What are gallstones?
Liver stones are called Gallsones ...mostly in the Gall bladder and hence the name. Gallstones usually form in the gallbladder; however, they also may form anywhere there is bile; in the intrahepatic, hepatic, common bile, and cystic ducts. Gallstones also may move about within bile, for example, from the gallbladder into the cystic or common duct.
Types of Gall stones and its causes ..
Cholesterol gallstones
1)Cholesterol gallstones
are made primarily of cholesterol. They are the most common type of gallstone, comprising 80% of gallstones in individuals from Europe and the Americas. Cholesterol is one of the substances that liver cells secrete into bile. (Secretion of cholesterol into bile is an important way in which the liver eliminates excess cholesterol from the body.)
In order for bile to carry cholesterol, the cholesterol must be dissolved in the bile. Cholesterol is a fat, however, and bile is an aqueous or watery solution; fats do not dissolve in watery solutions. In order to make the cholesterol dissolve in bile, the liver also secretes two detergents-bile acids and lecithin-into the bile. These detergents, just like dish-washing detergents, dissolve the fatty cholesterol so that it can be carried by bile through the ducts. If the liver secretes too much cholesterol for the amount of bile acids and lecithin it secretes, some of the cholesterol does not dissolve. Similarly, if the liver does not secrete enough bile acids and lecithin, some of the cholesterol also does not dissolve. In either case, the undissolved cholesterol sticks together and forms particles of cholesterol that grow in size and eventually form larger gallstones.
There are two other processes that promote the formation of cholesterol gallstones though neither process is able to cause cholesterol gallstones by itself. The first is abnormally rapid formation and growth of cholesterol particles into gallstones. Thus, with the same concentrations of cholesterol, bile acids and lecithin in their bile, patients with gallstones form particles of cholesterol more rapidly than individuals without gallstones. The second process that promotes the formation and growth of gallstones is reduced contraction and emptying of the gallbladder that allows bile to sit in the gallbladder longer so that there is more time for cholesterol particles to form and grow.
2)Pigment gallstones
Pigment gallstones are the second most common type of gallstone. Although pigment gallstones comprise only 15% of gallstones in individuals from Europe and the Americas, they are more common than cholesterol gallstones in Southeast Asia. There are two types of pigment gallstones 1) black pigment gallstones, and 2) brown pigment gallstones.
Pigment is a waste product formed from hemoglobin, the oxygen-carrying chemical in red blood cells. The hemoglobin from old red blood cells that are being destroyed is changed into a chemical called bilirubin and released into the blood. Bilirubin is removed from the blood by the liver. The liver modifies the bilirubin and secretes the modified bilirubin or into bile.
3)Others:
types of gallstones. Other types of gallstones are rare. Perhaps the most interesting type of gallstone is the gallstone that forms in patients taking the antibiotic, ceftriaxone (Rocephin). Ceftriaxone is unusual in that it is eliminated from the body in bile in high concentrations. It combines with calcium in bile and becomes insoluble. Like cholesterol and pigment, the insoluble ceftriaxone and calcium form particles that grow into gallstones. Fortunately, most of these gallstones disappear once the antibiotic is discontinued; however, they still may cause problems until they disappear. Another rare type of gallstone is formed from calcium carbonate.
Who is at risk for gallstones?
1. Gender. Gallstones form more commonly in women than men.
2. Age. Gallstone prevalence increases with age.
3. Obesity. Obese individuals are more likely to form gallstones than thin individuals.
4. Pregnancy. Women who have been pregnant are more likely to form gallstones than women who have not been pregnant. Pregnancy increases the risk for cholesterol gallstones because during pregnancy, bile contains more cholesterol, and the gallbladder does not contract normally.
5. Birth control pills and hormone therapy The increased levels of hormones caused by either treatment mimics pregnancy.
6. Rapid weight loss. Rapid weight loss by whatever means, very low calorie diets or obesity surgery, causes cholesterol gallstones in up to 50% of individuals. Many of the gallstones will disappear after the weight is lost, but many do not. Moreover, until they are gone, they may cause problems.
7. Crohn's disease. Individuals with Crohn's disease of the terminal ileum are more likely to develop gallstones. Gallstones form because patients with Crohn's disease lack enough bile acids to solubilize the cholesterol in bile. Normally, bile acids that enter the small intestine from the liver and gallbladder are absorbed back into the body in the terminal ileum and are secreted again by the liver into bile. In other words, the bile acids recycle. In Crohn's disease, the terminal ileum is diseased. Bile acids are not absorbed normally, the body becomes depleted of bile acids, and less bile acids are secreted in bile. There are not enough bile acids to keep cholesterol dissolved in bile, and gallstones form.
8. Increased blood triglycerides. Gallstones occur more frequently in individuals with elevated blood triglyceride levels.
What are the symptoms of gallstones?
* dyspepsia (including abdominal bloating and discomfort after eating),
* intolerance to fatty foods,
* belching, and
* flatulence (passing gas or farting).
* Biliary Colic
What is Biliary Colic???
The most common symptom of gallstones is biliary colic. Biliary colic is a very specific type of pain, occurring as the primary or only symptom in 80% of people with gallstones who develop symptoms. Biliary colic occurs when the extrahepatic ducts-cystic, hepatic or common bile-are suddenly blocked by a gallstone. (Slowly-progressing obstruction, as from a tumor, does not cause biliary colic.) Behind the obstruction, fluid accumulates and distends the ducts and gallbladder. In the case of hepatic or common bile duct obstruction, this is due to continued secretion of bile by the liver. In the case of cystic duct obstruction, the wall of the gallbladder secretes fluid into the gallbladder. It is the distention of the ducts or gallbladder that causes biliary colic.
Characteristics of Biliary colic????
* It is a constant pain, it does not come and go, though it may vary in intensity while it is present.
* It lasts for 15 minutes to 4-5 hours. If the pain lasts more than 4-5 hours, it means that a complication - usually cholecystitis - has developed.
* The pain usually is severe, but movement does not make the pain worse. In fact, patients experiencing biliary colic often walk about or writhe (twist the body in different positions) in bed trying to find a comfortable position.
* Biliary colic often is accompanied by nausea.
* Most commonly, biliary colic is felt in the middle of the upper abdomen just below the sternum.
* The second most common location for pain is the right upper abdomen just below the margin of the ribs.
* Occasionally, the pain also may be felt in the back at the lower tip of the scapula on the right side.
* On rare occasions, the pain may be felt beneath the sternum and be mistaken for angina or a heart attack.
* An episode of biliary colic subsides gradually once the gallstone shifts within the duct so that it is no longer obstructing.
What are the complications of gallstones?
1)Cholecystitis - Cholecystitis means inflammation of the gallbladder.
2)Cholangitis - condition in which bile in the common, hepatic, and intrahepatic ducts
becomes infected.
3)Gangrene- condition in which the inflammation of cholecystitis cuts off the supply
of blood to the gallbladder.
4)Jaundice - condition in which bilirubin accumulates in the body.
5)Pancreatitis - inflammation of the pancreas.
6)Sepsis - condition in which bacteria from any source within the body, including the
gallbladder or bile ducts, get into the blood stream and spread throughout
the body.
7) A fistula - an abnormal tract through which fluid can flow between two hollow
organs or between an abscess and a hollow organ or skin.
8) Ileus - condition in which there is an obstruction of flow of digesting food, gas,
and liquid within the intestine.
9)Cancer of the gallbladder almost always is associated with gallstones, but it is not clear which comes first, that is, whether the gallstones precede the cancer and, therefore, could potentially be the cause of the cancer
