Gallstones are solid crystal deposits that form in the gallbladder, a pear-shaped organ that stores bile until it is needed to help digest fatty foods. These crystals can migrate to other parts of the digestive tract, causing severe pain and life-threatening complications. Gallstones vary in size and chemical structure. They may be as tiny as a grain of sand, or as large as a golf ball.
Description
Gallstones usually develop in adults between the ages of 20 and 50. The risk of developing gallstones increases with age. Young women are up to six times more likely to develop gallstones than men in the same age group. In patients over 50, however, the condition affects men and women with equal frequency. Native Americans develop gallstones more often than any other segment of the population, and Mexican Americans have the second highest incidence of this disease. Gallstones tend to be passed down genetically in families.
Eighty percent of gallstones are composed of cholesterol. They are formed when the liver produces more cholesterol than the digestive juices can liquefy. The remaining 20% of gallstones are composed of calcium and an orangeyellow waste product called bilirubin, which gives urine its characteristic color and sometimes causes jaundice.
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People who have gallstones may remain without symptoms for an extended period, especially if the stones remain in the gallbladder. In most cases, medical treatment is only deemed necessary if the individual is experiencing symptoms. When symptoms do appear, it is usually because the stones have left the gallbladder and are stuck somewhere else within the biliary system, blocking the flow of bile. If gallstones remain stuck in the biliary system, there can be damage to the liver, pancreas, or the gallbladder itself.
Gallstones bring on several disorders including:
- Cholelithiasis: Gallstones within the gallbladder itself. Pain is caused by the contractions of the gallbladder around the stone.
- Choledocholithiasis: The presence of gallstones within the common bile duct, which is the passage between that empties into the small intestine. Once discovered, common duct stones need to be removed in order to avoid further problems.
- Cholecystitis: A disorder marked by inflammation of the gallbladder. It is usually caused by the passage of a stone from the gallbladder into the cystic duct, which connects the gallbladder to the common bile duct. Cholecystitis causes painful enlargement of the gallbladder and is responsible for 10–25% of all gallbladder surgery.
Causes & symptoms
Gallstones are caused by an alteration in the chemical composition of bile, which is a fluid that helps the body break down and absorb fats. It is widely held that a diet high in fats and processed foods, and low in fiber and whole foods, is a strong contributor to gallstone formation. High levels of estrogen, insulin, or cholesterol can increase a person’s risk of developing gallstones. If left untreated, the risk of developing anemia is also increased.
Gallbladder attacks usually follow a meal of rich foods, typically high in fat. The attacks often occur in the middle of the night, sometimes waking the patient with such intense pain that the episode ends in a visit to the emergency room. Pain often occurs on the right side of the body.
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 fats, low fever, chills and sweating, nausea and vomiting, indigestion, gas, belching, and clay-colored bowel movements.
Pregnancy or the use of birth control pills slow down gallbladder activity and increase the risk of gallrestones, as do diabetes, pancreatitis, and celiac disease. This is due to an individual’s higher levels of cholesterol, insulin, or estrogen from oral contraceptives.
Other factors that may encourage gallstone formation are:
- infection
- anemia
- obesity
- intestinal disorders
- coronary artery disease
- multiple pregnancies
- a high-fat, low-fiber diet
- smoking
- heavy drinking
- rapid weight loss
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Diagnosis
When gallstones are suspected, blood tests for liver enzyme levels are often given. The levels are usually elevated when the stone cannot pass through the cystic duct or bile duct. Test results, taken together with symptom history (see above) and a physical exam, are simple and relatively inexpensive for diagnosing the presence of gallstones. However, ultrasound is the method of choice for a definite diagnosis. It has a high degree of accuracy, except in diagnosing cholecystitis (a stone in the cystic duct). Cholescintigraphy is an alternative method of diagnosis, in which radioactive dye is injected and photographed as it passes through the biliary system.
Treatment
An allergic reaction to certain foods may contribute to gallbladder attacks. These foods should be identified and removed from the diet, or at least seriously limited. Foods that might possibly bring on allergic reactions include eggs, pork, onions, chicken, milk, coffee, citrus, corn, nuts, and beans.
