gall blader stone

7/29/2019 Gall Blader stone

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Gallstones Overview

Gallstones (commonly misspelled gall stones or gall stone) are solid particles that form

from bile in the gallbladder.

The gallbladder is a small saclike organ in the upper right part of the abdomen. Itis located under the liver, just below the front rib cage on the right side.

The gallbladder is part of the biliary system, which includes the liver and thepancreas.

The biliary system, among other functions, produces bile and digestive enzymes.

Bile is a fluid made by the liver to help in the digestion of fats.

It contains several different substances, including cholesterol andbilirubin, a

waste product of normal breakdown of blood cells in the liver.

Bile is stored in the gallbladder until needed.

When we eat a high-fat, high-cholesterol meal, the gallbladder contracts and

injects bile into the small intestine via a small tube called the common bile duct.

The bile then assists in the digestive process.

There are two types of gallstones: 1) cholesterol stones and 2) pigment stones.
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1. Patients with cholesterol stones are more common in the United States;

cholesterol stones make up approximately 80% of all gallstones. They form when

there is too much cholesterol in the bile.

2. Pigment stones form when there is excess bilirubin in the bile.

Gallstones can be any size, from tiny as a grain of sand to large as a golf ball.

Although it is common to have many smaller stones, a single larger stone or any

combination of sizes is possible.

If stones are very small, they may form a sludge or slurry.

Whether gallstones cause symptoms depends partly on their size and their

number, although no combination of number and size can predict whether

symptoms will occur or the severity of the symptoms.

Gallstones within the gallbladder often cause no problems. If there are many or they arelarge, they may cause pain when the gallbladder responds to a fatty meal. They also may

cause problems if they move out of the gallbladder.

If their movement leads to blockage of any of the ducts connecting the

gallbladder, liver, or pancreas with the intestine, serious complications may result.

Blockage of a duct can cause bile or digestive enzymes to be trapped in the duct.

This can cause inflammation and ultimately severe pain, infection, and organ

damage.

If these conditions go untreated, they can even cause death.

Up to 20% of adults in the United States may have gallstones, yet only 1% to 3% developsymptoms.

Hispanics, Native Americans, and Caucasians of Northern European descent are

most likely to be at risk for gallstones. African Americans are at lower risk.

Gallstones are most common among overweight, middle-aged women, but the

elderly and men are more likely to experience more serious complications from

gallstones.

Women who have been pregnant are more likely to develop gallstones. The same

is true for women takingbirth control pills or on hormone/estrogen therapy as this

can mimicpregnancyin terms of hormone levels.

Gallstones Causes
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Gallstones occur when bile forms solid particles (stones) in the gallbladder.

The stones form when the amount of cholesterol or bilirubin in the bile is high.

Other substances in the bile may promote the formation of stones.

Pigment stones form most often in people with liver disease or blood disease, who

have high levels of bilirubin.

Poor muscle tone may keep the gallbladder from emptying completely. The

presence of residual bile may promote the formation of gallstones.

Risk factors for the formation of cholesterol gallstones include the following:

female gender,

being overweight,

losing a lot of weight quickly on a "crash" or starvation diet, or

taking certain medications such as birth control pills orcholesterol lowering

drugs.

Gallstones are the most common cause of gallbladder disease.

As the stones mix with liquid bile, they can block the outflow of bile from the

gallbladder. They can also block the outflow of digestive enzymes from the

pancreas.

If the blockage persists, these organs can become inflamed. Inflammation of the

gallbladder is called cholecystitis. Inflammation of the pancreas is calledpancreatitis.

Contraction of the blocked gallbladder causes increased pressure, swelling, and, at

times, infection of the gallbladder.

When the gallbladder or gallbladder ducts become inflamed or infected as the result of

stones, the pancreas frequently becomes inflamed too.

This inflammation can cause destruction of the pancreas, resulting in severeabdominal pain.

Untreated gallstone disease can become life-threatening, particularly if the

gallbladder becomes infecte
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Gallstone Symptoms

What Are the Symptoms of Gallstones?

As gallstones move into the bile ducts and create blockage, pressure increases in the

gallbladder and one or more symptoms may occur. Symptoms of blocked bile ducts areoften called a gallbladder "attack" because they occur suddenly. Gallbladder attacks often

follow fatty meals, and they may occur during the night. A typical attack can cause

steady pain in the right upper abdomen that increases rapidly and lasts from 30

minutes to several hours

pain in the back between the shoulder blades

pain under the right shoulder

Notify your doctor if you think you have experienced a gallbladder attack. Although

these attacks often pass as gallstones move, your gallbladder can become infected and

rupture if a blockage remains.

People with any of the following symptoms should see a doctor immediately:

prolonged pain - more than 5 hours

nausea and vomiting

fever - even low-grade - or chills

yellowish color of the skin or whites of the eyes

clay-colored stools

Many people with gallstones have no symptoms; these gallstones are called "silent

stones." They do not interfere with gallbladder, liver, or pancreas function and do notneed treatment.

