gallstones

summary of gallstones

A bilious person is usually that person who is irritable and in a bad mood. However, bile has nothing to do with mood. It is a liquid produced by the gallbladder, an important organ in the digestive process. The gallbladder does not produce bile. The latter is produced by the liver. The role of the gallbladder (small body, with a volume of 50 ml to 70 ml) is to store bile and secrete it into the small intestine through the cholecystokinin hormone signal. This hormone is released when the food bolus enters the intestine. Thus, it is during digestion that the secretion of bile takes place, about a liter per day.

The two main functions of bile are, on the one hand, to emulsify food fat, to improve digestion and absorption. On the other hand, this allows the elimination of waste products excreted by the human body, the liver. These unwanted products are eliminated in the stool. This is the case with bilirubin, a breakdown product of red blood cells.

Bile gallstones are essentially bile salts, cholesterol and lecithin. Sometimes pigments can cause the stones, but most of these stones are made of cholesterol. The presence of these stones usually goes unnoticed and is often accidentally discovered during a medical examination.
To treat gallstones, the doctor can use ultrasound, medication and surgery, if finally the first treatments are ineffective.

The pain caused when gallstones are present is called a “bilious attack”. The liver is not involved in this process, because it affects the gallbladder and bile ducts.

Definition

There are several types of calculations, also called stones. Such stones can form in the kidneys, salivary glands, and gallbladder. They then form small stones in the same organ (the gallbladder is an organ that stores and secretes bile) or in the excretory ducts (biliary tract, in the specific case of gallstones). Through the bile pass the cystic duct (outside the gallbladder), and the bile duct (channel that extends from the liver to the duodenum).

Gallstones are usually composed of cholesterol crystals (in 90% of cases), sometimes calcium salts or bile pigments. Precipitation of cholesterol crystals occurs when the liver is oversaturated with cholesterol.

This condition is more common than people realize. Gallstones can form in 10% of the population, mostly in people aged 55 to 65. However, it is symptomatic in only 20% of patients.

Thus, gallstones are mostly asymptomatic and are often discovered “by chance”, during a medical examination, for example.

Epidemiology

A study published in 2016 in the Journal of the American Geriatrics Society   showed that the incidence of gallstones increases with age, significantly after the age of 70. This study carried out by the University of Taiwan in Taiwan showed that the elderly had in some cases of gallstones the asymptomatic form, that is, without symptoms.

Causes

Gallstones are mainly caused due to precipitation of cholesterol in the gallbladder or bile ducts. This occurs when the liver produces bile that is supersaturated with cholesterol. Cholesterol is not soluble in bile and forms crystals.

There are several causes for the concentration of cholesterol in the bile. Causes include diet, obesity, alcohol, stress, certain medications.

Food

High-calorie diets and excess fat lead to a high concentration of cholesterol in the blood. Food can trigger this type of crisis.

Obesity

Obesity or being overweight is the source of many metabolic diseases. Reducing your weight prevents many diseases and helps in reducing the frequency of occurrence of gallstones. The body works better.

Alcohol

Too much alcohol can damage the liver causing cirrhosis. A poorly functioning liver overloads the bile and causes gallstones.

Medicines

Drugs that can result in the formation of gallstones include estrogens, oral contraceptives, or lipid-lowering drugs (used to treat high cholesterol) such as fibrates.

Gallstones risk groups

Gallstones are a condition that affects around 10% of the adult population in Europe. This is a common condition, mostly affecting the 50-60 year old age group. By age 80, it appears that 60% of people are affected.

It seems that women are affected more than men. Periods of cramps that precede menses are the most common.

Genetic predisposition can promote the development of gallstones. In fact, Native Americans and Hispanics are the populations with the highest incidence of gallstones.

So people can suffer from gallstones and biliary colic are therefore:

– People between 50-60 years old. The risk increases with age (60% of the population over 80 years).

– Women.

– People who consume alcohol in excess.

– The obese or overweight people .

Symptoms

Gallstones are not usually painful and therefore often go unnoticed. However, their migration to the biliary tract can be accompanied by characteristic and very strong symptoms that can last for several hours. Attacks most often occur at night after high-fat meals. Symptoms usually start in the upper abdomen. The pain intensifies and can radiate to the right arm, shoulder and scapula.

Thus, the characteristic symptoms are:

– Cramps. High-intensity pains that appear quickly in the upper right or center abdomen.

– Violent pain beyond the abdomen (see above), the pain can take the form of an ache in the back, in particular between the shoulder blades and the right shoulder.

– Nausea.

– Vomiting.

Other gastrointestinal symptoms may appear, such as:

– Digestive disorders, loss of appetite.

– To lose weight.

– Headache .

– Fatigue .

During violent attacks, the patient may have pale hands and sweat profusely.

Unfortunately, these symptoms are not typical of “liver crisis” caused by the presence of gallstones or their migration into the biliary tract. Therefore, it is important to exclude other diseases to correctly diagnose gallstones, such as hepatitis , appendicitis , renal colic, pancreatitis, intestinal obstruction, ulcer, stomach peritonitis or myocardial infarction.

When the bile duct is blocked by gallstones, jaundice can occur. The characteristic symptoms of jaundice are: pale eyes and yellow skin.

Stone size
These gallstones or bile clots can be the size of grains of sand or a golf ball.

Duration of symptoms
Symptoms can last from a few minutes to hours.

Diagnosis

The diagnosis of gallstones is complicated by the fact that the presence of gallstones is usually asymptomatic and may go unnoticed. This takes the name of latent stones. Without pain and other gastrointestinal symptoms, we don’t think to go to the doctor. Sometimes, however, when stones migrate to the biliary tract, they cause severe pain and digestive disorders. Diagnosis is made when an emergency. The doctor performs an ultrasound scan. It is also possible to order magnetic resonance imaging. Additional tests may be needed, such as a functional liver test or an X-ray.

ultrasound

Ultrasound allows you to see:

– Stones in the gallbladder.

