in ageing and weather-damaged skin. They are most common in women. Smoking and alcohol also increase the risk. There is a genetic component. In women hormone changes in pregnancy and menopause may make them more likely. Telangiectasia of the face occur in rosacea. Prolonged use of steroid medication can cause changes in the skin leading to telangiectasia.

They don't usually cause any problems but can be unsightly and this is what normally drives people to seek treatment. Laser treatment can be very effective especially for smaller veins. There are many medical laser clinics around the country. Laser treatment is an out-patient procedure.

It can be uncomfortable but as each pulse lasts seconds the discomfort passes quickly. It feels a bit like the splash of fat from a frying pan. Several treatments may be required.

Sclerotherapy may be used for larger veins especially those on the legs.

A substance which damages the vein is injected into the vein through a tiny needle. The vein will then eventually shrink and disappear over a few weeks. Laser treatment of the face is normally very successful. If you have rosacea using other treatment for this can also help.

In order to avoid developing further telangiectasia always wear sunscreen and avoid exposing your skin to extreme heat or cold. Don't smoke and avoid too much alcohol.

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