Gallstone

Gallstone: Description:GallstoneA concretion in the gallbladder or a bile duct, composed chiefly of a mixture of cholesterol, calcium bilirubinate, and calcium carbonate, occasionally as a pure stone composed of just one of these substances.Alternative Name: Biliary calculus, cholelith, gallbladder attack; Biliary colic; gallstone attack.The gallbladder is a small, pear-shaped sac located below your liver in the right upper abdomen. Gallstone form when liquid stored in the gallbladder hardens into pieces of stone-like material. The liquid — called bile — helps the body digest fats. Bile is made in the liver, then stored in the gallbladder until the body needs it. The gallbladder contracts and pushes the bile into a tube—called the common bile duct—that carries it to the small intestine, where it helps with digestion.Bile contains water, cholesterol, fats, bile salts, proteins, and bilirubin—a waste product. Bile salts break up fat, and bilirubin gives bile and stool a yellowish-brown color. If the liquid bile contains too much cholesterol, bile salts, or bilirubin, it can harden into gallstones.There are two main types of gallstones:Gallstone made out of cholesterol are by far the most common type. Cholesterol gallstones have nothing to do with the cholesterol levels in the blood.
  1. Stones made from too much bilirubin in the bile. Bile is a liquid made in the liver that helps the body digest fats. Bile is made up of water, cholesterol, bile salts, and other chemicals, such as bilirubin. Such stones are called pigment stones.
Causes and Risk Factors:Factors that contribute to the formation of gallstones, particularly cholesterol stones, includeSex: Women are twice as likely as men to develop gallstones. Excess estrogen from pregnancy, hormone replacement therapy, and birth control pills appears to increase cholesterol levels in bile and decrease gallbladder movement, which can lead to gallstones.
  • Family history: Gallstone often run in families, pointing to a possible genetic link.
  • Weight: A large clinical study showed that being even moderately overweight increases the risk for developing gallstones. The most likely reason is that the amount of bile salts in bile is reduced, resulting in more cholesterol. Increased cholesterol reduces gallbladder emptying. Obesity is a major risk factor for gallstones, especially in women.
  • Diet: Diets high in fat and cholesterol and low in fiber increase the risk of gallstones due to increased cholesterol in the bile and reduced gallbladder emptying.
  • Age: People older than age 60 are more likely to develop gallstones than younger people. As people age, the body tends to secrete more cholesterol into bile.
  • Ethnicity: American Indians have a genetic predisposition to secrete high levels of cholesterol in bile. In fact, they have the highest rate of gallstones in the United States. The majority of American Indian men have gallstones by age 60. Among the Pima Indians of Arizona, 70 percent of women have gallstones by age 30. Mexican American men and women of all ages also have high rates of gallstones.
  • Diabetes: People with diabetes generally have high levels of fatty acids called triglycerides. These fatty acids may increase the risk of gallstones.
However, if a large stone blocks either the cystic duct or common bile duct (called choledocholithiasis), you may have a cramping pain in the middle to right upper abdomen. This is known as biliary colic. The pain goes away if the stone passes into the first part of the small intestine (the duodenum).Symptoms:Symptoms that may occur include fever, abdominal fullness, clay colored stools, yellowish color of the skin or whites of the eyes, nausea and vomiting.Diagnosis:The gallstones are often discovered when having a routine x-ray, abdominal surgery, or other medical procedure.Tests used to detect gallstones or gallbladder inflammation include:Abdominal ultrasound.
  • Gallbladder radionuclide scan.
  • Abdominal CT scan.
  • Endoscopic ultrasound.
  • Percutaneous transhepatic cholangiogram (PTCA).
  • Endoscopic retrograde cholangiopancreatography (ERCP).
  • Magnetic resonance cholangiopancreatography (MRCP).
Your doctor may order the following blood tests:Bilirubin.
  • Liver function tests.
  • Pancreatic enzymes.
Treatment Options:Initial treatment include:Medicines called chenodeoxycholic acids (CDCA) or ursodeoxycholic acid (UDCA, ursodiol) may be given in pill form to dissolve cholesterol gallstones. However, they may take 2 years or longer to work, and the stones may return after treatment ends.Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.In general, patients who have symptoms will need surgery either right away, or after a short period of time.In the past, open cholecystectomy (gallbladder removal) was the usual procedure for uncomplicated cases. However, this is done less often now. A technique called laparoscopic cholecystectomy is most commonly used now. This procedure uses smaller surgical cuts, which allow for a faster recovery. Patients are often sent home from the hospital on the same day as surgery, or the next morning. Endoscopic retrograde cholangiopancreatography (ERCP) and a procedure called a sphincterotomy may be done to locate or treat gallstones in the common bile duct.Nonsurgical Treatment:Nonsurgical approaches are used only in special situations—such as when a patient has a serious medical condition preventing surgery—and only for cholesterol stones. Stones commonly recur within 5 years in patients treated nonsurgically.Oral dissolution therapy: Drugs made from bile acid are used to dissolve gallstones. The drugs ursodiol (Actigall) and chenodiol (Chenix) work best for small cholesterol stones. Months or years of treatment may be necessary before all the stones dissolve. Both drugs may cause mild diarrhea, and chenodiol may temporarily raise levels of blood cholesterol and the liver enzyme transaminase.Contact dissolution therapy: This experimental procedure involves injecting a drug directly into the gallbladder to dissolve cholesterol stones. The drug—methyl tert-butyl ether—can dissolve some stones in 1 to 3 days, but it causes irritation and some complications have been reported. The procedure is being tested in symptomatic patients with small stones.There is no known way to prevent gallstones. If you have gallstone symptoms, eating a low-fat diet and losing weight may help you control symptoms.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care. 

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