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Definition:
Gallstones (commonly misspelled gall stones or gall stone) are solid particles that form from bile in the gallbladder.
•The gallbladder is a small saclike organ in the upper right part of the abdomen. It is located under the liver, just below the front rib cage on the right side.
•The gallbladder is part of the biliary system, which includes the liver and the pancreas.
•The biliary system, among other functions, produces bile and digestive enzymes.
Bile is a fluid made by the liver to help in the digestion of fats.
•It contains several different substances, including cholesterol and bilirubin, a waste product of normal breakdown of blood cells in the liver.
•Bile is stored in the gallbladder until needed.
•When we eat a high-fat, high-cholesterol meal, the gallbladder contracts and injects bile into the small intestine via a small tube called the common bile duct. The bile then assists in the digestive process
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here are two types of gallstones: 1) cholesterol stones and 2) pigment stones.
1.Patients with cholesterol stones are more common in the United States; cholesterol stones make up approximately 80% of all gallstones. They form when there is too much cholesterol in the bile.
2.Pigment stones form when there is excess bilirubin in the bile.
Gallstones can be any size, from tiny as a grain of sand to large as a golf ball.
•Although it is common to have many smaller stones, a single larger stone or any combination of sizes is possible.
•If stones are very small, they may form a sludge or slurry.
•Whether gallstones cause symptoms depends partly on their size and their number, although no combination of number and size can predict whether symptoms will occur or the severity of the symptoms.
Gallstones within the gallbladder often cause no problems. If there are many or they are large, they may cause pain when the gallbladder responds to a fatty meal. They also may cause problems if they move out of the gallbladder.
•If their movement leads to blockage of any of the ducts connecting the gallbladder, liver, or pancreas with the intestine, serious complications may result.
•Blockage of a duct can cause bile or digestive enzymes to be trapped in the duct.
•This can cause inflammation and ultimately severe pain, infection, and organ damage.
•If these conditions go untreated, they can even cause death.
Up to 20% of adults in the United States may have gallstones, yet only 1% to 3% develop symptoms.
•Hispanics, Native Americans, and Caucasians of Northern European descent are most likely to be at risk for gallstones. African Americans are at lower risk.
Stones can form in the bladder if waste products in the urine crystallize. About 8 in 10 stones consist of calcium, which comes from excessive salts in the urine. Most are between 1/16 in (2 mm) and ¾ in (2 cm) in diameter, but some grow much larger. bladder stones are about three times more common in men than in women and are much more common in people over 45 years old.
The condition may develop if urine stagnates in the bladder as a result of incomplete emptying. It is also more likely to develop in people who have recurrent or chronic urinary tract infections. In addition, metabolic disorders, such as gout, can give rise to increased levels of waste products in the urine and encourage the formation of bladder stones.
Symptoms:
Often gallstones don’t cause symptoms, but if one partially or completely blocks the normal flow of bile it may cause an attack of biliary colic, with upper abdominal pain, nausea and vomiting.
These episodes are normally brief and typically follow a fatty meal, which causes the gall bladder to contract.
Stones that continue to block the drainage of bile can cause inflammation or infection of the gall bladder and bile ducts, jaundice and acute pancreatitis
A small bladder stone may not cause any symptoms. however, as a stone increases in size, it may start to irritate the bladder lining, causing some or all of the following symptoms:
· painful and difficult urination.
· frequent and sometimes urgent need to urinate.
· blood in the urine.
If you develop any of these symptoms, you should consult your doctor without delay. Left untreated, a stone may irritate the muscles in the bladder wall and cause urge incontinence. A stone that blocks the bladder outlet can cause urinary retention or cystitis, which may be intensively painful.
Causes:
Gallstones occur when bile forms solid particles (stones) in the gallbladder.
•The stones form when the amount of cholesterol or bilirubin in the bile is high.
•Other substances in the bile may promote the formation of stones.
•Pigment stones form most often in people with liver disease or blood disease, who have high levels of bilirubin.
•Poor muscle tone may keep the gallbladder from emptying completely. The presence of residual bile may promote the formation of gallstones.
Risk factors for the formation of cholesterol gallstones include the following:
•female gender,
•being overweight,
•losing a lot of weight quickly on a “crash” or starvation diet, or
•taking certain medications such as birth control pills or cholesterol lowering drugs.
Gallstones are the most common cause of gallbladder disease.
