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:
| Obesity: increases cholesterol and reduces the
amount of bile salts. The gallbladder is also emptied less frequently.
|
| Estrogen: 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.
|
| Ethnicity: Native Americans are much more likely to
have gallstones than any other ethnicity. |
| Gender: women between the ages of 20 and 60 are
twice as likely to develop gallstones than men. |
| Age: gallstones are much more likely in people ages
60 and up. |
| Cholesterol-lowering drugs: these drugs, although
lower cholesterol in the blood, increase it in the bile. |
| Diabetes: individuals with diabetes have an elevated
level of triglycerides (fatty acids), which are known to increase the
likelihood of developing gallstones. |
| Rapid weight loss: the liver will produce extra
cholesterol in individuals who experience rapid weight loss. |
| Fasting: 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:
| steady pain lasting anywhere from 30 mins. to a few
hours. |
| pain in the back between the shoulder blades
|
| pain under the right shoulder |
| nausea |
| vomiting |
Secondary symptoms include:
| bloating |
| recurring intolerance of fatty foods |
| colic |
| belching |
| gas |
| indigestion |
If the above symptoms occur with any of the following,
you should see a physician immediately:
| sweating |
| chills |
| low-grade fever |
| jaundice (yellowish color to skin and whites of
eyes) |
| clay-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:
| Laparoscopic 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. |
| "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:
| Oral 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. |
| Contact 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. |
| Extracorporeal 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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