From Ask Dr Wiki
In medicine, gallstones (choleliths) are crystalline bodies formed within the body by accretion or concretion of normal or abnormal bile components.
Gallstones can occur anywhere within the biliary tree, including the gallbladder and the common bile duct. Obstruction of the common bile duct is choledocholithiasis; obstruction of the biliary tree can cause jaundice; obstruction of the outlet of the pancreatic exocrine system can cause pancreatitis. Cholelithiasis is the presence of stones in the gallbladder—chole- means "bile", lithia means "stone", and -sis means "process".
The characteristics of gallstones are various. Independent of appearance, however, gallstones from animals are valuable on the market.
Characteristics
Size
A gallstone's size varies and may be as small as a sand grain or as large as a golf ball. The gallbladder may develop a single, often large, stone or many smaller ones, even several thousand.
Content
Gallstones have different appearance, depending of their contents. On the basis of their contents, gallstones can be subdivided into the two following types:
Cholesterol stones
Cholesterol stones are usually green, but are sometimes white or yellow in color and account for about 80 percent of gallstones. They are made primarily of cholesterol.
Pigment stones
Pigment stones are small, dark stones made of bilirubin and calcium salts that are found in bile. They account for the other 20 percent of gallstones. Risk factors for pigment stones include cirrhosis, biliary tract infections, and hereditary blood cell disorders, such as sickle cell anemia and Spherocytosis. Stones of mixed origin also occur.
Causes
Progress has been made in understanding the process of gallstone formation. Researchers believe that gallstones may be caused by a combination of factors, including inherited body chemistry, body weight, gallbladder motility (movement), and perhaps diet. Additionally, people with erythropoietic protoporphyria (EPP) are at increased risk to develop gallstones.[1]
Cholesterol gallstones develop when bile contains too much cholesterol and not enough bile salts. Besides a high concentration of cholesterol, two other factors seem to be important in causing gallstones. The first is how often and how well the gallbladder contracts; incomplete and infrequent emptying of the gallbladder may cause the bile to become overconcentrated and contribute to gallstone formation. The second factor is the presence of proteins in the liver and bile that either promote or inhibit cholesterol crystallization into gallstones.
In addition, increased levels of the hormone oestrogen as a result of pregnancy, hormone therapy, or the use of combined (estrogen-containing) forms of hormonal contraception, may increase cholesterol levels in bile and also decrease gallbladder movement, resulting in gallstone formation.
No clear relationship has been proven between diet and gallstone formation. However, low-fiber, high-cholesterol diets, and diets high in starchy foods have been suggested as contributing to gallstone formation. Other nutritional factors that may increase risk of gallstones include rapid weight loss, constipation, eating fewer meals per day, eating less fish, and low intakes of the nutrients folate, magnesium, calcium, and vitamin C.[2] On the other hand, wine and whole grain bread may decrease the risk of gallstones.[3]
Symptoms
Gall stones usually remain asymptomatic initially.[4] They start developing symptoms once the stones reach a certain size (>8mm).[5] A main symptom of gallstones is commonly referred to as a gallstone "attack", also known as biliary colic, in which a person will experience intense pain in the upper abdominal region that steadily increases for approximately thirty minutes to several hours. A victim may also encounter pain in the back, ordinarily between the shoulder blades, or pain under the right shoulder. In some cases, the pain develops in the lower region of the stomach, nearer to the pelvis, but this is less common.Template:Fact Nausea and vomiting may occur.
These attacks are intensely painful, similar to that of a kidneystone attack. One way to alleviate the abdominal pain is to drink a full glass of water at the start of an attack to regulate the bile in the gallbladder, but this does not work in all cases.Template:Fact Another way is to take magnesium followed by a bitter liquid such as coffee or swedish bitters an hour later.Template:Fact Bitter flavors stimulate bile flow.Template:Fact A study has found lower rates of gallstones in coffee drinkers.[6]
Often, these attacks occur after a particularly fatty meal and almost always happen at night. Other symptoms include abdominal bloating, intolerance of fatty foods, belching, gas, and indigestion. If the above symptoms coincide with chills, lowgrade fever, yellowing of the skin or eyes, and/or clay-colored stool, a doctor should be consulted immediately.[7]
Some people who have gallstones are asymptomatic and do not feel any pain or discomfort. These gallstones are called "silent stones" and do not affect the gallbladder or other internal organs. They do not need treatment.[7]
Medical options
Cholesterol gallstones can sometimes be dissolved by oral ursodeoxycholic acid. Gallstones may recur however, once the drug is stopped. Obstruction of the common bile duct with gallstones can sometimes be relieved by endoscopic retrograde sphinceterotomy (ERS) following endoscopic retrograde cholangiopancreatography (ERCP). A common misconception is that the use of ultrasound (Extracorporeal Shock Wave Lithotripsy) can be used to break up gallstones.Template:Fact Although this treatment is highly effective against kidney stones, it can only rarely be used to break up the softer and less brittle gallstones.
