Gallstones

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Obesity, Sleep & Internal medicine
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CT_of_cholecystitis

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Histopathology_of_cholelithiasis

Gallstones are crystalline bodies formed within the biliary system due to the accretion or concretion of components found in bile. The biliary system, encompassing the gallbladder, bile ducts, and related structures, plays a critical role in digestion. Gallstones can emerge in varying parts of this system, potentially leading to significant medical complications.

Introduction

Gallstones, medically termed choleliths, arise when components of bile solidify within the biliary tree. Bile, a digestive fluid produced by the liver, might either have its typical or abnormal components crystallize. Factors like dieting can sometimes elevate the risk of gallstone formation, but this connection is less frequently observed.

Gallstones

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Types of Gallstones

There are two primary categories of gallstones:

Ultrasonography of common bile duct stone, with_arrow

1. Cholesterol Gallstones: These are the most prevalent type, accounting for approximately 80% of all gallstones. Greenish in hue, they can sometimes appear white or yellow. They primarily consist of cholesterol.
2. Pigment Gallstones: These small, dark stones comprise bilirubin and calcium salts found in bile. They represent the remaining 20% of gallstones. Risk factors encompass conditions such as cirrhosis, biliary tract infections, and hereditary blood disorders, including sickle cell anemia. Mixed-origin stones can also form.

Stones can form anywhere in the biliary tree, from the gallbladder to the common bile duct. A blockage in the common bile duct is termed choledocholithiasis. Such obstructions can result in jaundice, or, if affecting the outlet of the pancreatic exocrine system, can lead to pancreatitis. When stones are present in the gallbladder, it is referred to as Cholelithiasis, with chole- denoting "gall bladder", lithia meaning "stone", and -sis indicative of a "process".

Gallstones can significantly vary in size - from as minuscule as a grain of sand to as large as a golf ball. An individual's gallbladder might contain a single large stone, several smaller ones, or even thousands in some cases.

Interestingly, gallstones have found value in some cultural herbal medicine practices as a purported aphrodisiac. Sourced predominantly from aged dairy cows, these stones can fetch up to $900 US an ounce. Owing to their value, similar to diamond mines, slaughterhouses vigilantly monitor their workers, especially in the offal department, to prevent gallstone theft.

Causes of Gallstone Formation

Understanding gallstone formation has witnessed substantial progress in recent times. A combination of factors, encompassing inherited body chemistry, body weight, gallbladder motility, and potentially diet, might be responsible for the development of gallstones.

• Cholesterol Gallstones: These form when the bile has an excessive cholesterol concentration and an inadequate amount of bile salts. In addition to high cholesterol levels, two factors contribute to their formation:
• Gallbladder contraction frequency and efficiency: Infrequent and incomplete emptying can cause bile overconcentration, promoting gallstone formation.
• Presence of specific proteins in liver and bile that either encourage or prevent cholesterol from crystallizing into gallstones.
• Increased estrogen levels due to pregnancy, hormone therapy, or the usage of birth control pills can elevate cholesterol levels in bile and reduce gallbladder movement, thereby leading to gallstones.

The relationship between diet and gallstone formation remains unclear. However, diets rich in cholesterol, low in fiber, and high in starchy foods might elevate the risk.

Weight, Diet, and Gallstones

• Weight and Gallstones: Being overweight or obese can heighten the risk of gallstones, particularly in females. Obesity might induce high cholesterol production, leading to bile that is overly saturated with cholesterol, fostering stone formation. An obese individual might also have a larger gallbladder that functions sub-optimally.
• Rapid Weight Loss: Rapid weight loss can exacerbate the risk of gallstones. If silent gallstones are present, symptoms are more likely to manifest. People shedding more than 3 pounds weekly are more susceptible to gallstones than those losing weight at a gradual pace.
• Weight Cycling: Consistently gaining and shedding weight can elevate the risk of gallstones. The intensity of this risk correlates with the amount of weight lost and regained during each cycle. Avoiding "crash diets" and aiming for sustained, gradual weight loss is recommended.

Gallstone Symptoms

The hallmark symptom of gallstones is a gallstone "attack", characterized by intense upper abdominal pain that can persist from half an hour to several hours. This pain might radiate to the back, especially between the shoulder blades, or beneath the right shoulder. Nausea and vomiting are other associated symptoms. Sometimes, pain might localize lower in the abdomen, near the pelvis, though this is rarer.

Gallstone attacks, comparable in intensity to kidneystone attacks, are excruciating. Some opine that gallstone pain can rival or even surpass the severity of childbirth pains. Drinking water might alleviate some of the discomfort by regulating bile in the gallbladder, but this remedy isn't universally effective.

Individuals with asymptomatic gallstones have "silent gallstones", typically not necessitating treatment. However, if a stone lodges in the bile duct, it can inflame the gallbladder, ducts, liver, or pancreas.

Medical and Surgical Interventions

1. Medical Treatments: Oral ursodeoxycholic acid can occasionally dissolve cholesterol gallstones. However, it's expensive and discontinuation might lead to recurrence. Endoscopic retrograde sphincterotomy (ERS) after endoscopic retrograde cholangiopancreatography (ERCP) can relieve common bile duct obstructions caused by gallstones. Online sources suggest lemon juice and olive oil for treatment, but their efficacy is unsubstantiated.
2. Surgical Treatments: Cholecystectomy, the removal of the gallbladder, is 99% effective in preventing gallstone recurrence. Surgery is typically indicated only for symptomatic patients. Post-surgery, 5-40% of patients might develop postcholecystectomy syndrome, presenting as persistent upper abdominal pain.

Prevention

To avoid gallstones, a balanced diet, maintaining a healthy weight, and avoiding rapid weight fluctuations are essential. If experiencing abdominal pain, consulting a healthcare professional is imperative.

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