Gallstones and Diet

The role of diet in the formation of gallstones is not clear.

We do know that anything that increases the level of cholesterol in the blood

increases the risk of gallstones.

It is reasonable to assume that a diet with large amounts of cholesterol and other

fats increases the risk of gallstones, but it is also important to remember that theamount of cholesterol in your bile has no relationship to your blood cholesterol.

Loosing weight rapidly seems to increase the risk of gallstones and so doesskipping meals.

Obesity is a risk factor for gallstones.


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Eating a fatty or greasy meal can precipitate the symptoms of gallstones.

Gallstones Symptoms

Most people with gallstones (60% to 80%) have no symptoms. In fact, they are usually

unaware that they have gallstones unless symptoms occur. These "silent gallstones"usually require no treatment.

Symptoms usually occur as complications develop. The most common symptom is pain

in the right upper part of the abdomen. Because the pain comes in episodes, it is often

referred to as an "attack."

Attacks may occur every few days, weeks, or months; they may even be separatedby years.

The pain usually starts within 30 minutes after a fatty or greasy meal.

The pain is usually severe, dull, and constant, and can last from one to five hours.

It may radiate to the right shoulder or back.

It occurs frequently at night and may awaken the person from sleep.

The pain may make the person want to move around to seek relief, but many

patients prefer to lay still and wait for the attack to subside.

Other common symptoms of gallstones include the following:

nausea and vomiting,

fever,

indigestion,belching, bloating,

intolerance for fatty or greasy foods, and

jaundice (yellowing of the skin or the whites of the eyes).

Gallstones Diagnosis

Upon hearing the patient's symptoms, the health care practitioner will probably suspect

gallstones. Because the symptoms of gallbladder disease can resemble those of other

serious conditions, he or she will ask the patient questions and examine them to try toconfirm this diagnosis and rule out other conditions.

There is no blood test that can identify gallstones.
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Blood will be taken for tests that can help to determine if the gallbladder is

obstructed, if the liver or pancreas is inflamed or not functioning properly, or if

the patient has an infection.

If you are a woman, the blood may also be tested to check for a possible

pregnancy,

Urine may be tested to rule out kidney infection. Kidney infections can causeabdominal pain similar to that caused by gallstones.

Ultrasound is the best test to examine the gallbladder for stones.

Ultrasound uses painless sound waves to create images of organs.

Ultrasound examinations are very good at seeing abnormalities in the biliary

system, including stones or signs of inflammation or infection.

This is the same technique used to look at a fetus in a pregnant woman.

Finding gallstones by ultrasound does not diagnose gallbladder disease. The

doctor has to correlate the ultrasound findings with the patient's symptoms.

An alternative to ultrasound is an oral cholecystogram (OCG).

An X-ray is taken of the gallbladder after the patient swallow pills containing a

safe, temporary dye.

The dye helps the gallbladder and gallstones show up better on the X-ray.

Both ultrasound and OCG can detect gallstones in the gallbladder about 95% of the time.

Ultrasound is usually the first choice because it is completely noninvasive and

involves no exposure to radiation.

If either test gives an uncertain result, another test usually is necessary.

These tests are the alternatives to ultrasound and OCG. They are better choices ifgallstones have left the gallbladder and moved into the ducts.

Cholescintigraphy (HIDA scan): This is a test in which a solution is injectedinto an IV line in the patient's arm. The liquid is absorbed by the liver, then

passed on to be stored in the gallbladder (much like bile). The solution contains aharmless radioactive marker, which is seen by a special camera. If the gallbladder

is inflamed or blocked by gallstones, none of the marker is seen in the gallbladder.
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CT scan: This test is similar to an X-ray, however more detailed. It shows the

gallbladder and the biliary ducts and can detect gallstones, blockages, and other

complications.

Endoscopic retrograde cholangiopancreatography (ERCP): A thin, flexible

endoscope is used to view parts of the patient's biliary system. The patient issedated, and the tube is passed through the mouth and stomach and into the small

intestine. The device then injects a temporary dye into the biliary ducts. The dyemakes it easy to see any stones in the ducts when X-rays are taken. Sometimes a

stone can be removed during this procedure.

A chest X-raymay be performed to make sure there are no other reasons for the

abdominal pain.

Sometimes problems in the chest (such aspneumonia ) can cause pain in theupper abdomen.

Occasionally the chest X-ray can also show stones in the gallbladder.

As most gallstones are asymptomatic, many times gallstones are diagnosed when the

patient undergoes a test for another reason.

Gallstones Treatment

Self-Care at Home

After a diagnosis of gallstones, the patient may choose not to have surgery or may not be

able to have surgery right away. There are measures the patient can take to relieve thesymptoms to include:

intake of only clear liquids to give the gallbladder a rest,

avoid fatty or greasy meals, and

take acetaminophen (Tylenol, etc.) for pain.

