Gallstones Information

Gallstones (choleliths) are pieces of solid material that form in the gallbladder.

They form when the liquid (bile) stored in the gallbladder, mainly cholesterol and bile pigments, hardens into crystal-like particles.

Cholesterol stones account for about 80 percent of gallstones and are made primarily of cholesterol.

They are generally green but can also be white or yellow.

Pigment stones account for the other 20 percent. They are small, dark stones made of bilirubin and calcium salts found in bile.

Risk factors for formation of pigment stones include cirrhosis, biliary tract infections, and hereditary blood cell disorders such as sickle cell anaemia. Stones of mixed origin can also occur.

Gallstones can occur anywhere within the biliary tree. These include areas such as the gallbladder and the common bile duct.

Obstruction of the common bile duct is called choledocholithiasis. Obstruction of the biliary tree can cause jaundice. Obstruction of the outlet of the pancreatic exocrine system may cause pancreatitis.

Cholelithiasis is the presence of stones in the gallbladder.

The stones vary in size. They may be as small as a grain of sand or as large as a golf ball. The gallbladder may develop a single large stone. It can also develop many smaller ones some running into thousands.

Causes of Gallstones

The stones may be caused by a combination of factors. These include inherited body chemistry, body weight, gallbladder movement, and diet.

Cholesterol gallstones develop when the bile contains too much cholesterol and not enough bile salts.

Factors likely to cause formation of gallstones include:

  • A high concentration of cholesterol.

  • How often and how well the gallbladder contracts: Incomplete and irregular emptying of the gallbladder may cause the bile to become over-concentrated and contribute to gallstone formation.

  • Presence of proteins in the liver and the bile: Proteins either promote or inhibit cholesterol crystallization into gallstones.

  • Use of birth control pills or estrogens replacement therapy: Increased levels of the hormone estrogens because of pregnancy, hormone therapy, or the use of birth control pills may increase cholesterol levels in bile and decrease gallbladder movement. This results in gallstone formation.

  • Obesity: Being obese increases chances of gallstones by two to three times especially in women. Being even somewhat overweight still increases one's risk for developing gallstones. This because obesity causes excess cholesterol in bile, low bile salts, and decreased gallbladder emptying.

  • Very low calorie and rapid weight-loss diets may also cause gallstone formation. People who go on "crash" diets and those who lose a lot of weight quickly may get gallstones.

  • Low-fibre and high-cholesterol diets as well as diets high in starchy foods are also thought to contribute to gallstone formation. They disrupt your bile chemistry and cause the gall bladder to contract less often.

  • Fasting: Fasting decreases gallbladder movement. This causes the bile to become over concentrated with cholesterol and can lead to gallstones.

  • Cholesterol-lowering medication: Medication that lowers cholesterol levels in the blood increases the amount of cholesterol secreted in bile. This increases the risk of gallstones.

  • Diabetes: Diabetes patients generally have high levels of fatty acids called triglycerides. Triglycerides increase the risk of gallstones.

    Prevention of Gallstones and Diet

    From what is known about the causes, it is recommended you achieve and maintain ideal body weight.

    It is further recommended that you do not lose more than 3 lbs per week especially using the super low-calorie liquid fasting diets.

    Choose a low fat, high-fibre diet with lots of fresh fruits, vegetables and whole grains. No more than 500 mg of vitamin C a day and caffeinated coffee may be helpful. In addition, reduce your intake of animal fat, butter, margarine, mayonnaise and fried foods.

    Avoid “crash diets” or a very low calorie intake (less than 800 calories a day).

    Regular recreational and physical activity such as power walking, cycling, swimming, aerobics etc. have a protective value.

    Symptoms of Gallstones

    A majority of people with this problem do not have symptoms. This is called silent stones. Generally, people with silent stones remain symptom free for years. They require no treatment. Silent stones are normally detected during routine medical check up or during examination for other sicknesses.

    Those who get symptoms may experience:

  • Abdominal bloating
  • Recurring intolerance of fatty foods
  • Colic
  • Belching
  • Gas
  • Indigestion
  • Nausea

    However, persons without stones experience these symptoms as well. As a result, the doctor may not be certain that stones are causing these symptoms unless she does a diagnosis.

