Gallstones are the stone formed out of bile components, present in the gall bladder.
The condition of presence of gallstones in the gall bladder & the subsequent symptoms manifested by it is called Cholelithiasis.
Composition of Gallstones are:
- Cholesterol Stones
- Bilirubin stones
- Bile pigment stones
- Calcium stones
- Mixed stones
SIGNS & SYMPTOMS OF GALLSTONES
- Gallstones may be asymptomatic, even for years.
- Nausea & vomiting
- Pain in upper right side of the abdomen & belly.
- Acidity & heartburn
- A patient may also experience referred pain between the shoulder blades or below the right shoulder.
- Biliary Colic or a gallbladder attack which can last for 30 minutes that manifests sharp pain & vomiting.
- Cholecystitis, inflammation of the gall bladder.
- Pancreatitis, inflammation of the pancreas.
- Cholangitis, inflammation of the bile duct.
- Secondary infection by bacteria.
- Dark urine
- Pale stool
- Gall bladder cancer.
CAUSES FOR GALLSTONES
- The symptoms are presented due to the blocking of the common biliary duct by gallstones.
- Lack or decreased production of melatonin which is considered a potent antioxidant.
- Genetic factors
- Age: people near or above the age of 40
- Females before menopause.
- Low fluid consumption
- High intake of carbohydrates & sugars.
- Diet that is low in folate, Magnesium, calcium & Vitamin C.
- Rapid weight loss
- Obesity & a high cholesterol diet.
- Increased levels of estrogen in pregnancy.
- Some drugs that are a risk factor are; PPIs, Hormonal drugs for replacement therapy, fibrates, etc.
- Some diseases that can increase the risk of Gallstones are;
- Celiac Disease
- Hemolytic anemia.
- Biliary tract infection
- Liver cirrhosis or damage that can lead to increased secretion of bile products that lead to the formation of gallstones.
- Intestinal diseases like Crohn’s Disease.
- Blood tests for checking of high levels of serum bilirubin.
- Endoscopic retrograde cholangiopancreatography (ERCP) for checking of presence of gallstones in the bile ducts.
- Magnetic resonance cholangiopancreatography (MRCP), utilizes MRI for imaging of the gallbladders & affected ducts.
- Cholescintigraphy (HIDA scan), in which a radiographic dye is injected in the gallbladder, in order to check for the proper draining action of the gallbladder.
- Endoscopic Ultrasound
- Oral cholecystography
- CT scanning
- Liver function test for checking of the presence of enzymes, ALT & AST which are indicative of a liver disease.
- Lipase enzyme test is also essential for determination of any damage to the pancreas.
TREATMENT OF GALLSTONES
- Cholesterol gallstones can sometimes be dissolved by oral ursodeoxycholic acid or chenodeoxycholic acid, which is to be taken for 2 years.
- Pain management by NSAID drugs & opioid analgesic drugs.
- Management of bile duct infection by antibiotics.
- Gallstones can be broken up using a procedure called extracorporeal shock wave lithotripsy(often simply called “lithotripsy”).
- Obstruction of common bile duct is relieved by endoscopic retrograde sphincterotomy (ERS) following endoscopic retrograde cholangiopancreatography (ERCP).
- Surgical cholecystectomy which is the surgical removal of gallbladder. The surgery is of two types;
a) Open cholecystectomy
b) Laparoscopic cholecystectomy.
PREVENTION & MANAGEMENT
- Eating a healthy diet.
- Low fat & cholesterol diet.
- Low carbohhydrate & sugar diet.
- Intake of essential vitamins & minerals like VIT-C, Magnesium, folate, etc.
- Decreasing consumption of alcohol.
- Staying hydrated.
- Eating high fiber foods.
- Management of underlying comorbidities.