Surgical options
Cholecystectomy (gallbladder removal) has a 99% chance of eliminating the recurrence of cholelithiasis. Only symptomatic patients must be indicated to surgery. The lack of a gall bladder does not seem to have any negative consequences in many people. However, there is a significant proportion of the population, between 5-40%, who develop a condition called postcholecystectomy syndrome.[8] Symptoms include gastrointestinal distress and persistent pain in the upper right abdomen.
There are two surgery options: open procedure and laparoscopic: see the cholecystectomy article for more details.
- Open cholecystectomy procedure: This involves a large incision into the abdomen (laparotomy) below the right lower ribs. A week of hospitalization, normal diet a week after release and normal activity a month after release.
- Laparoscopic cholecystectomy: 3-4 small puncture holes for camera and instruments (available since the 1980s). Typically same-day release or one night hospital stay, followed by a week of home rest and pain medication. Can resume normal diet and light activity a week after release. (Decreased energy level and minor residual pain for a month or two.) Studies have shown that this procedure is as effective as the more invasive open cholecystectomy, provided the stones are accurately located by cholangiogram prior to the procedure so that they can all be removed. The procedure also has the benefit of reducing operative complications such as bowel perforation and vascular injury.
Alternative Medicine
A regimen called a "gallbladder flush" or "liver flush" is a popular remedy in alternative medicine. In this treatment, often self-administered, the patient drinks four glasses of apple cider and eats five apples per day for five days, then fasts briefly, takes magnesium, and then drinks large quantities of lemon or grapefruit juice mixed with olive oil or other oil before bed; the next morning, they painlessly pass a number of green and brown pebbles purported to be stones flushed from the biliary system. A New Zealand hospital analyzed stones from a typical gallbladder flush and found them to be composed of fatty acids similar to those in olive oil, with no detectable cholesterol or bile salts,[9] demonstrating that they are little more than hardened olive oil. Despite the gallbladder flush, the patient still required surgical removal of multiple true gallstones. The note concluded: "The gallbladder flush may not be entirely worthless, however; there is one case report in which treatment with olive oil and lemon juice resulted in the passage of numerous gallstones, as demonstrated by ultrasound examination (Br J Surg 1992;79:168)."
In the case mentioned (Br J Surg 1992;79:168), ultrasound confirmed multiple gallstones, but after waiting months for a surgical option, the patient underwent a treatment with olive oil and lemon juice resulting in the passage of four 2.5 cm by 1.25 cm stones and twenty pea-sized stones. Two years later symptoms returned, and ultrasound showed a single large gallstone; the patient chose to have this removed surgically.[10]
Value
Gallstones are, oddly, a valuable by-product of meat processing, fetching up to US$32 per gram in their use as a purported aphrodisiac in the herbal medicine of some cultures, particularly in China. The finest gallstones tend to be sourced from old dairy cows. Much as in the manner of diamond mines, slaughterhouses carefully scrutinize offal department workers for gallstone theft.[11]
References
Chinese traditional herbal medicine doesn't use the ox gallstone for aphrodisiac purpose. It mainly act as an important agent which as functions of cooling patient's inner system, cleansing of heart and liver.
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External links
{{#ifeq:|plain||{{#if:| |}}
}} |
|---|
{{#if:| |
}}{{#if:Esophagitis - GERD - Achalasia - Boerhaave syndrome - Nutcracker esophagus - Zenker's diverticulum - Mallory-Weiss syndrome - Barrett's esophagus|{{#if:|{{#ifeq:{{#if:EsophagusStomach/
