GALLSTONES
Dr Tariq Jagnarine
Family Medicine, Endocrinology and Diabetes
Gallstones are stones or lumps that develop in the gallbladder or bile duct when certain substances harden. The gallbladder is a small sac located on the right-hand side of the body, on the underside of the liver. Some of the chemicals that exist in the gallbladder can solidify into either one large stone or several small ones.
A study revealed that the prevalence of gallstones in adults in industrialized countries is around 10 percent and appears to be rising.
RISK FACTORS
People at risk include:
* Women who have been pregnant
* Previous family members with a history of gallstones
* People who have recently lost lots of weight
* Intentionally losing weight rapidly and then regaining it may increase men’s risk for gallstones later in life
* Women taking oral contraceptives
* Being sedentary
* Women undergoing high-dose oestrogen therapy
* People whose intake of dietary fat is high
* Twice as many women get gallstones than men
* People over 60 years of age
* People who take cholesterol-lowering drugs called statins
* People with diabetes
Additionally, hormone replacement therapy (HRT) for women during the menopause is linked to a higher risk of gallbladder problems. A study found that HRT administered by skin patches or gels poses a smaller risk than HRT given orally.
CAUSES
Gallstones may form when the chemicals in the gallbladder are out of balance, such as cholesterol, calcium bilirubinate, and calcium carbonate.
There are two main types of gallstones:
* Cholesterol gallstones: These may form if there is too much cholesterol in the bile. They are the main type of gallstones.
* Pigment gallstones: These form when the bile has too much bilirubin. They are more common among people with liver disease, infected bile tubes, or blood disorders, such as sickle-cell anaemia.
Experts are not completely sure why some people develop the chemical imbalance in their gallbladder that causes gallstones, while others do not. However, it is known that gallstones are more common among people with obesity, especially women. In fact, a recent study revealed that a bulging mid tummy almost doubles a woman’s chances of developing gallstones and the need for surgery to remove them.
SYMPTOMS
The majority of people with gallstones experience no symptoms at all. This is because the stones stay in the gallbladder and cause no problems.
* Sometimes, however, gallstones may lead to cholecystitis, or an inflamed gallbladder.
* Symptoms of gallstones may include pain on the right-hand side of the body suddenly and quickly which can worsen with time.
Back pain between the shoulder blades
* Pain in the right shoulder
* Nausea
* Vomiting
* Sweating
* Restlessness
DIAGNOSIS
In many cases, gallstones are discovered by accident when an individual is being treated for a different condition. A doctor may suspect gallstones after a cholesterol test, an ultrasound scan, a blood test, or even an X-ray. Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice including:
* Cholangiography
* CT scan
* Cholescintigraphy (HIDA scan)
TREATMENT
Gallstones are only treated if they have caused gallbladder inflammation, blockage of the bile ducts, or if they have moved from the bile ducts into the intestines.
* Ursodeoxycholic acid- dissolves gallstones made from cholesterol over a 12-month period.
* Surgeries: Cholecystectomy – means the surgical removal of the gallbladder.
* Endoscopic retrograde cholangiopancreatolography- removal of the stones using a camera and tube through the mouth.
* Lithotripsy – shock waves to break up the stones and allow them to better pass out in stool.
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COMPLICATIONS
If gallstones block the bile duct or duodenum, the flow of digestive juices to the pancreas may be blocked. This can cause jaundice and acute pancreatitis. Treatment usually involves the surgical removal of the gallbladder.
It is common for people who have had their gallbladder removed to experience feelings of bloating and indigestion, especially when they have a high-fat meal. Some may pass stools more often than before.
* Biliary colic: When a stone is stuck in the opening of the gallbladder and will not easily pass through, the contraction of the gallbladder may cause severe pain. When this happens, an individual may experience a painful condition called biliary colic. The pain is felt in the upper part of the abdomen, but can also exist in the centre or to the right of the abdomen. Pain is more common about an hour after eating, especially if an individual has had a high-fat meal. The pain will be constant and last a few hours, and then subside. Some people will experience non-stop pain for 24 hours, while others may experience waves of pain.
* Infection: If the gallstones have caused a gallbladder infection, the person with the condition may have a fever and experience shivering. In the majority of gallstone infection cases, people will be hospitalized for the removal of the gallstone.
* Jaundice: If the gallstone leaves the gallbladder and is stuck in the bile duct, it may block the passage of bile into the intestine. The bile will then seep into the bloodstream, causing signs of jaundice. In most cases, this complication will require the surgical removal of the gallstone. For some people, the gallstone eventually passes into the intestine.
* Pancreatitis: If a small gallstone passes through the bile duct and blocks the pancreatic duct, or causes a reflux of liquids and bile into the duct, an individual may develop pancreatitis.
A person can survive without a gallbladder. The liver produces enough bile to digest a normal diet. A small proportion of people who have had their gallbladder removed will experience softer and more frequent stools for a while because their bile flows into the small intestine more often.
PREVENTION
Some factors that increase the risk of developing gallstones, such as age, sex, and ethnic origin, cannot be altered.
* However, it is possible that following a vegetarian diet will reduce the risk of developing gallstones. Vegetarians have a significantly lower risk of developing gallstones, compared with people who eat meat.
* Many experts say that a diet low in fat and high in fruit and vegetables, including plenty of dietary fibre, may help protect people from developing gallstones.
* Controlling body weight may also help prevent the formation of gallstones. However, crash dieting and rapid weight loss increase the risk of developing gallstones.
* Moderation of weight and diet is important.
Diet
It used to be the case that people with gallstones who were not yet ready for surgery would be prescribed an extremely low-fat diet to prevent gallstone growth. This has recently been shown to be less helpful than previously thought, as rapid weight loss can cause gallstones. A balanced diet with regular meals is recommended. This will not cure gallstones, but it can have a positive impact on any symptoms and pain experienced.
Avoiding foods high in saturated fats can help to reduce the risk of gallstones developing, such as butter, hard cheese, cakes, and biscuits. Cholesterol is thought to have a role in forming gallstones. Dietary steps can be taken to help prevent the condition, such as eating more nuts and consuming small amounts of alcohol.
