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Tuesday, January 29, 2008

Gallstones

Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. The liquid, called bile, is used to help the body digest fats. Bile is made in the liver, then stored in the gallbladder until the body needs to digest fat. At that time, the gallbladder contracts and pushes the bile into a tube called a duct that carries it to the small intestine, where it helps with digestion.
Bile contains water, cholesterol, fats, bile salts, and bilirubin. Bile salts break up fat, and bilirubin gives bile and stools a brownish color. If the liquid bile contains too much cholesterol, bile salts, or bilirubin, it can harden into stones.
The two types of gallstones are cholesterol stones and pigment stones. 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.
Gallstones can block the normal flow of bile if they lodge in any of the ducts that carry bile from the liver to the small intestine, That includes the hepatic ducts, which carry bile out of the liver, the cystic duct, which takes bile to and from the gallbladder, and the common bile duct, which takes bile from the cystic and hepatic ducts to the small intestine. Bile trapped in these ducts can cause inflammation in the gallbladder, the ducts, or rarely, the liver. Other ducts open into the common bile duct, including the pancreatic duct, which carries digestive enzymes out of the pancreas. If a gallstone blocks the opening to the duct, digestive enzymes can become trapped in the pancreas and cause an extremely painful inflammation called pancreatitis.
If any of these ducts remain blocked for a significant period of time, severepossiblo@atal, damage can occur/ affecting the gallbladder, liver, or pancreas. Warning signs of a serious problem are fever, jaundice, and persistent pain.
Cholesterol Stones
Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty, as it should for some other reason.
Pigment Stones
The cause of pigment stones is uncertain. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anemia.
Other Factors
It is believed that the mere presence of gallstones may cause more gallstones develop. However, other factors that contribute to gallstones have been identified, especially for cholesterol stones.
  • Obesity
  • Excess estrogen
  • Gender: Women between 20 and 60 years of age are twice as likely to develop gallstones as men.
  • Age: People over age 60 are more likely to develop gallstones than younger people.
  • Cholesterol-lowering drugs
  • Diabetes
  • Rapid weight loss
  • Fasting
  • Women
  • People over age 60.
  • Overweight men and women
  • People who fast or lose a lot of weight quickly
  • Pregnant women, women on hormone therapy, and women who use birth control pills.
Symptoms of gallstones are often called a gallstone "attack" because they occur suddenly. A typical attack can cause
  • Steady, sever pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours.
  • Pain in the back between the shoulder blades.
  • Pain under the right shoulder.
  • Nausea or vomiting.
Gallstone attacks often follow fafty meals, and they may occur during the night. Other gallstone symptoms include
  • Abdominal bloating
  • Recurring intolerance of fafty foods
  • Colic
  • Belching
  • Gas
  • Indigestion
People who also have the following symptoms should see a doctor right away:
  • Sweating
  • Chills
  • Low-grade fever
  • Yellowish color of the skin or whites of the eyes
  • Clay-colored stools
Many people with gallstones have no symptoms. These patients are said to be a symptomatic, and these stones are called "silent stones". They do not interfere in gallbladder, liver, or pancreas function.
Many gallstones, especially silent stones, are discovered by accident during tests for other problems. But when gallstones are suspected to be the cause of symptoms, the doctor is likely to do an ultrasound exama Ultrasound uses sound waves to create images of organs. If stones are present, the sound waves will bounce off them, showing their location.
Other tests used in diagnosis include
  • Cholecystogram or cholescintigraphy
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Blood tests: Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice.
Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis. So accurate diagnosis is important.
Surgery
Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones.
The standard surgery is called laparoscopic cholecystectomy. For this operation, the surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures. Then the cystic duct is cut and the gallbladder removed through one of the small incisions.
Because the abdominal muscles are not cut during laparoscopic surgery, patients have less pain and fewer complications than they would have had after surgery using a large incision across the abdomen. Recovery usually involves only one night in the hospital, followed by several days of restricted activity at home.
If the surgeon discovers any obstacles to the laparoscopic procedure, such as infection or scarring from other operations, the operating team may have to switch to open surgery. It is called "open" surgery because the surgeon has to make a 5 to 8 inch incision in the abdomen to remove the gallbladder. This is a major surgery and may require about a 2 to 7 day stay in the hospital and several more weeks at home to recover. Open surgery is now required in less than 2 percent gallbladder operations, in specialized centres.
The most common complication in gallbladder surgery is injury to the bile ducts. An injured common bile duct can leak bile and cause a painful and potentially dangerous infection. Mild injuries can sometimes be treated nonsurgically. Major injury, however, is more serious and requires additional surgery.
If gallstones are in the bile ducts, the surgeon may use ERCP in removing them before or during the gallbladder surgery. Once the endosr-ope is in the small intestine, the surgeon locates the affected bile duct. An instrument on the endoscope is used to out the duct, and the stone is captured in a tiny basket and removed with the endoscope. This two-step procedure is called ERCR with endoscopic sphincterotomy.
Nonsurgical treatment
Nonsurgical approaches are used only in special situations such as when a patient's condition prevents using an anesthetic and only for cholesterol stones. Stones recur after nonsurgical treatment about half the time.
Fortunately, the gallbladder is an organ that people can live without. Losing it won't even require a change in diet. Once the gallbladder is removed, bile flows out of the liver through the hepatic ducts into the common bile duct and goes directly into the small intestine, instead of being stored in the gallbladder. However, because the bile isn't stored in the gallbladder, it flows into the small intestine more frequently, causing diarrhea in some people. Also, some studies suggest that removing the gallbladder may cause higher blood cholesterol levels, so occasional cholesterol tests may be necessary.
  • Gallstones from when substances in the bile harden.
  • Gallstones are common among women and people who are overweight.
  • Gallstone attacks often occur after eating a fatty meal.
  • Symptoms can mimic those of other problems, including heart attack, so accurate diagnosis is important.
  • Gallstones can cause serious problems if they become trapped in the bile ducts.

  • Laparoscopic surgery to remove the gallbladder is the most common treatment.

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