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Gallstones

A liquid known as bile which is produced in the liver and stored in the gallbladder can harden into "pebbles" of stone-like material called gallstones.  Bile is used to digest fat in the small intestine.  If the liquid bile does not have enough bile salts, has too much cholesterol or too much bilirubin (a substance which gives bile and stool its yellowish color), it can harden into gallstones.  There are two types of gallstones: cholesterol stones and pigment stones.

Cholesterol stones are yellow-green, hardened cholesterol and account for about 80% of gallstones.  Pigment stones are small and dark and made up of primarily bilirubin.  These two types of stones can be either very small or as large as a golf ball.  There can also be many of them in any combination of size.

If gallstones block the bile ducts then bile becomes trapped causing inflammation of the gallbladder, bile ducts and, possibly, the liver.  If gallstones block the pancreatic duct, digestive enzymes become trapped causing an extremely painful condition called gallstone pancreatitis.  If any type of blockage is left untreated, sever and even fatal damage may result in the gallbladder, liver or pancreas.

Warning signs of gallstones include fever, jaundice and persistent pain in the abdomen.

Cholesterol stones are caused by a lack of bile salts or too much bilirubin and cholesterol.  This type of gallstone also forms when the gallbladder does not empty as often as it should.  The cause of pigment stones are unknown.  Patients with cirrhosis, biliary tract infection or hereditary blood disorders such as sickle cell anemia, which produces too much bilirubin in the blood, are more likely to produce this type of gallstone.  Other risk factors for gallstones include:

bulletObesity: increases cholesterol and reduces the amount of bile salts.  The gallbladder is also emptied less frequently.
bulletEstrogen: pregnancy, hormone therapy and birth control pills can cause an increase in estrogen, which can lead to and increase in cholesterol and a decrease in emptying of the gallbladder.
bulletEthnicity: Native Americans are much more likely to have gallstones than any other ethnicity.
bulletGender: women between the ages of 20 and 60 are twice as likely to develop gallstones than men.
bulletAge: gallstones are much more likely in people ages 60 and up.
bulletCholesterol-lowering drugs: these drugs, although lower cholesterol in the blood, increase it in the bile.
bulletDiabetes: individuals with diabetes have an elevated level of triglycerides (fatty acids), which are known to increase the likelihood of developing gallstones.
bulletRapid weight loss: the liver will produce extra cholesterol in individuals who experience rapid weight loss.
bulletFasting: results in less frequent emptying of the gallbladder and an overconcentration of cholesterol.

Symptoms

Symptoms of gallstones are usually called "attacks."  These attacks commonly occur at night, following meals.  They are characterized by:

bulletsteady pain lasting anywhere from 30 mins. to a few hours.
bulletpain in the back between the shoulder blades
bulletpain under the right shoulder
bulletnausea
bulletvomiting

Secondary symptoms include:

bulletbloating
bulletrecurring intolerance of fatty foods
bulletcolic
bulletbelching
bulletgas
bulletindigestion

If the above symptoms occur with any of the following, you should see a physician immediately:

bulletsweating
bulletchills
bulletlow-grade fever
bulletjaundice (yellowish color to skin and whites of eyes)
bulletclay-colored stools.

Sometimes, gallstones do not have any symptoms (asymptomatic).  These "silent stones" do not affect any of the organs and do not require treatment.

Diagnosis

The most common and sensitive form of diagnosis for gallstones is ultrasonography.  This procedure uses sound waves, which bounce of organs and gallstones, to form an image on a viewing screen.  Other procedures used to diagnose gallstones are Computerized Axial Tomography (CAT or CT Scan), Magnetic Resonance Cholangiogram (to view blocked bile ducts), Cholescintigraphy (HIDA Scan), which injects a radioactive chemical into the gallbladder, stimulating its contraction in order to diagnose abnormal contraction or obstruction.

Endoscopic Retrograde Cholangiopancreatography (ERCP) can be used to detect and remove gallstones located in the bile ducts using a small thin viewing tube called and endoscope.  Blood tests can also be used to determine signs of infection, obstruction, pancreatitis and jaundice.

Treatment

The most common form of treatment for gallstones is surgery.  This type of surgery is called a cholecystectomy.  There are two types:

bulletLaparoscopic Assisted Cholecystectomy: the gallbladder is removed through a very small incision in the abdomen using a laparoscope (viewing tube), which gives the surgeon a view of the organs and tissues surrounding the gallbladder.  SInce no abdominal muscle is cut, recovery is very quick with one night stay in the hospital and a few days of restricted activity at home.
bullet"Open" surgery:  In cases where laparoscopy is not an option, a 5"-8" incision is made in the abdomen, through which the gallbladder is removed.  Recovery takes much longer: approximately 2-7 days in the hospital followed by several weeks at home.  5% of operations are of this kind.

The major complication to surgery is bile duct damage, which is painful and can cause severe infection.  If stones are located in the bile ducts, ERCP is used to locate and remove by cutting away the ducts using the endoscope.

Fortunately, the galldbladder is an organ that the body can do without, much like the appendix.  When the gallbladder is removed, bile can no longer be stored: thus, it goes directly from the liver, where it is produced, to the small intestine, where it is used for digestion.  This frequency in transmission of bile causes diarrhea in approximately 1% of patients.

