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Gallstones - Gallstones symptom, treatment, causes

Gallstones are solid lumps or stones that form in the gallbladder or bile duct. They are formed when some of the chemicals stored in the gallbladder harden into a mass. Some people with gallstones will have a gallbladder attack that can cause symptoms such as nausea and an intense, steady ache in their upper middle or upper right abdomen. In some cases, the pain can be severe and intermittent. The two types of gallstones are cholesterol stones and pigment stones. Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Pigment stones are small, dark stones made of bilirubin. Gallstones' size varies and may be as small as a sand grain or as large as a golf ball. The gallbladder may develop a single, often large, stone or many smaller ones, even several thousand. Gallstones can occur anywhere within the biliary tree, including the gallbladder and the common bile duct. Obstruction of the common bile duct is choledocholithiasis; obstruction of the biliary tree can cause jaundice; obstruction of the outlet of the pancreatic exocrine system can cause pancreatitis. Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or almost any combination. You are at greater risk of developing gallstones if you're older, female or overweight. Rapid weight loss or eating a very low calorie diet also can put you at risk of gallstones.

Some people who have gallstones do not feel any pain or discomfort. These gallstones are called "silent stones" and do not affect the gallbladder or other internal organs. Eating a low-fat diet and maintaining an ideal weight may help to prevent the formation of gallstones. Gallstones affect as many as one in 12 Americans. Obesity has been shown to be a major risk factor for gallstones. A large clinical study showed that being even moderately overweight increases one's risk for developing gallstones. Cholesterol gallstones develop when bile contains too much cholesterol and not enough bile salts. Besides a high concentration of cholesterol, two other factors seem to be important in causing gallstones. The first is how often and how well the gallbladder contracts; incomplete and infrequent emptying of the gallbladder may cause the bile to become overconcentrated and contribute to gallstone formation. The second factor is the presence of proteins in the liver and bile that either promote or inhibit cholesterol crystallization into gallstones. 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. Complications from gallstones can be serious, and even fatal, if left untreated. Fortunately, treatment is usually straightforward, and newer techniques often allow faster recovery time.

Solid bodies that form in the gall bladder from constituents of bile such as cholesterol, bile pigment, mucin and calcium. The size of gal1stones ranges from grit-like to several centimetres in width. There may be a single stone, but more often there are many.

Causes of Gallstones

The cause of Gallstones (also called cholelithiasis) is uncertain. It has been suggested that bile containing more than the usual amount of cholesterol (a normal bile constituent) and a smaller than usual amount of bile acid may be likely to lead to stone formation, production of this type of bile is an inherited tendency, which would explain why gallstones often run in families. Other possible factors include inflammation or infection of the gall bladder, increased bile pigment formation, and hormonal and other genetic factors. The common causes and risk factor's of Gallstones include the following:

• Obesity is a major risk factor for gallstones.
• Losing a lot of weight quickly on a "crash" or starvation diet.
• Drugs that lower cholesterol levels in blood actually increase the amount of cholesterol secreted in bile. This in turn can increase the risk of gallstones.
• Being overweight.
• Excess estrogen from pregnancy, hormone replacement therapy, or birth control pills appears to increase cholesterol levels in bile and decrease gallbladder movement, both of which can lead to gallstones.
• Blood disorders like sickle-cell anaemia.

Incidence of Gallstones

Gallstones are common. In Australia I in 5 women and I in I0 men develop them: 20 000 to 25 000 people a year need treatment for symptoms; and many more have stones that cause no symptoms, why are they so common? Western lifestyle and diet have been blamed, but even grassfed animals can get gallstones. It may be that more people in Westenl society than elsewhere have genetic tendencies to develop stones. Gallstones are generally more common from middle age onwards and in obese people, but it is a myth that they only affect women who are 'fair, fat and forty'. They can occur in young, slender women, sometimes after their first pregnancy

Symptoms of Gallstones

The most common symptoms are bouts of moderate upper abdominal pain, sometimes brought on by a fatty meal. A stone wedged in the ducts that drain the gall bladder causes the agonising pain of biliary COLIC. If the stone blocks the common bile duct (which drains bile from both the liver and gall blander) there may be jaundice as well as colic. A stone below the junction of the common bile duct and the pancreatic duct can, in addition,cause acute PANCREATITIS. However, many people with gall-stones have no symptoms: the stones may be discovered by chance if abdominal X-ray or ultra-sound is performed for other reasons. Some sign and symptoms related to Gallstones are as follows:

• Pain in the back between the shoulder blades.
• Nausea or vomiting.
• Low-grade fever.
• Yellowish color of the skin or whites of the eyes.
• Dark urine.
• Indigestion, belching, bloating.
• Sweating.
• Restlessness.

Treament of Gallstones

Surgery to remove the gall bladder (cholecystectomy) is most commonly advised. Minimal access ('keyhole') surgery is suitable for 8 out of 10 people needing cholecystectomy. Only three tiny incisions are used. You leave hospital on the second or third day, and are usually back to normal activities within a week- a far cry from the old techniques that needed 2 weeks in hospital and 6 weeks of convalescence, and often left a 10 cm scar. Here is list of the methods for treating Gallstones:

• Oral dissolution therapy involves taking oral drugs to dissolve gallstones. The drugs Chenix (chenodiol) and Actigall (ursodiol) work best for small stones made from cholesterol.
• Obstruction of the common bile duct with gallstones can sometimes be relieved by endoscopic retrograde sphinceterotomy.
• Contact dissolution therapy is an experimental treatment being tested for safety and effectiveness. It involves injecting a chemical, methyl tert butyl ether, directly into the gallbladder to dissolve stones. The chemical can dissolve only cholesterol stones.
• Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones. The surgery is called cholecystectomy.
• Sometimes, keyhole surgery is not possible and an open cholecystectomy is needed. This involves the removal of the gallbladder under general anaesthesia through a larger cut in the abdomen.

If surgery is too risky, it may be possible to break the stones into small fragments by means of ultra soundand then attempt to dissolve them via oral medication.