notes about Gallbladder stone

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Gallstones: Causes, Treatment and Prevention

Gallstones are supersaturated, pebble-like deposits of bile inside the gallbladder. They can be as small as a grain of sand or as big as a golf ball and can occur as a single stone or as a collection of stones in a combination of sizes. There are two types of gallstones — cholesterol stones, which account for 80 percent of gallstones, and pigment stones, which are composed of bilirubin, a chemical found in bile, according to the National Institutes of Health.

Causes

Bile is made in the liver and it is stored in the gallbladder until it is transported to the small intestine, where it helps with digestion of fats and fat-soluble vitamins.

Gallstones occur when there's an imbalance in the bile transportation process. Cholesterol stones can form when bile contains too much cholesterol, too much bilirubin or not enough bile salts.

"Cholesterol is a naturally occurring substance within our bile, When you have an abnormal accumulation, you can wind up with cholesterol crystals precipitating out, and growing over time into what we call stones."

Gallstones can also occur when the gallbladder does not empty into the common bile duct completely or often enough. Women are twice as likely as men to develop gallstones because excess estrogen from pregnancy, hormone replacement therapy, and birth control pills may increase cholesterol levels and decrease gallbladder movement, which can facilitate gallstones.

Black pigment stones usually consist of bilirubin polymers and calcium carbonate, and they rarely contain cholesterol. These stones are mostly found in the gallbladder, and can develop as a result of liver damage, alcoholic liver disease, hemolytic anemia and old age. 

Brown pigment stones usually consist of calcium bilirubinate, fatty acids and small amounts of cholesterol. These are usually found in the bile duct and they are almost always associated with bile infections, inflammations and occasionally, parasitic infestations in the liver.

People who have significant fluctuations in weight, such as from a pregnancy or operation, are also at risk of developing gallstones.

Diagnosis & tests

The majority of people with gallstones are asymptomatic. Therefore, gallstones are often discovered during routine X-ray, abdominal surgery or other medical procedures.

Occasionally, gallstones can cause prolonged discomfort and cramps as the stones wind down the bile duct, creating a blockage and increasing the pressure in the gallbladder. These sudden occurrences are known as gallbladder "attacks" and they often happen during the night or after a fatty meal.

Symptoms include pain in the center or upper right of the upper abdomen, or pain around the back or right shoulder blade.

When pain occurs, the doctor will order an ultrasound exam to look for gallstones. Although ultrasound is the most sensitive and specific test for gallstones, the doctor may also order a CT scan if the symptoms are more serious, since the CT scan can also detect complications such as a ruptured or infected gallbladder or bile duct.

Gallstones can sometimes lead to pancreatitis. They can also lead to cholangitis, an infection that happens when a gallstone becomes trapped in the bile duct.

"It’s a potentially life threatening infection of the bile ducts and liver," Bencsath said. "It requires rapid and prompt attention with antibiotics with ERCP procedure. Once the patient has recovered, then the recommendation can be to remove the gallbladder, so that the risk of that happening again is eliminated."

Treatment & medication

If a person has minimal or no symptoms, and if they have few or small stones, then they can take medication for gallstones.

Surgery may not be needed unless there are symptoms, according to the NIH. However, people with frequent gallbladder attacks may opt to have their gallbladder surgically removed. The procedure is known as cholecystectomy and it can be performed using a laparoscope and a miniature video camera. The process is minimally invasive, and patients can typically go home following the operation. 

Prevention

Gallstones occur more frequently in people at two opposite ends of the weight spectrum — those who are overweight or obese, and those who fast or lose a lot of weight quickly. In addition, research published in the journal Gut in 2005 suggests that high intake of carbohydrate, a fluctuating glycaemic load and glycaemic index increase the risk of symptomatic gall stone disease in men. Therefore, it is important to adopt a healthy diet and stick to regular meal times. 

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