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Gallstone

Overview of gallstone

Ever wondered what a gallstone really is? Are these actually stones or crystals that get accumulated with our food, or is it a disease in which stones forms inside the body?

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Simply said, ‘gallstones’, also called cholelithiasis are lumps of solid material formed in the gallbladder, a pear-shaped bag in the body that stores bile juices needed for digestion of fatty food. They are generally as big as peas, but sometimes grow to the size of pebbles. Gallstones can be found in the gallbladder itself or in the bile duct that connects the gallbladder to the small intestine. In USA, nearly 10% of the adult population has gallstones.1

Types of gallstones

Gallstones occur in different sizes and have different appearances. This depends on their content.

They are primarily of two types:

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  • Cholesterol stones (generally green, but can be white or yellow) are made primarily of cholesterol
  • Pigment stones are dark in color. These are made of bilirubin (a bile pigment) and calcium salts
  • Black pigment stones
  • Brown pigment stones

Signs and Symptoms of gallstone

The main symptom is gallstone ‘attack’, or biliary colic. The affected person experiences intense pain in the upper abdominal region that steadily increases,duration could be 30 min to several hours. Pain in the back, between the shoulder blades, or near the pelvis, along with nausea and vomiting also occurs in extreme conditions.

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Other symptoms include

Causes of gallstone

Different kinds of stones have different causes and different risk factors. Cholesterol stones are believed to be more common among Fat and Fertile Females of Forty years and above.

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  • Obesity is a major risk factor. Obese people produce and secrete higher amounts of cholesterol. This increases the risk for development of cholesterol stones.
  • Women who have experienced multiple pregnancies are more prone to gallstones because of the high levels of the hormone progesterone during pregnancy. This hormone reduces the contractility of the gallbladder and leads to retention of bile. Prolonged retention can lead to cholesterol stones.
  • Birth control pills and hormone replacement therapy: The hormonal changes with these drugs mimic pregnancy and therefore increase the risk of gallstones.
  • Females, especially in the reproductive age, are more likely to develop cholesterol stones than males. The female-to-male ratio is 4:1.1 This is due to the female hormone estrogen that increases cholesterol secretion. However, with age this difference between the two sex’s decreases.
  • Gallstones continue to form throughout life and the prevalence is greatest in the elderly age group.
  • Predisposition to cholesterol stones is hereditary in 25% of cases. There are many different genes that contribute to this risk.
  • Diet rich in refined carbohydrates and saturated fats is associated with a higher risk for gallstones.2

Black pigment gallstones are seen more often in individuals whose hemoglobin breaks down rapidly leading to increased production of the bile pigment bilirubin.

This includes those with following:

Brown pigment stones are formed when cholesterol stones are colonized with bacteria. Enzymes from these bacteria react with bilirubin conjugates and fatty acids. Over time, calcium salts may accumulate on these cholesterol stones to produce mixed stones. Both men and women are equally at risk of developing pigment stones.

Diagnosis and Tests for gallstone

When one visits the doctor with symptoms of gallstone, he or she may suggest an ultrasound examination as the diagnostic test. It uses sound waves to create images of the internal organs and pinpoint the location of any stone.

Blood and/or urine tests are also advised in some cases to check for signs of infection, inflammation, jaundice or problems with the pancreas.The patient may also be advised to undergo one of the following tests:

Computerized tomography (CT) scan: Computer generated X-rays provide a comprehensive view of the gallbladder and its surrounding organs.

Radionuclide scan (cholescintigraphy, hepatobiliary iminodiacetic acid (HIDA) scan): A radioactive tracer material is injected through a vein. The gallbladder is then scanned to see if the tracer reaches it. If it does not, a stone is probably blocking the opening of the gallbladder.

Endoscopic retrograde cholangiopancreatography (ERCP): This is done to locate and remove stones in the duct. A flexible endoscope is passed down the throat, through the stomach and into the upper part of the small intestine. The intestinal tract is inflated with air so that the bile duct and the pancreatic duct can be easily seen. A dye is then injected through a hollow cannula that passes through the endoscope. X-rays of the ducts are then taken. If there is a stone in the duct, it is cut down with a specialized instrument and removed through the endoscope.

Complications of gallstone3

Gallstones lead to painful conditions but can be treated surgically or with medicine in most of the cases. But sometimes, they can lead to secondary complications such as

Treatment of gallstone

Treatment of gallstone

Cholecystectomy

Prevention of gallstone

To prevent initial or recurrent development of gallstones, try the following:

  • Eat three well-balanced meals everyday
  • Eat a diet that is high in fiber and calcium
  • Avoid saturated fats and refined carbohydrates
  • Drink at least 8 –10 glasses of water every day
  • Maintain healthy body weight
  • Exercise for at least 30 min 5 days a week
  • Avoid taking high dose birth control pills

When to Seek Medical Care

If one has a sudden, intense pain in the abdomen, especially accompanied by nausea and vomiting, call the doctor.

If the above mentioned symptoms coincide with chills, low-grade fever, yellowing of the skin or eyes etc., then seek emergency care.6

Living with the Condition of gallstone

Some people have asymptomatic gallstones, that is, they do not feel any pain or discomfort and do not need treatment either. However, symptoms of gallstones develop only when the stones reach a certain size (>8 mm).7 In these cases, the patient should visit the doctor and follow the diet and medication suggested by him or her.

References

1.Schirmer BD, Winters KL, Edllich RF. Cholelithiasis and cholecystitis. J Long Term Eff Med Implants. 2005; 15(3): 329–338.

2.Cuevas A, Miquel JF, Reyes MS, Zanlungo S, Nervi F. Diet as a risk factor for cholesterol gallstone disease. J Am Coll Nutr. 2004; 23(3): 187–196.

3.MayoClinic.com. Gallstones. [Homepage on the Internet] Available at: http://www.mayoclinic.com/health/gallstones/DS00165/DSECTION=7. Last updated on: 25 July 2007. Last accessed on: 15 February 2008.

4.The Cleveland Clinic Health Information Center. Laparocopic Cholecystectomy. [Homepage on the Internet]. Available at: http://www.clevelandclinic.org/health/health-info/docs/1700/1715.asp?index=7017. Last reviewed on: April 12, 2006. Last accessed on: 15 February 2008.

5.Michael FL, Walter CW, Eric B. A Prospective Study of Coffee Consumption and the Risk of Symptomatic Gallstone Disease in Men. JAMA. 1999; 281: 2106–2112.

6.Gallstones. National Digestive Diseases Information Clearinghouse. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones/index.htm#symptoms. Last reviewed in July, 2007. Last accessed on: 14 February 2008.

7.Gallstones. Medline Plus. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000273.htm#Symptoms%20Medline%20Plus. Last reviewed on: 7 August 2007. Last accessed on: 15 February 2008.