Other dietary changes may help relieve the symptoms of gallstones. Generally, a vegetarian diet is protective against the formation of gallstones. Recurrent attacks can be diminished by maintaining a healthy weight and a healthy diet.
Choleretic herbs encourage the liver to secrete bile. They help maintain the appropriate chemical composition of bile so that it does not form stones. These herbs include:
- A tincture of dandelion (Taraxacum officinale), 2–6 ml once daily.
- Milk thistle seeds (Sylibum marianum), a dose equivalent to 70–210 mg of silymarin.
- Artichoke leaves (Cynara scolymus), 150 mg three times per day.
- Turmeric (Curcuma longa), used as a spice; 150 mg three times per day.
Use of the above herbs cause some possible reactions, such as gas, diarrhea, nausea, and indigestion.
Other therapeutic approaches that have been found to be helpful in treating gallstones include homeopathy, traditional Chinese herbal medicine, and acupuncture. Knowledgeable practitioners should be consulted.
Allopathic treatment
Watchful waiting
One-third of all patients with gallstones never experience a second attack. For this reason, many doctors advise an attitude of “wait and see” after the first episode. Changing the diet or following a sensible weight loss plan may be the only treatments required. A person having only occasional mild gallstone attacks may be able to manage them by using non-prescription forms of acetaminophen, such as Tylenol or Anacin. A doctor should be notified if pain intensifies or lasts for more than three hours; if the fever rises above 101°F (38.3°C); or if the skin or whites of the eyes have a yellowish cast.
Surgery
Surgical removal of the gallbladder, called cholecystectomy, is the most common conventional treatment for recurrent or worsening gallstone attacks. However, surgery is unecessary in most cases where the gallstones remain without symptoms. Laparoscopic cholecystectomy is the technique most widely used. It has mostly replaced traditional open surgery because of a shorter recovery time, decreased pain, and reduced scarring. However, the open surgery procedure is still used in about 5% of cases because of various complications.
Nonsurgical therapy
If surgery is considered inappropriate, gallstones can be dissolved in 30–40% of patients by taking bile acids in tablet form. Dissolution of gallstones by this method may take many months or years depending on the size. Unfortunately, though, recurrence of stones is common after cessation of the medication.
Lithotripsy uses high-frequency sound waves directed through the skin to break up the stones. The process can be combined with the use of bile acid tablets. However, lithotripsy requires special equipment and is not always readily available.
Direct cholangiography can be used to remove gallstones by contact dissolution. The procedure is used to insert a catheter to inject medication into the gallbladder. Stones are often dissolved within a few hours by this method.
Expected results
Forty percent of all patients with gallstones have “silent gallstones” that do not require treatment. If symptoms develop, however, medical intervention may become necessary. Gallstone problems requiring treatment may also develop infections that require antibiotics. In rare instances, severe inflammation can cause the gallbladder to burst, causing a potentially fatal situation. The gallbladder is not an organ that is required to retain health. It can be successfully removed, with no recurrence of stones. Fat digestion, however, becomes more difficult after surgery, since the gallbladder is no longer there to store and release bile as needed.
Prevention
It is easier, in general, to prevent gallstones than to reverse the process. The best way to prevent gallstones is to minimize risk factors. Since gallstones seem to develop more often in people who are obese, eating a balanced diet, exercising, and losing weight may help keep gallstones from forming. In addition, a diet high in dietary fiber and low in fats, especially saturated fats, is recommended. Processed foods should be replaced by complex carbohydrates, such as whole grains.
Increased intake of fluids will dilute the bile and inhibit gallstone formation. Six to eight glasses of water should be consumed daily, along with plenty of herbal teas and diluted juices.
Recent studies indicate that consumption of about two tablespoons of olive oil per day, which can be mixed with food, helps reduce cholesterol levels in the bloodstream and the gallbladder. However, large amounts of olive oil, taken as a so-called liver flush, should be avoided. This method can stress the gallbladder and lead to an emergency situation.