There also non-surgical methods of treatment for patients with cholesterol stones only, and if surgery is definitely not an option because of a prior or existing medical condition.  Such methods include:

bulletOral Dissolution Therapy: drugs of bile acid are ingested to dissolve the stones.  Months to years of treatment is necessary to dissolve the stones.  Diarrhea is a frequent side-effect.
bulletContact Dissolution Therapy: drugs are injected directly into the gallbladder to dissolve the stones.  This procedure is experimental.  It usually takes 1 to 3 days for the stones to dissolve.  This procedure is still being tested because the chemical used to dissolve the stones is extremely toxic.
bulletExtracorporeal Shockwave Lithotripsy (ESWL): shockwaves break-up stones into small pieces which can pass though bile ducts.  Attacks of biliary colic (pain) are common with this form of treatment and its rate of success is unknown.  This procedure is usually combined with ERCP.

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BrooklynGI.com with offices in New York City Brooklyn Queens and Manhattan. Treating patients from New York, New Jersey and Connecticut. is dedicated to helping patients and physicians receive accurate and up-to-date information on the Gastrointestinal tract (GI Tract) The organs that compose the GI tract include, Esophagus, Stomach, Small Intestine, Large Intestine (Colon), Pancreas and the Liver and Gall Bladder (Hepato-Biliary Tree) Dr. Scott Tenner
Physicians include Dr. Scott Tenner Dr. Robin Baradarian Dr. Susan Ramdhaney Dr. Nison Badalov
Private Practice at 2211 Emmons Ave. Other locations include Maimonides Medical Center 1025 48th Street, Beth Israel Medical Center at KD3201 Kings Highway, Kingsbrook Jewish Medical Ctr at 585 Schenectady Ave, Brookdale Hospital at One Brookdale Plaza, and Kings Highway Hospital at 2525 Kings Highway
We treat a variety of gastrointestinal GI diseases and conditions including Achalasia
Barrett's Esophagus Chronic Hepatitis Cirrhosis of the liver Celiac disease Collagenous Colitis Colorectal cancer Colorectal polyps Constipation Crohn's disease Diverticulosis And Diverticulitis Fatty liver (Steatohepatitis) Gallstones Gas Gastritis Gastric Cancer GERD Helicobacter pylori infection Hemochromatosis Hemorrhoids Hepatitis (Viral Hepatitis A, B, C etc) Hiatus Hernia Irritable Bowel Syndrome Lactose Intolerance Liver failure and transplantation Lymphocytic Colitis Microscopic Colitis Esophageal Cancer Pancreatitis Peptic Ulcer Primary biliary cirrhosis Reflux esophagitis Ulcerative colitis
A premier site for the diagnosis, treatment and management Gastrointestinal diseases, Drs. Tenner and Baradarian provide a variety of Patient Services.
Drs. Tenner and Baradarian are Board Certified Gastroenterologists performing a variety of tests and procedures at their private offices and at Maimonides Medical Center.
We perform many tests & procedure, including: Barium Enema Barium Esophagram Capsule Endoscopy Colonoscopy Colon Cancer Screening EGD (Esophagogastroduodenoscopy) Endoscopic Ultrasound ERCP (Endoscopic Retrograde Cholangiopancreatography) Esophageal Dilation Esophageal pH Fundoplication Hemorrhoid Banding Hemorrhoidectomy Lactose Tolerance Test Liver Biopsy PEG (Percutaneous Endoscopic Gastrostomy) Sigmoidoscopy Stool Acidity Test Upper GI Series
BrooklynGI.com with offices in New York City Brooklyn Queens and Manhattan. Treating patients from New York, New Jersey and Connecticut. is dedicated to helping patients and physicians receive accurate and up-to-date information on the Gastrointestinal tract (GI Tract) The organs that compose the GI tract include, Esophagus, Stomach, Small Intestine, Large Intestine (Colon), Pancreas and the Liver and Gall Bladder (Hepato-Biliary Tree) Dr. Scott Tenner. Physicians include Dr. Scott Tenner Dr. Robin Baradarian Dr. Susan Ramdhaney Dr. Nison Badalov.
Gastrointestinal GI diseases and conditions including Achalasia Private Practice at 2211 Emmons Ave. Other locations include Maimonides Medical Center 1025 48th Street, Beth Israel Medical Center at KD3201 Kings Highway, Kingsbrook Jewish Medical Ctr at 585 Schenectady Ave, Brookdale Hospital at One Brookdale Plaza, and Kings Highway Hospital at 2525 Kings Highway
Barrett's Esophagus Chronic Hepatitis Cirrhosis of the liver Celiac disease Collagenous Colitis Colorectal cancer Colorectal polyps Constipation Crohn's disease Diverticulosis And Diverticulitis Fatty liver (Steatohepatitis) Gallstones Gas Gastritis Gastric Cancer GERD Helicobacter pylori infection Hemochromatosis Hemorrhoids Hepatitis (Viral Hepatitis A, B, C etc) Hiatus Hernia Irritable Bowel Syndrome Lactose Intolerance Liver failure and transplantation Lymphocytic Colitis Microscopic Colitis Esophageal Cancer Pancreatitis Peptic Ulcer Primary biliary cirrhosis Reflux esophagitis Ulcerative colitis
A premier site for the diagnosis, treatment and management Gastrointestinal diseases, Drs. Tenner and Baradarian provide a variety of Patient Services.
Drs. Tenner and Baradarian are Board Certified Gastroenterologists performing a variety of tests and procedures at their private offices and at Maimonides Medical Center.
We perform many tests & procedure, including: Barium Enema Barium Esophagram Capsule Endoscopy Colonoscopy Colon Cancer Screening EGD (Esophagogastroduodenoscopy) Endoscopic Ultrasound ERCP (Endoscopic Retrograde Cholangiopancreatography) Esophageal Dilation Esophageal pH Fundoplication Hemorrhoid Banding Hemorrhoidectomy Lactose Tolerance Test Liver Biopsy PEG (Percutaneous Endoscopic Gastrostomy) Sigmoidoscopy Stool Acidity Test Upper GI Series

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