– Thickening of the gallbladder wall, which may reveal acute inflammation (cholecystitis).

– bile duct dilation

– Obstacles, like a tumor, for example.

In addition, ultrasound also generates images of the liver and pancreas that can complete the diagnosis (in the case of a pancreas tumor , for example)

Magnetic

cholangiography Magnetic cholangiography is used to diagnose gallstones contained in the gallbladder. This technique gives less information about the status of the gallbladder wall, but it does provide good information about gallstones and the morphology of the biliary tract.

Complications

The most frequent complications of gallstones are cholecystitis, cholelithiasis and acute cholangitis.

cholecystitis

We can distinguish cholecystitis from acute cholecystitis. Cholecystitis is inflammation of the gallbladder. It is characterized by the occurrence of abdominal pain and fever. While acute cholecystitis is an infection of the gallbladder and its contents. The stones clog the channel and impede bile flow. This causes an infection of the bile and then the gallbladder. Sometimes the channel can be blocked by a tumor, although this is less common.

Other cases of acute cholecystitis without stones can be due to a bacterial infection or shock states, but they usually occur in people who suffer from diabetes or who are immunocompromised.

cholelithiasis

The common bile duct is the channel that connects the intestine to the gallbladder. This channel can be blocked by a gallstone and then cause gallstones. This blocks the flow of bile and causes jaundice.

Acute cholangitis

Following a cholelithiasis, it is possible for the infection called acute cholangitis to occur. The bacteria responsible for acute cholangitis are mainly E. Coli, enterococci, or Klebsiella. However, in 10% of cases of acute cholangitis, the disease may be due to a malformation of the bile ducts, a tumor present in the bile duct or a tumor of the pancreas.

Treatments

The pain crises are due to the presence of gallstones, that’s why analgesics and spasmolytics are administered.

For the treatment of gallstones, there are several possible strategies, such as dissolving the hair crystals with drugs, using ultrasound to break up stones, or surgery to remove stones or remove the gallbladder.

Medicines against gallstones

Drugs used in gallstones are used to dissolve the stones made up of cholesterol.

We cannot use drugs if the crystals are made of bile pigments. This treatment is usually long, with a low success rate, and frequent recurrences.

It is important to use medication even when the symptoms are not pronounced (presence of little or no severe pain from gallstones and non-calcified gallbladder that is still functional). Medications should be taken for 6 to 18 months for dissolving gallstones.

The drugs used are Ursodeoxycholic acid and Chenodeoxycholic acid.

ultrasound

The purpose of ultrasound is to break up gallstones. Smaller fragments can more easily migrate along the biliary tract and reach the intestine for elimination. Ultrasound is applied outside the body.

The success rate of ultrasound against gallstones remains low. Even if gallstones are broken into smaller pieces, they can still cause pain during their migration or result in cramping.

Surgery

Surgical treatment is considered when complications are serious. One may choose to have the gallbladder removed, called a cholecystectomy operation.

Complications in it are frequent painful colic and acute cholecystitis.
As the gallbladder is not vital for the body, a cholecystectomy does not lead to particular problems. After a cholecystectomy, bile flows directly from the liver into the small intestine.

Herbal medicine

– The fumigant can be used as an adjuvant treatment in the case of gallstones.

– Drinking infusions of pine buds can help in cases of gallstones. To do this, you need to infuse 20 g of pine buds in 1 liter of boiling water for 10 minutes. This tea can be consumed during the day.

– The coffee . Drinking 3 cups of coffee a day was associated with a lower risk of gallstones, according to a large study ( umbrella review ) published November 22, 2017 in the British journal The BMJ   (DOI: 10.1136/ bmj.j5024). This study also showed that drinking 3 or 4 cups of coffee a day reduced the risk of overall mortality and heart disease.

Tips

– When treating gallstones, you must first relax and not overeat. The supine position (belly up) promotes better and less painful recovery. Its main objective is to reduce pain and spasms with the help of analgesics and antispasmodics.

– Try to understand that you will need medication prescribed by your doctor to dissolve gallstones.

– If fever occurs during liver attacks, a doctor must be called urgently, in order to exclude the possibility of infection and appropriate treatment as soon as possible.

– Once the crises have passed, you should consider reducing your weight if you suffer from obesity, as well as diet control. Remember that a high-fat diet promotes the appearance of liver pain in the liver.

– Note that cholecystectomy does not result in complications. Digestion can be carried out normally. The bile produced by the liver, instead of being stored and released by the gallbladder (now removed), is just continuously released into the duodenum. Thus, bile can always, by its enzymatic activity, facilitate the digestion of dietary fats, as well as some wastes excreted from the body by the liver.

Prevention

– To reduce cholesterol levels it is important to reduce weight if you suffer from obesity. Therefore, avoid sedentary lifestyle. Remember that to maintain good health, we must practice about 30 minutes of physical activity a day. Twice a week, it is recommended to practice sports for 1:30h. It is essential to train properly, not straining the body, but focusing on the exercise rather than a strenuous workout done a few times.

– Remember that sufficient amounts of water are essential for both diet and physical activity. Drink about 2 liters a day.

– Also avoid fatty foods, as well as all foods that contribute to the appearance of flatulence, such as cabbage and broccoli. Rather than having heavy meals, eat light foods more frequently.

– Avoid chronically excessive alcohol consumption – alcohol poses a risk factor for the formation of gallstones.

– Fasting or skipping meals can also increase the risk of gallstones.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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