duodenumHerniaNoninfective enteritis and colitisOther intestinalLiver/hepatitisAccessory digestiveOther/general|false|true}}|true| | }}}}{{#if:Esophagus|Esophagus | }}Esophagitis - GERD - Achalasia - Boerhaave syndrome - Nutcracker esophagus - Zenker's diverticulum - Mallory-Weiss syndrome - Barrett's esophagus | {{#if:| | }}
}}{{#if:Peptic (gastric/duodenal) ulcer - Gastritis - Gastroenteritis - Duodenitis - Dyspepsia - Pyloric stenosis - Achlorhydria - Gastroparesis - Gastroptosis - Portal hypertensive gastropathy|{{#if:Stomach/
duodenum|Stomach/
duodenum | }}Peptic (gastric/duodenal) ulcer - Gastritis - Gastroenteritis - Duodenitis - Dyspepsia - Pyloric stenosis - Achlorhydria - Gastroparesis - Gastroptosis - Portal hypertensive gastropathy |
}}{{#if:Inguinal (Indirect, Direct) - Femoral - Umbilical - Incisional - Diaphragmatic - Hiatus|{{#if:Hernia|| Hernia | }}Inguinal (Indirect, Direct) - Femoral - Umbilical - Incisional - Diaphragmatic - Hiatus |
}}{{#if:IBD (Crohn's, Ulcerative colitis) - noninfective gastroenteritis|{{#if:Noninfective enteritis and colitis|| Noninfective enteritis and colitis | }}IBD (Crohn's, Ulcerative colitis) - noninfective gastroenteritis |
}}{{#if:vascular (Abdominal angina, Mesenteric ischemia, Ischemic colitis, Angiodysplasia) - Ileus/Bowel obstruction (Intussusception, Volvulus) - Diverticulitis/Diverticulosis - IBS
other functional intestinal disorders (Constipation, Diarrhea, Megacolon/Toxic megacolon, Proctalgia fugax) - Anal fissure/Anal fistula - Anal abscess - Rectal prolapse - Proctitis (Radiation proctitis)|{{#if:Other intestinal|| Other intestinal | }}vascular (Abdominal angina, Mesenteric ischemia, Ischemic colitis, Angiodysplasia) - Ileus/Bowel obstruction (Intussusception, Volvulus) - Diverticulitis/Diverticulosis - IBS
other functional intestinal disorders (Constipation, Diarrhea, Megacolon/Toxic megacolon, Proctalgia fugax) - Anal fissure/Anal fistula - Anal abscess - Rectal prolapse - Proctitis (Radiation proctitis) |
}}{{#if:Alcoholic liver disease - Liver failure (Acute liver failure) - Cirrhosis - PBC - NASH - Fatty liver - Peliosis hepatis - Portal hypertension - Hepatorenal syndrome|{{#if:Liver/hepatitis|| Liver/hepatitis | }}Alcoholic liver disease - Liver failure (Acute liver failure) - Cirrhosis - PBC - NASH - Fatty liver - Peliosis hepatis - Portal hypertension - Hepatorenal syndrome |
}}{{#if:Gallbladder (Gallstones, Choledocholithiasis, Cholecystitis, Cholesterolosis, Rokitansky-Aschoff sinuses)
Biliary tree (Cholangitis, Cholestasis/Mirizzi's syndrome, PSC, Biliary fistula, Ascending cholangitis)
Pancreas (Acute pancreatitis, Chronic pancreatitis, Pancreatic pseudocyst, Hereditary pancreatitis)|{{#if:Accessory digestive|| Accessory digestive | }}Gallbladder (Gallstones, Choledocholithiasis, Cholecystitis, Cholesterolosis, Rokitansky-Aschoff sinuses)
Biliary tree (Cholangitis, Cholestasis/Mirizzi's syndrome, PSC, Biliary fistula, Ascending cholangitis)
Pancreas (Acute pancreatitis, Chronic pancreatitis, Pancreatic pseudocyst, Hereditary pancreatitis) |
}}{{#if:Appendicitis - Peritonitis (Spontaneous bacterial peritonitis)
Malabsorption (celiac, Tropical sprue, Blind loop syndrome, Whipple's)
postprocedural: Gastric dumping syndrome - Postcholecystectomy syndrome
bleeding: Hematemesis - Melena - Gastrointestinal bleeding (Upper, Lower)|{{#if:Other/general|| Other/general | }}Appendicitis - Peritonitis (Spontaneous bacterial peritonitis)
Malabsorption (celiac, Tropical sprue, Blind loop syndrome, Whipple's)
postprocedural: Gastric dumping syndrome - Postcholecystectomy syndrome
bleeding: Hematemesis - Melena - Gastrointestinal bleeding (Upper, Lower) |
}}{{#if:See also congenital|{{#if:| | }}See also congenital |
}}{{#if:|{{#if:| | }} |
}}{{#if:|{{#if:| | }} |
}}{{#if:|{{#if:| | }} |
}}{{#if:|{{#if:| | }} |
}}{{#if:|{{#if:| | }} |
}}{{#if:|{{#if:| | }} |
}}{{#if:|{{#if:| | }} |
}}{{#if:|{{#if:| | }} |
}}{{#if:|{{#if:| | }} |
}}{{#if:|{{#if:| | }} |
}}{{#if:|{{#if:| | }} |
}}{{#if:| |
}}
]]
de:Gallenstein
es:Litiasis biliar
eo:Galŝtono
fr:Calcul biliaire
hr:Žučni kamenci
it:Colelitiasi
lt:Tulžies pūslės akmenligė
ml:ആഗ്നേയഗ്രന്ഥീ ശില
nl:Galsteen
ja:胆石
pl:Kamica żółciowa
pt:Colelitíase
fi:Sappikivitauti
sv:Gallsten
vi:Sỏi mật
tr:Safra taşı
ur:سنگ صفراء
zh:膽石症
