Gallstones

February 7, 2017

Gallstones are lumps of solid material that form in the gallbladder. They usually look like small stones or gravel, but can be as small as sand or as large as pebbles, sometimes filling the gallbladder.

The gallbladder is a small, pear-shaped pouch about three to six inches long. It is tucked just under the liver, below the right rib cage and is connected to the intestine and liver by small tubes called bile ducts. Bile ducts carry bile, a yellow-green fluid produced by your liver. Bile contains water, cholesterol, phospholipids and chemicals to aid digestion (bile acids), as well as waste products for excretion via the bowel, such as bilirubin.

Bile is collected and stored in the gallbladder, and released along the bile ducts into the intestine when we eat food. It plays a central role in helping the body digest fat. Bile acts as a detergent, breaking up the fat from food in the gut into very small droplets, so that it can be absorbed. It also makes it possible for the body to take up the fat-soluble vitamins A, D, E and K from the food passing through the gut.

Gallstones develop when cholesterol levels in the bile are too high and excess cholesterol turns into stones. Most gallstones are mixed stones or cholesterol stones, mostly made up of cholesterol. They are usually yellow or green. Another type of gallstones are pigment stones, which are mostly made up of bilirubin and are smaller and darker.

Pure Cholesterol Stones – these are the most common type of stone and are made up of cholesterol, which is a type of fat
Pure Pigment Stones – these consist of calcium and bilirubin (a pigment from broken down red blood cells) which have solidified
Mixed Stones – these are a combination of cholesterol and pigment stones

Gallstones vary greatly in size. Some people may form one large stone, whereas others may have hundreds of tiny stones. Most commonly, gallstones are 5-10 mm in diameter.

About 70 per cent of people who have gallstones do not have noticeable symptoms and are often unaware that they have them. Gallstones may be discovered only during investigations for other problems. For this reason, they are sometimes called ‘silent’ gallstones.

Causes

Gallstones are formed when the different elements which make up the bile become imbalanced. Cholesterol stones form when cholesterol levels in the bile are much greater than the bile acid levels, this causes the cholesterol in the bile to solidify.

There is evidence that dietary factors, such as diets high in cholesterol, saturated fat, refined sugar and low in fibre, increase the risk of developing cholesterol gallstones.

Gallstones are more common in women than in men, especially during women’s fertile years and during pregnancy. This is because cholesterol is a component of oestrogen, and at these times fluctuating levels of oestrogen need to be broken down to cholesterol and excreted in bile.

Pigment stones may form when the amount of bilirubin in bile is excessive. This can occur in conditions such as sickle cell disease.

Gallstones can also form when the flow of bile is reduced. This may occur due to –

damage to the liver (cirrhosis) or damage to the biliary tract which affects the secretion and flow of bile
long periods of fasting during which there is less requirement for bile, leading to bile stasis (decreased flow of bile).

Genetics – Having a family member or close relative with gallstones may increase the risk. Up to one-third of cases of painful gallstones may be related to genetic factors. A mutation in the gene ABCG8 significantly increases a person’s risk of gallstones. This gene controls a cholesterol pump that transports cholesterol from the liver to the bile duct. It appears this mutation may cause the pump to continuously work at a high rate. A single gene, however, does not explain the majority of cases, so multiple genes and environmental factors play a complex role.

Risk Factors

Risk factors for developing gallstones include –

Being overweight or obese
Being female
Being over 40
A woman who’s had more than one pregnancy
Having cirrhosis of the liver
Having Crohn’s disease or IBS ( irritable bowel syndrome)
A family history of gallstones
Having weight loss surgery or recently having lost weight
Being treated with the antibiotic ceftriaxone
Being on the Pill
Women taking high-dose oestrogen therapy
Having type 2 diabetes is suspected of being a risk factor
A lack of exercise is also thought to increase the risk of gallstones

Symptoms

Gallstones vary in chemical structure. The two main types of gallstones are:

Cholesterol gallstones

The amount of cholesterol that can dissolve in bile depends on how much bile salt it contains. Too much cholesterol, or too little bile salt, tends to cause gallstones to form in the gallbladder. Approximately 80% of all gallstones are cholesterol stones.

Pigment gallstones

These are formed by calcium and bilirubin and account for approximately 20% of all gallstones. Pigment stones tend to form in patients with haemolytic anaemias (fragile red blood cells), including sickle-cell disease and thalassaemia.

Most people with gallstones do not experience any symptoms. If symptoms are present, the most common early sign of gallstones is upper abdominal pain. This pain usually occurs in the upper right side of the abdomen, is often severe, and may radiate to the chest, back or the area between the shoulders. Other symptoms that may occur include –

Indigestion
Nausea or vomiting
Jaundice (the yellow appearance of skin and the whites of eyes caused by bilirubin build-up in the blood) when gallstones block the passage of bile
Light coloured stools

Symptoms can occur suddenly and may be referred to as biliary colic. This type of pain is commonly set off by eating fatty foods and often occurs in the middle of the night. The symptoms experienced may be so severe that people need to seek immediate medical attention.

