Gallstones – Causes, Symptoms, Treatment And Complications

Gallstones (biliary calculi) are small stones made from cholesterol, bile pigment and calcium salts, usually as a mixture that forms in the gall bladder. The gall bladder is a small sac that holds bile, a digestive juice produced by the liver that is used in the breakdown of dietary fats. The gall bladder extracts water from its store of bile until the liquid becomes highly concentrated. The presence of fatty foods triggers the gall bladder to squeeze its bile concentrate into the small intestine.

Gallstones are a common health problem worldwide. Gallstones can occur anywhere within the biliary tree, including the gallbladder and the common bile duct. Obstruction of the common bile duct is choledocholithiasis; obstruction of the biliary tree can cause jaundice; obstruction of the outlet of the pancreatic exocrine system can cause pancreatitis.

Causes

Weight. A large clinical study showed that being even moderately overweight increases the risk for developing gallstones. The most likely reason is that the amount of bile salts in bile is reduced, resulting in more cholesterol. Increased cholesterol reduces gallbladder emptying. Obesity is a major risk factor for gallstones, especially in women.

Pigment Stones. The cause of pigment stones is uncertain. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anemia in which too much bilirubin is formed.

Rapid weight loss. As the body metabolizes fat during prolonged fasting and rapid weight loss—such as “crash diets”—the liver secretes extra cholesterol into bile, which can cause gallstones. In addition, the gallbladder does not empty properly.

Symptoms of Gallstones

Often, there are no symptoms of gallstones. The gallstones lie quietly within the gall bladder and are usually found by chance. If a gallstone is obstructing the gall bladder, there will be severe pain in the upper right side of the abdomen. The pain will come and go in waves as strong muscular contractions. Strong muscular contractions occur because the body is trying to get rid of the obstruction.

Treatment

Laparoscopic cholecystectomy (keyhole gallbladder removal) - This is the most common treatment. Under general anaesthesia a hollow needle is inserted through or near your navel. This is used to inflate the abdomen with carbon dioxide gas. The laparoscope (a long, thin telescope with a light and camera lens at the tip) is then inserted through a small cut at the same spot. This gives the surgeon a view of your internal organs on a video monitor. To remove the gallbladder, specially adapted surgical instruments are then inserted through some more small incisions.

Complications of Gallstones.

Cholecystitis. Cholecystitis means inflammation of the gallbladder. Like biliary colic, it too is caused by sudden obstruction of the ducts by a gallstone, usually the cystic duct. In fact, cholecystitis may begin with an episode of biliary colic. Obstruction of the cystic duct causes the wall of the gallbladder to begin secreting fluid just as with biliary colic, however, for unclear reasons, inflammation sets in.

Cholangitis. Cholangitis is a condition in which bile in the common, hepatic, and intrahepatic ducts becomes infected. Like cholecystitis, the infection spreads through the ducts from the intestine after the ducts become obstructed by a gallstone. Patients with cholangitis are very sick with a high fever and elevated white blood cell counts.