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Gallstones

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Gallstones
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Gallstones

Gallstones vary in size and chemical structure. A gallstone may be as tiny as a grain of sand or as large as a golf ball. Eighty percent of gallstones are composed of cholesterol. They are formed when the liver produces more cholesterol than digestive juices can liquefy. The remaining 20% of gallstones are composed of calcium and an orange-yellow waste product called bilirubin. Bilirubin gives urine its characteristic color and sometimes causes jaundice.

Gallstones are the most common of all gallbladder problems. They are responsible for 90% of gallbladder and bile duct disease, and are the fifth most common reason for hospitalization of adults in the United States. Gallstones usually develop in adults between the ages of 20 and 50; about 20% of patients with gallstones are over 40. The risk of developing gallstones increases with age-at least 20% of people over 60 have a single large stone or as many as several thousand smaller ones. The gender ratio of gallstone patients changes with age. Young women are between two and six times more likely to develop gallstones than men in the same age group. In patients over 50, the condition affects men and women with equal frequency. Native Americans develop gallstones more often than any other segment of the population; Mexican-Americans have the second-highest incidence of this disease.

Gallbladder attacks usually follow a meal of rich, high-fat foods. The attacks often occur in the middle of the night, sometimes waking the patient with intense pain that ends in a visit to the emergency room. The pain of a gallbladder attack begins in the abdomen and may radiate to the chest, back, or the area between the shoulders. Other symptoms of gallstones include:
. inability to digest fatty foods
. low-grade fever
. chills and sweating
. nausea and vomiting
. indigestion
. gas
. belching.
. clay-colored bowel movements

Gallstones occur when bile forms solid particles (stones) in the gallbladder.

The stones form when the amount of cholesterol or bilirubin in the bile is high.
Other substances in the bile may promote the formation of stones.
Pigment stones form most often in people with liver disease or blood disease, who have high levels of bilirubin.
Poor muscle tone may keep the gallbladder from emptying completely. The presence of residual bile may promote the formation of gallstones.
Risk factors for the formation of cholesterol gallstones include the following:

female gender,
being overweight,
losing a lot of weight quickly on a "crash" or starvation diet, or
taking certain medications such as birth control pills or cholesterol lowering drugs.
Gallstones are the most common cause of gallbladder disease.

As the stones mix with liquid bile, they can block the outflow of bile from the gallbladder. They can also block the outflow of digestive enzymes from the pancreas.
If the blockage persists, these organs can become inflamed. Inflammation of the gallbladder is called cholecystitis. Inflammation of the pancreas is called pancreatitis.
Contraction of the blocked gallbladder causes increased pressure, swelling, and, at times, infection of the gallbladder.
When the gallbladder or gallbladder ducts become inflamed or infected as the result of stones, the pancreas frequently becomes inflamed too.

This inflammation can cause destruction of the pancreas, resulting in severe abdominal pain.
Untreated gallstone disease can become life-threatening, particularly if the gallbladder becomes infected or if the pancreas becomes severely inflamed
allstones are only treated if they have caused gallbladder inflammation, blockage of the bile ducts, or if they have moved from the bile ducts into the intestines. Patients who are treated are generally put on a low fat diet.

Cholecystectomy
Cholecystectomy means the surgical removal of the gallbladder. This is usually performed with keyhole surgery (minimally invasive surgery). Keyhole surgery is not possible for about 10 percent of patients who need open cholecystectomy; they will have open surgery instead.

With open cholecystectomy a large cut is made in the patient's abdomen. Patients who undergo open surgery require a longer hospital stay and recovery time. If a patient's gallbladder is severely inflamed he/she will require open surgery.

For a large proportion of patients who undergo a cholecystectomy, gallstones come back within a year; to help prevent this, many patients are given urosdeoxycholic acid (the acid found in bile). Urosdeoxycholic acid lowers the cholesterol content of bile, making it less likely that stones will form.

Ursodeoxycholic acid
If the gallstone is made of cholesterol it can sometimes be slowly dissolved with ursodeoxycholic acid. This type of treatment, known as dissolution, may take up to 24 months to be effective. It is not as effective as surgery, but is sometimes the only choice for patients who cannot have a general anesthetic.

Endoscopic retrograde cholangiopancreatolography
In some rare cases, when a patient cannot have surgery or ursodeoxycholic acid, he/she may undergo endoscopic retrograde cholangiopancreatolography (ERCP), which requires a local anesthetic. A flexible fiber-optic camera (endoscope) goes down the patient's mouth, through their digestive system and into the gallbladder. An electrically heated wire widens the opening of the bile duct; the stones are removed or left to pass into the intestine.

Lithotripsy
Ultrasonic shock waves are aimed at the gallstones, which break them up. If they become small enough they can then pass safely in the patients stools. This type of treatment is uncommon and is only used when there are few gallstones present.

Gallstones complications
If the bile duct or duodenum are blocked by gallstones, the flow of digestive juices to the pancreas may be blocked, this can cause jaundice and acute pancreatitis. Treatment usually involves the surgical removal of the gallbladder.

If is common for people who have had their gallbladder removed to experience feelings of bloating and indigestion, especially
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Gallstones

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