    Other symptoms include:

  • Chills
  • Low-grade fever
  • Yellowish colour of the skin or whites of the eyes
  • Clay-coloured stools

    If you observe the above and any of following symptoms, see your doctor.

  • Colic: The pain associated with colic usually occurs after meals when the gallbladder contracts. The stones can lodge in the outlet neck of the gallbladder or in the main bile duct to the intestine during this process. This causes intermittent and severe pain. The pain is experienced in the upper-middle or right side of the upper abdomen. It can also be experienced in the right shoulder and sometimes, under the breastbone. Colic attacks last from a few minutes to several hours.

  • Gallbladder Inflammation (cholecystitis): The stones may irritate the gallbladder to the extent that active and acute inflammation occurs. This produces steady, dull, and usually severe pain in the upper-right abdomen. This is known as acute cholecystitis and is a serious condition.

  • Yellow Jaundice: This happens when a stone becomes lodged in the bile ducts between the liver and the intestine. The bile flow is blocked so that it cannot reach the intestine. Bile therefore backs up in the liver and spills into the blood. The skin turns yellow and the urine dark.

    Gallstones may also interfere with the flow of digestive fluids secreted from the pancreas into the small intestine, leading to pancreatitis. Pancreatitis is an inflammation of the pancreas.

    Prolonged blockage of these ducts can cause severe damage to the gallbladder, liver, or pancreas. This can be fatal. Symptoms of this include fever, jaundice, and persistent pain.

    Gallstones Diagnosis

    The stones may be detected during an abdominal x-ray, computerized axial tomography (CT) scan, or abdominal ultrasound that has been taken for unrelated problems.

    To identify gallstones, the following methods may be used:

  • A hepatobiliary scan: A small amount of radioactive material is injected in the vein intravenously (IV). The material concentrates in the gallbladder. Another agent is then given by IV to cause the gallbladder to contract and empty. A sick gallbladder does not contract and empty very well. This test can therefore indicate a gallbladder problem.

  • Ultrasound: This is the most common diagnostic tool. An ultrasound examination uses sound waves. It is also known as ultrasonography. Pulses of sound waves are beamed into the gallbladder. If stones are present, the sound waves will bounce off the stones and reveal their location. Ultrasound has a number of advantages: It is non-invasive since nothing is injected into the body. It is painless, has no known side effects, and does not involve radiation.

  • Blood tests: These may be used to look for signs of infection, obstruction, pancreatitis, or jaundice.

    Treatment of Gallstones

    It is normally recommended that patients without symptoms receive no treatment. Non-surgical treatments are used in special situations such as when a patient has a serious medical condition that would prevent surgery. Stones normally recur after non-surgical treatment.

    Treatment may involve:

  • Oral ursodeoxycholic acid can dissolve cholesterol gallstones. Complete dissolving of the stones takes six months to two years. Maintenance treatment is required; stopping the drug causes the gallstones to recur.

  • Obstruction of the common bile duct with gallstones can sometimes be relieved by endoscopic retrograde sphinceterotomy (ERS) following endoscopic retrograde cholangiopancreatography (ERCP).

  • Cholecystectomy or surgical gallbladder removal has a 99% chance of eliminating the recurrence of cholelithiasis. The lack of a gall bladder does not have any negative consequences in most people. However, diarrhoea can be a problem, especially in patients with irritable bowel syndrome.

    There are two surgery options: laparoscopic and open procedure:

  • Laparoscopic: 3-4 small incisions are made for camera and instruments. An incision is made through the navel and a micro video tube is then inserted through it.

    Three other needle-like instruments are then inserted through incisions in the upper abdomen. The instruments are used to pick up and dissect the gallbladder. It can then be removed through the small incision in the navel.

    Same-day release or one night hospital stay is normal. This is followed by a week of home rest and pain medication. You can resume normal diet and light activity a week after release. You will experience decreased energy level and minor residual pain for a month or two.

    This procedure is as effective as the open cholecystectomy, provided the stones are accurately located by cholangiogram prior to the procedure so that they can all be removed.

  • Open procedure: This involves a large incision into the abdomen (laparotomy) below the right lower ribs.

    A week of hospitalisation, normal diet a week after release and normal activity a month after release. There are cases in which this type of surgery is necessary.

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