Complications

Biliary colic – Sometimes the gallstones may pass down through the bile duct into the duodenum. When this happens the patient may experience biliary colic – a painful condition. The pain is felt in the upper part of the abdomen, but can also exist in the center of the abdomen, or a little to the right of it. Pain is more common about an hour after eating, especially if the patient has had a high-fat meal. The pain will be constant and will last a few hours, and then subside. Some patients will have non-stop pain for 24 hours, while others may experiences waves of pain.

Infection – If the gallstones have caused a gallbladder infection the patient may have a fever and experience shivering. In the majority of gallstone infection cases the patient will be hospitalized and have the gallstone surgically removed.

Jaundice – If the gallstone leaves the gallbladder and gets stuck in the bile duct it may block the passage of bile into the intestine. The bile will then seep into the bloodstream and the patient will show signs of jaundice – the skin and the whites of the eyes will be yellow. In most cases this complication will require the surgical removal of the gallstone. Some patients are lucky and the gallstone eventually passes into the intestine.

Pancreatitis – If a small gallstone passes through the bile duct and blocks the pancreatic duct, or causes a reflux of liquids and bile into the duct, the patient may develop pancreatitis.

Treatment

Surgery – Surgery to remove the gallbladder, called cholecystectomy, is one of the most common operations performed on adults in the United States. Surgeons perform two types of cholecystectomy.

Laparoscopic cholecystectomy – In a laparoscopic cholecystectomy, the surgeon makes several tiny incisions in the abdomen and inserts a laparoscope—a thin tube with a tiny video camera attached. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of organs and tissues. While watching the monitor, the surgeon uses instruments to carefully separate the gallbladder from the liver, bile ducts, and other structures. Then the surgeon removes the gallbladder through one of the small incisions. Patients usually receive general anesthesia.
Open cholecystectomy – An open cholecystectomy is performed when the gallbladder is severely infl‑amed, infected, or scarred from other operations. In most of these cases, open cholecystectomy is planned from the start. However, a surgeon may perform an open cholecystectomy when problems occur during a laparoscopic cholecystectomy. In these cases, the surgeon must switch to open cholecystectomy as a safety measure for the patient.

Medication – Ursodiol (Actigall) and chenodiol (Chenix) are medications that contain bile acids that can dissolve gallstones. These medications are most effective in dissolving small cholesterol stones. Months or years of treatment may be needed to dissolve all stones.

Shock wave lithotripsy – A machine called a lithotripter is used to crush the gallstone. The lithotripter generates shock waves that pass through the person’s body to break the gallstone into smaller pieces. This procedure is used only rarely and may be used along with ursodiol.

Lifestyle Changes – Although lifestyle changes cannot eliminate the risk of developing gallstones for everyone, avoiding fatty food and cutting cholesterol and consuming a healthy balanced diet may be recommended.

Losing weight can help reduce the risk of gallstones. However, a gradual approach is better as rapid weight loss can increase the risk of gallstones.

Alternative Treatment

Multivitamins – A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.

Vitamin C acts as an antioxidant and for immune support.

Phosphatidylcholine, may help dissolve gallstones. It may interfere with some medications, including anticholinergic medications used in the treatment of Alzheimer’s disease and glaucoma, among others.

Magnesium, for nutrient support. Magnesium can potentially react with a variety of medications, including some antibiotics, blood pressure medicines, diuretics, muscle relaxers, and others.

Taurine, for nutrient support. Taurine can potentially interact with lithium.

Globe artichoke, for support of gallbladder and liver function. Due to its ability to increase bile production, globe artichoke could trigger a gallbladder attack if there is bile duct obstruction.

Milk thistle or liver and gallbladder detoxification support.

Dandelion root is another liver tonic.

Acupuncture – Acupuncture may be especially helpful in pain relief, reducing spasm, easing bile flow, and restoring proper liver and gallbladder function.

Reference –

http://www.seattlechildrens.org/medical-conditions/digestive-gastrointestinal-conditions/gallstones/

http://patient.info/health/gallstones-leaflet

http://www.livescience.com/34726-gallstones-symptoms-treatment.html

http://www.dailymail.co.uk/health/article-3340198/Irritable-stomach-t-tolerate-gluten-REAL-problem-gallstones-woman-discovered-hand.html

https://my.clevelandclinic.org/health/diseases_conditions/hic_Gallstones

http://www.medicalnewstoday.com/articles/153981.php

http://umm.edu/health/medical/reports/articles/gallstones-and-gallbladder-disease

http://www.webmd.boots.com/digestive-disorders/gallstones

http://www.healthline.com/health/chronic-cholecystitis

http://www.everydayhealth.com/gallbladder/symptoms/

http://www.medicinenet.com/gallstones/article.htm