Medical Term: GALLSTONES (Cholelithiasis)

Common Name: Gallstones

Description: Gallstones are a  collection of one or more stones in the
gallbladder, which is the hollow organ under the liver, that
stores bile. When the gallstones are in the gallbladder, the
condition is called cholelithiasis; when they are in the bile
ducts the condition is called choledocolithiasis.

 Most gallstones in North America are composed primarily

of cholesterol (75%). 25% of gallstones are composed of
pigment (60% in Japan). 

Affects both sexes  but twice as common in females. It is

also more common in certain groups of people, such as
Native Americans and Hispanics.. It can occur at any age,
but incidence increases with age and peaks at age 65.Rarely
occurs in children under ten. 

Most gallstones form in the gallbladder. Most gallstones in

the bile ducts travel there from the gallbladder. Stones may
form in the bile duct when bile backs up because a duct has
narrowed or after the gallbladder has been removed. 

 
Causes:  Definite cause unknown. Possible causes are as follows:
Alterations in bile composition, such as increased
concentration of cholesterol or decrease in concentration of
phopholipids or bile acids;  Failure of gallbladder to empty
adequately;  Infection; Hemolytic disorders such as sickle
cell anemia.

 
Prevention: Avoid risk factors where possible.

 Use of ursodiol (drug that dissolves gallstones)  with rapid 

weight loss prevents stone formation.
Signs & Symptoms
Mostly asymptomatic. Inthe  United States, 20% of people over
age 65  have gallstones but most have no symptoms. 5-10%
become symptomatic each year. Over lifetime, less than half
of the patients with gallstones develop symptoms.
Episodic pain (Is a transitory exacerbation of pain that changes with time)
in the upper right abdomen or between the shoulder blades.
Intolerance for fatty foods (indigestion, pain, bloating and belching).
 Nausea and vomiting.
Bloating or belching (a distended (inflated) stomach caused by swallowed
air.)
Jaundice- sometimes.

Risk Factors
Family history of gallstones.
Genetic factors. Some ethnic groups are more susceptible, such as Native
Americans and Hispanics.
Obesity.
Excess alcohol consumption
Oral contraceptives.
High fat, low fiber diet.
Rapid weight loss.
Women who have had many children.(multiparity)
Hemolytic disorders such as sickle cell anemia, hereditary spherocytosis. 
Liver cirrhosis.
Diabetes.
Female gender.
Inflammatory bowel disease such as crohns.

Diagnosis & Treatment

Diagnostic tests may include laboratory studies such as blood count and
blood chemistry, CT scan, ultrasound, cholecystography, and X-rays of the
gallbladder. Ultrasound scanning is the best method for diagnosing
gallstones in the gallbladder.
General Measures:
Treatment steps vary depending on severity of symptoms. Most people
who have "silent" gallstones do not require any treatment.Gallstones that
cause no symptoms can safely be left alone. They are unlikely to cause
problems. They do no need surgery.
People with intermittent pain can try  a low fat diet. Doing so may help
prevent or reduce the number of pain episodes.
 If you know you have gallstones and experience pain in the upper right
abdomen, apply heat to the area. If pain worsens or continues more than
3 hours, seek medical help.    Hospitalization may be required for patients
with pain lasting more than 6 hours. 
If gallstones in the gallbladder cause recurring bouts of pain  in spite of
dietary changes than surgery to remove the gallbladder 
(cholecystectomy)  is indicated. Surgery to remove the gallbladder and
stones in the bile duct may be needed for patients with severe symptoms.

 Laparoscopic cholecystectomy is usually the preferred procedure.

Laproscopic surgery was first introduced in 1990. About 90% of
 cholecystectomies are performed laproscopically. In laproscopic surgery,
the gallbladder is removed through tubes  that are inserted through small
incisions in the abdominal wall. The whole procedure is performed with
the help of a camera (laproscope) , also placed in the abdomen through
the small incisions. Laproscopic surgery has markedly reduced post-
operative discomfort, shortened hospital stay, and reduced time of work.
Shockwave (lithotripsy) treatment to break up (shatter) the stones may be
recommended in some cases.

Medications:
For minor discomfort, you may use non-prescription drugs such as
acetaminophen.
Oral medication to try to dissolve stones. This treatment is used for certain
types of stones and can take up to two years.

Activity:
No restriction, except to rest during attacks of gallbladder
colic.
Diet:
During an attack, sip water occasionally, but don't eat.
At other times, eat low-fat diet. Fatty meals may bring on mild attacks.
If you are overweight, begin a weight reduction program.

Possible Complications :
Infection or rupture of the gallbladder.
Common bile duct stone with obstructive jaundice.
Gall bladder cancer.
Small bowel obstruction and paralysis due to gallstone causing
obstruction.

Prognosis
Most people with gallstones have no symptoms. For those who do, the
disorder is curable with surgery.

 About 10 to 15% of people with gall bladder stones will have associated
choledocolithiasis  (stones in the bile duct). Also, after cholecystectomy,
stones may recur in the bile duct.