Call a health care practitioner if symptoms worsen or if new symptoms appear.Abdominal pain with vomiting, fever, or jaundice warrants an immediate visit to a

doctor's office or a hospital emergency department.

Gallstone Medical Treatment

There is no permanent medical cure for gallstones. Although there are medical measures

that can be taken to remove stones or relive symptoms, they are only temporary. If a

patient has symptoms from gallstones, surgical removal of the gallbladder is the besttreatment. Asymptomatic (producing no symptoms) gallstones do not require treatment.
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Extracorporeal shockwave lithotripsy (ESWL): A device that generates shock waves

is used to break gallstones up into tiny pieces.

These tiny pieces can pass through the biliary system without causing blockages.

This is usually done in conjunction with ERCP to remove some stones.

Many people who undergo this treatment suffer attacks of intense pain in the right

upper part of the abdomen after treatment.

The effectiveness of ESWL in treating gallstones has not been fully established.

Dissolving stones: Drugs made from bile acids are used to dissolve the gallstones.

It may take months or even years for the gallstones to all dissolve.

The stones often come back after this treatment.

These drugs work best for cholesterol stones.

They cause mild diarrhea in many people.

This treatment is usually offered only to people who are not able to have surgery.

If an individual goes to an emergency department, an IV line may be started, and pain

medication and antibiotics may be given through the IV.

If the patient's health permits it, the health care practitioner will probably recommend

surgery to remove the gallbladder and the stones. Surgical removal helps prevent futureepisodes of abdominal pain and more dangerous complications such as inflammation of

the pancreas and infection of the gallbladder and liver.

If there is no infection or inflammation of the pancreas, the operation to remove

the gallbladder can be performed immediately or within the next several days.

If there is inflammation of the pancreas or infection of the gallbladder, the patient

will most likely be admitted to the hospital to receive IV fluid and possibly IV

antibiotics for several days prior to the operation.

Gallstone Surgery (Cholecystectomy)

The usual treatment for symptomatic or complicated gallstones is surgical removal of thegallbladder. This is called cholecystectomy.

Many people who have gallbladder disease are understandably concerned about having

their gallbladder removed. They wonder how they can function without a gallbladder.
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Fortunately, you can live without your gallbladder.

Living without a gallbladder does not require a change in diet.

When the gallbladder is gone, bile flows directly from the liver into the small

intestine.

Because there is nowhere to store bile, sometimes bile flows into the intestine

when it is not needed. This does not cause a problem for most people, but causes

mild diarrhea in about 1% of patients.

Laparoscopic removal: Most gallbladders are removed by laparoscopiccholecystectomy. The gallbladder is removed through a small slit in the abdomen using

small tube-like instruments.

The tube-like instruments have a camera and surgical instruments attached, whichare used to take out the gallbladder with the stones inside it.

This procedure causes less pain than open surgery.

It is less likely to cause complications, and has a faster recovery time.

A laparoscopic procedure is preferred if it is appropriate for the patient.

The procedure is performed in an operating room with the patient under general

anesthesia.

It usually takes 20 minutes to one hour.

A general surgeon performs the operation.

In some cases a laparoscopic procedure is started and then changed to an open

abdominal procedure (see below).

Open removal: The gallbladder is sometimes removed through a 3 to 6 inch incision inthe right upper abdomen.

The open procedure usually is used only when laparoscopic surgery is not feasible

for a specific person.

Common reasons for doing an open procedure are infection in the biliary tract andscars from previous surgeries.

About 5% of all gallbladder removals in the United States are done as open

procedures.

This procedure is performed in the operating room with the patient under generalanesthesia.


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It usually takes 45 to 90 minutes.

A general surgeon performs the operation.

Occasionally, ERCP is done just before or during surgery to locate any gallstones that

have left the gallbladder and are located elsewhere in the biliary system. These can beremoved at the same time as surgery, eliminating the risk that they might cause acomplication in the future. ERCP also may be performed after surgery if a gallstone is

later found in the biliary tract. Sometimes ERCP is done without surgery, for example in

people who are too frail or ill to undergo surgery.

Gallstone Outlook

If gallstones block one of the biliary ducts, the result is inflammation and swelling of theorgans "upstream" of the blocked duct.

This complication alone can cause symptoms and warrants treatment, possiblysurgery.

If untreated, it can lead to more serious conditions such as infection and damage

to the gallbladder, liver, and pancreas.

If these organs sustain enough damage, they can no longer carry out their normal

functions. This is a life-threatening complication.

If a patient has surgery, you should know the following:

A person who has had laparoscopic surgery to remove the gallbladder may leave

the hospital 12-48 hours after surgery and return to full activities within three

weeks.

If open surgery was required to remove the gallbladder, recovery takes a little

longer. The person may leave the hospital within three to seven days and couldresume normal activity after a six week recovery period.

The most common complication of surgery is damage to the biliary tract. If bile

leaks out of the biliary system, it can cause an infection.

If a person chooses not to have their gallbladder removed, it is likely you will have

recurring abdominal pain and possibly complications.

gall blader stone

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