Also known as Cholelithiasis, gallstones are solid masses are formed in the gallbladder or in the passages that lead to it. They can cause excruciating pain in the upper right abdomen which radiates to the right shoulder due to blocked bile flow.
Initially this disease was prevalent only in individuals but in the last few years, pediatricians have also observed it in children and have recorded an increase in no hemolytic cases in the last 20 years. The ratio is 1.3 children per 1000 individuals. In America alone, more than 25 million individuals report of this disorder with almost 500000-700000 cholecystectomies per year.
This is a common digestive disorder worldwide, each year the total cost of gallstones is approximately $ 5,000,000,000 in the U.S., where 75-80% of gallstones are cholesterol-type, and about 10-25% are black or brown bilirubinate. In the Asian continent, pigmented stones are the most common, although researchers found that cholesterol stones are predominant in the Far East.
There are various causes of this disorder with some case being idiopathic (no known cause). The have a tendency to develop in some people who are suffering from various other underlying disorders such as cirrhosis, hereditary blood disorders (sickle cell anemia) and biliary tract infections.
Some of the other factors include:
- High level of cholesterol and bile results in stone formation
- Infection or foreign body in the bile can also result in stone formation.
- When the muscle tone is poor, the gall bladder does not get completely empty. The bile that is left behind encourages formation of gallstones.
- Estrogen: During pregnancy, there is excessive secretion of estrogen in the blood. This phenomenon also occurs during hormone replacement therapy or due to intake of birth control pills which can increase the level of cholesterol level in bile. This can cause decrease in the gall bladder movement which can lead to gallstone formations.
- High fat diet: It’s been observed that people who consume a high fat diet are more susceptible to gall stone formation.
Certain risk factors increase the chances of having gallstones
- Sex: Women between the age of 20 and 60 have twice the chances of developing gallstones than men.
- Body weight: Overweight population is more prone to gallstones than people who have their weight in check.
- Irregular eating habit: People who are in the habit of losing weight quickly in the form of crash dieting, overtime develop a tendency to gall stones.
- Medications: Studies have shown that people who are taking medications for lowering their cholesterol or take birth control pills are prone to gallstones.
- Age: As people age, they have higher chances of developing gall stones.
- Diabetes: Patients suffering from this disorder have increased level of triglycerides in their circulation. These fatty acids increase the risk of gallstones.
- Fasting: When people go without food for a long time, it decreases their gall bladder movement due to which the level of cholesterol in the bile increases leading to gall stone formation.
- Genetics: Studies have shown that genetics plays and important role in gallstone formation. If a person has a history of gallstones in the family, his chances of encountering this disorder are double.
- Bariatric surgery: People who undergo surgeries to loose weight have higher chances of developing gallstones. In this surgery the size of the stomach in decreased by implanting a medical device in the stomach or by banding (tying the stomach partially). The person looses weigh rapidly which causes mobilization of tissue cholesterols and the concentration of bile increases causing gallstones.
They can also occur along with gallbladder disease in the form of a complication.
- Along with the bile, gall stones can block the exit of bile from the bladder during digestion. They can also block the secretion of digestive enzymes from the pancreas causing incomplete digestion.
- Long duration of blockage can cause aggravation of the condition due to which the organ can become inflamed. This can result in a condition known as cholecystitis. Inflammation of the pancreas is called as pancreatitis.
- When the gall bladder contracts, it can result in increased pressure, swelling along with infection of the gallbladder.
In most cases gallstones are usually asymptomatic with no external signs. These are also referred to as silent stones. More than 60 % to 80 % of gall stones are asymptomatic.
Some of the classic symptoms of gallstones are
- Episodic pain: Normally there is pain in upper part of the abdomen which can radiate to the right shoulder or back. This pain can last from an hour to five hours. It also occurs as a result of contraction of gall bladder post a high fat diet against a stone that maybe blocking the pathway. The intensity of the pain can vary from dull to severe and usually goes away within a few hours after the stone falls back in the bladder.
- Nausea- Post meal, the patient may feel like vomiting and the sensation can last for sometime.
- Vomiting- In few cases, the person may vomit post nausea.
- Diaphoresis- During the pain, the person may experience profuse sweating.
The occurrence of these symptoms differs on patient where. In some cases it can occur in other parts of the stomach and may or may not have the associated symptoms of nausea, vomiting and diaphoresis. The pain goes away of its own accord. It does not decrease post passing stool, flatus or changing positions.
Physical symptoms: The occurrence of these symptoms vary. They become more common on complications that develop along with gall stones.
- Febrile: The patient may present with fever
- Jaundice: In some cases, the person may suffer from jaundice along with increased heart rate (tachycardia) and decreased blood pressure (hypotension).
- Peptic ulcer
- Gastroesophageal reflux disease
- Cardiac chest pain
- Irritable bowel syndrome
When any of these symptoms are observed, the physician needs to examine the case thoroughly to detect any underlying cause and follow it up.
Treatments of cholelithiasis:
In cases where gallstones are asymptomatic, they are detected during checkups relating to other underlying disorders.
- Surgery or cholecystectomy: In gallstones with symptoms and complications, the fastest and the safest way to remove gallstones is through surgery.
- In who are detected gall stones but do not have any external symptoms, it is not advised to go for a surgery. These gall stones are usually gotten rid of using medications.
- Diabetic and pregnant women need close follow up to ensure that they do not develop complications and the symptoms do not aggravate.
- Patients who are already suffering from liver cirrhosis, portal hypertension, sickle cell anemia or have undergone transplants are highly susceptible to complications arising from gall stones (even if they are asymptomatic). In such cases doctors usually advice cholecystectomy.
Following certain diet plans also relieves the symptoms of gall stones.
- Decreased amount of fat: as mentioned above, it has been observed that consumption of high fat diet can cause gall stones. Thus the first thing to do is decrease the intake of diet to just 30g per day especially during treatment.
- Raw diet: Gradually increase the amount of raw diet in the daily meals. It’s important to add a generous amount of fresh fruits and vegetables in the daily diet as they contain soluble fibers and help to detoxify body.
- Dairy products: Dairy products are naturally high in fat content. It’s important to have only fat free and skimmed milk while consuming tea or coffee in any form.
- Protein: Increase the protein intake in the form of poultry, choice cuts, lean pork and meat which are high in protein but low in fat. It’s important to have them grilled or steam rather than fried to further avoid fat.
- Water: It is recommended to increase the amount of water intake. An average person detected with gallstones should have at least 8 liters of water in a day. Water keeps the body dehydrated and it is also a natural detoxifier as it flushes out all the impurities. It also helps to maintain the fluid balance.
- Avoid coffee and tea: Minimize the intake of coffee or tea as they dehydrate the body and also increase the level of toxins in the body.
- Carrots and lemons: It is believed that taking a glass of carrot and lemons juice for dinner on an empty stomach helps to cure gallstones.