•As the stones mix with liquid bile, they can block the outflow of bile from the gallbladder. They can also block the outflow of digestive enzymes from the pancreas.
•If the blockage persists, these organs can become inflamed. Inflammation of the gallbladder is called cholecystitis. Inflammation of the pancreas is called pancreatitis.
•Contraction of the blocked gallbladder causes increased pressure, swelling, and, at times, infection of the gallbladder.
When the gallbladder or gallbladder ducts become inflamed or infected as the result of stones, the pancreas frequently becomes inflamed too.
•This inflammation can cause destruction of the pancreas, resulting in severe abdominal pain.
•Untreated gallstone disease can become life-threatening, particularly if the gallbladder becomes infected or if the pancreas becomes severely inflamed.
•Gallstones are most common among overweight, middle-aged women, but the elderly and men are more likely to experience more serious complications from gallstones.
•Women who have been pregnant are more likely to develop gallstones. The same is true for women taking birth control pills or on hormone/estrogen therapy as this can mimic pregnancy in terms of hormone levels.
Diagnosis:
Choledocholithiasis (stones in common bile duct) is one of the complications of cholelithiasis (gallstones), so the initial step is to confirm the diagnosis of cholelithiasis. Patients with cholelithiasis typically present with pain in the right-upper quadrant of the abdomen with the associated symptoms of nausea and vomiting, especially after a fatty meal. The physician can confirm the diagnosis of cholelithiasis with an abdominal ultrasound that shows the ultrasonic shadows of the stones in the gallbladder.
The diagnosis of choledocholithiasis is suggested when the liver function blood test shows an elevation in bilirubin. The diagnosis is confirmed with either an Magnetic resonance cholangiopancreatography (MRCP), an ERCP, or an intraoperative cholangiogram. If the patient must have the gallbladder removed for gallstones, the surgeon may choose to proceed with the surgery, and obtain a cholangiogram during the surgery. If the cholangiogram shows a stone in the bile duct, the surgeon may attempt to treat the problem by flushing the stone into the intestine or retrieve the stone back through the cystic duct.
On a different pathway, the physician may choose to proceed with ERCP before surgery. The benefit of ERCP is that it can be utilized not just to diagnose, but also to treat the problem. During ERCP the endoscopist may surgically widen the opening into the bile duct and remove the stone through that opening. ERCP, however, is an invasive procedure and has its own potential complications. Thus, if the suspicion is low, the physician may choose to confirm the diagnosis with MRCP, a non-invasive imaging technique, before proceeding with ERCP or surgery.
Treatment:
Eating a low-fat diet and maintaining an ideal weight may help to prevent the formation of gallstones.
Occasionally they pass out into the intestines on their own, especially if they’re small. Treatment is only needed if gallstones are causing problems.
Complementary therapies may be tried to help remove gallstones, but there’s little evidence they do any good.
Medical (non-surgical) treatments include a drug to dissolve the gallstones (ursodeoxycholic acid) and ultrasonic shockwaves, called lithotripsy, to break down the stones within the body so they can pass out on their own. These are suitable for about one in five patients, but there may be side-effects and the stones may simply form again.
There are various different surgical options:–
•Operating through an endoscope, a telescope into the gut. The stones may be broken down within the gall bladder and removed
•Removal of stones and gall bladder (cholecystectomy) – this is the most reliable treatment. As with all operations, there are risks and complications, but these are steadily reducing as techniques improve
Cholecystectomy may be done as an open operation through a cut in the abdomen, or a closed or minimally invasive operation via an endoscope put through a tiny cut in the abdominal wall. There used to be concern about the safety of this type of surgery, but in skilled hands it’s now as safe as open surgery and is how most cholecystectomies are done in the UK.
Bladder stones often recur. About 3 in 5 of the people successfully treated for bladder stones develop the condition again within 7 years.
After gall bladder surgery:
It used to be thought people adapted quickly to the loss of a gall bladder, but there may be problems. Some patients still have symptoms, albeit much milder. Others have problems with bile refluxing into the stomach and gullet, causing severe indigestion.
There may also be reduced absorption of fat resulting in diarrhoea. This usually – but not always – settles.
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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies
Resources:
http://www.emedicinehealth.com/gallstones/article_em.htm
http://en.wikipedia.org/wiki/Gallstone
http://www.bbc.co.uk/health/physical_health/conditions/gallstones1.shtml
http://www.charak.com/DiseasePage.asp?thx=1&id=235
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