33 years
Do stones form in gallbladder? If yes, how and what from?!
Aug 7, 2014
In order to fully understand how they form and where they come from, it is important to know more about the gall bladder.
• The gallbladder sits beneath the liver and stores bile (an important digestive “juice” that mainly acts on dietary fat).
• Gallstones are crystallized pieces of bile, which can vary in size (microscopic to > 2.5 cm).
• The most common treatment option is cholecystectomy, or surgical resection of the gall bladder.
The gallbladder is a sac-like structure, about the size and shape of a pear; it lies on the undersurface of the liver in the upper right-hand portion of the abdominal cavity. It is connected to the liver and the intestine by a series of small tubes, or ducts, that look like the branches of a tree, which is why they are called the “biliary tree”. The primary function of the gallbladder is to store bile. Upon food intake, the gallbladder contracts and bile is secreted into the intestine. When digestion of the meal is over, the gallbladder relaxes and once again begins to store bile.
Bile is a brown liquid which contains bile salts, cholesterol, bilirubin and lecithin. About 3 cups of bile are produced by the liver every day. Some substances in bile, including bile salts and lecithin, act like detergents to break up fat so that it can be easily digested. Others, like bilirubin, are waste products. Bilirubin is a dark brown substance which gives a brown color to bile and stool.
Gallstones are pieces of hard solid matter that form in the gallbladder when the components of bile — including cholesterol and bilirubin — precipitate out of solution and form crystals. The majority of gallstones have cholesterol stones. Gallstones vary widely in size, from being as small as a grain of sand or as large as a golf ball, and the gallbladder may harbor up to hundreds of them. If the crystals and stones are too small to see with the naked eye, they form biliary sludge.
The reason why some people develop gallstones and others don’t is not well understood; there are however risk factors that increase the chances of developing gallstones:
• An increased amount of cholesterol or bilirubin in bile
• Poor contraction of the gallbladder muscle with incomplete emptying of the gallbladder
• Obesity
• Sedentary lifestyle
• Female gender
• Age above 40
• Diabetes
• Liver disease
• Family history of gallstones
Pigment (bilirubin) gallstones are found most often in:
• Patients with severe liver disease.
• Patients with some blood disorders such as sickle cell anemia and leukemia.
Cholesterol gallstones are found most often in:
• Women >20 years of age, especially pregnant women, and men >60 years of age.
• Overweight men and women.
• People on “crash diets” who lose a lot of weight quickly.
• Patients who use certain medications including birth control pills and cholesterol lowering agents.
Symptoms may be absent in gallstone disease, the so-called “silent gallstones”, which will most likely to remain silent, and no treatment is recommended.
If symptoms are to be present, severe steady pain in the upper abdomen or right side is the most common presentation. Pain may persist for 15 minutes or last for hours. The pain may radiate to the back, in between the shoulder blades or in the right shoulder. Sometimes patients also have vomiting or sweating. Attacks of gallstone pain may be separated by weeks, months or even years.
The pain results from blockage of the gallbladder duct (cystic duct) by a stone. When the blockage lasts for a long time (greater than several hours), the gallbladder may get inflamed, this is known as acute cholecystitis, where the patient gets fever, prolonged pain and eventually infection of the gallbladder.
More serious complications may result if a gallstone lodges in the main bile duct, because it can lead to a serious bile duct infection. If it goes down through the bile duct, it can cause an inflammation of the pancreas, which has a common drainage channel with the bile duct. Either of these situations can be very serious medically. Stones in the bile duct usually cause pain, fever and jaundice (yellow discoloration of the eyes and skin) sometimes accompanied by itching.
When gallstones are suspected, routine liver blood tests (liver function tests) are ordered. Imaging may also be necessary:
• Abdominal ultrasound: Most commonly used to determine the presence of gallstones; ~95% effective in diagnosing gallstones; however, it is not very accurate in determining if a stone has passed out of the gallbladder into the bile duct.
• Cholescintigraphy, or HIDA scan: A radioactive tracer is injected into a vein, taken up by the liver and excreted, or eliminated, into the bile. It can help identify how well the gallbladder contracts in addition to giving information about whether stones are present within the cystic or common bile ducts.
• CT scans: May detect gallstones; however, are less accurate than abdominal ultrasound.
The most accurate tests to identify stones in the bile duct include:
• Magnetic resonance imaging (MRI) scans.
• Endoscopic ultrasound or EUS (which utilizes a small ultrasound probe at the tip of an endoscope passed into the stomach).
• Endoscopic retrograde cholangiopancreatography or ERCP (X-ray dye injected into the bile duct through an endoscope passed through the mouth).
When gallstones are not causing symptoms, no treatment is usually needed. Surgical removal of the gallbladder (cholecystectomy), whether laparoscopic (الجراحة التنظيرية) or open surgery is the most widely used therapy when symptoms have arisen from gallstones. Patients generally do well after surgery and have no difficulty with digesting food, even though the gallbladder’s function is to aid digestion.
Alternatives to surgery include:
Endoscopic retrograde cholangiopancreatography (ERCP) can be used to find and remove stones in the bile duct, by widening the bile duct opening and pulling the stones into the intestine.
Medications: Gallbladder stones can sometimes be dissolved by a chemicals (ursodiol or chenodiol), which are taken as tablets. This medicine thins the bile and allows stones to dissolve, but is only effective in the case of small stones composed of cholesterol.
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