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What
are gallstones?
Bile is composed of three major components: cholesterol, bile salts,
and bilirubin. When the gallbladder is not functioning properly,
the components of the bile become out of balance leading to the
formation of solid crystals. The majority of stones (80%) are composed
of cholesterol, the remainder are pigmented stones consisting of
bilirubin. Stones can be large or small, single or multiple. These
factors do not necessarily predict the frequency of symptoms or
the severity of the disease. In many cases gallbladder symptoms
are caused by the dysfunctional gallbladder that is forming stones
rather than the stones themselves. The exception to this is when
stones block off the cystic or common bile duct.
What
are the risk factors for gallbladder disease?
- Age:
more common in patients greater than 40
- Obesity
- Rapid
weight loss
- Sex:
more common in women, especially women of childbearing age who
have had children
- Estrogen
intake
- Ethnic
background: Certain ethnic groups have a higher prevalence (Native
Americans, Mexican-Americans)
- Diabetics
have a higher rate
- Lipid
lowering agents
What
are the symptoms of gallbladder disease?
Asymptomatic cholelithiasis
- The large number of patients with gallstones have no symptoms
at all. Stones in these patients are found incidentally during medical
tests for other conditions.
Biliary Colic - For patients who do
have symptoms, gallbladder symptoms can be variable. Classic
gallbladder attacks consist of right upper quadrant abdominal pain
which is pain just under the rib cage on the right side.) The pain
often radiates around the abdomen to the back and is associated
with nausea and sometimes vomiting. The pain is severe and lasts
from 30 minutes to several hours. Often this is followed by less
intense soreness in the area that lasts for a day or so. Attacks
are often instigated by a fatty meal. Gallbladder disease can also
cause chronic nausea.
Cholecystitis - A more serious form
of gallbladder disease, cholecystitis is an infection or inflammation
of the gallbladder often caused by obstruction of the cystic duct.
The symptoms are similar to biliary colic but more prolonged. Patients
can also have fever, chills and an elevated white blood cell count.
Choledocholithiasis (common bile duct
stones) - Stones can drop out of the gallbladder into the common
bile duct. These stones often pass into the intestines without incident.
Sometimes they can cause obstructions in the bile duct leading to
jaundice and life threatening infections of the bile ducts.
Biliary pancreatitis - When stones
pass by the pancreatic duct the pancreas can be irritated leading
to this potentially serious condition. Symptoms usually consist
of mid-abdominal pain radiating to the back with nausea and vomiting.
How
are gallbladder problems diagnosed?
Some tests used to evaluate the above conditions include:
- Lab
tests to check for jaundice and signs of liver inflammation
- Blood
Amylase level to check for pancreatic inflammation
- Ultrasound:
Uses sound waves to image the intra-abdominal organs including
the gallbladder
- CT
scan: Computer constructed x-ray images of the abdominal organs
- Heida
scan: Uses a low level radioactive tracer that is taken up by
the gallbladder to measure gallbladder function.
- MRCP:
A type of MRI scan that visualizes the common bile duct to check
for bile duct obstruction.
- ERCP:
A test where a scope is passed via the mouth into the common bile
duct allowing dye to be injected into the common bile duct. X-ray
pictures are then taken. This test gives the most accurate assessment
of the common bile duct. It also is sometimes required to extract
stones from the common bile duct.
How
are gallbladder problems treated?
In most situations gallbladder problems require
surgical treatment. Since gallstones
are often just a sign of the problem, treatment is directed towards
the gallbladder rather than the gallstones. The treatment involves
removing the gallbladder. This is done in most cases using laparoscopic
surgery. Non-surgical treatments such as dissolution therapy and
lithotripsy have a poor success rate and a high recurrence rate
so are used only in very limited circumstances.
Additional
information
Medical
University of South Carolina - very comprehensive site
Mayo
clinic - comprehensive site, good anatomical diagrams
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