Cholelithiasis

Cholelithiasis Cholelithiasis is then the medical name given to the deposition of hard and crystalline deposits within the gallbladder, normally referred to as gallstones. In the United States, the condition is relatively common, affecting about 10 percent of adult females and about six percent of adult males in the country. Additionally, cholelithiasis is among the leading cause of surgical operations across the world.

Based on statistical findings, the condition is more prevalent in the western countries. For instance, between 8 and 20 percent of United States nationals are expected to develop this condition by the time they attain 40 years of age. The American Indians and the Mexican Americans are also more likely to develop this condition, as compared to other races, with the ladies being more susceptible as compared to the men by a ratio of 2:1. However, the chances of developing gallstones increase with advancing age, regardless of the race and gender.

What Is Cholelithiasis?
Basically, gallstones are hard, crystalline, pebble-like substances that develop within the gall bladder. Situated just below the liver, the gall bladder stores bile before it is secreted in the intestines to aid in digestion. Bile juice, on the other hand, is a liquid that is synthesized by the liver to aid in digestion of fats within the intestines. Gallstones form as a result of crystallization of bile. The main components of bile juice include cholesterol, fats, water, bile salts, bilirubin and proteins. The bile salts aid in digestion of fats, within the digestive system while bilirubin gives the stool and bile their characteristic color. If bile contains large quantities of bilirubin, bile salts or cholesterol, it is more likely to crystallize and form gallstones.

Currently, there are two main types of gallstones, the pigment stones and the cholesterol stones. The cholesterol stones are rather common, accounting for about 80 percent of all cholelithiasis cases. Cholesterol stones have a characteristic yellow-green color and are a result of hardened cholesterol in the gall bladder. Pigment stones, on the other hand, are dark and small crystalline pebbles that are formed as a result of hardened bilirubin. In general, the size of gallstones varies, ranging from the size of sand grains to the size of a golf ball. As such, cholelithiasis may be a result of a single large gallstone, hundreds of tiny stones or even a combination of large and small stones.

Symptoms of Cholelithiasis
Although the gallstones may be formed in the gallbladder, they may relocate to the bile ducts and cause blockage. This blockage may lead to an array of symptoms, which normally occur suddenly. Owing to the sudden occurrence of the symptoms, they are commonly referred to as gallbladder 'attack'. In most cases, the attack occurs after having a fatty meal and may occur at night. Some of the symptoms associated with the gallbladder ‘attack’ are:

• Back pain, normally between the shoulder blades


• Patients may also experience pain under the right shoulder


• Nausea and vomiting


• Low fever and chills


• Prolonged pain, which may last for more than five hours


• Clay-colored fecal matter


• The whites of the eyes and the skin may turn yellowish in color.


• Steady pain in the upper abdomen, on the right side. The intensity of the pain increases rapidly and lasts for a while, about 30 minutes on average.

While such symptoms may only happen when the gallstones are moving, an extended blockage of the bile ducts may result into a rupture and even infection. In other cases, people suffering from this condition may not experience any symptoms. Such gallstones are referred to as silent stones. Such stones will not interfere with the functioning of the liver, Pancreas">Pancreas or the gall bladder. As such, gallstone treatment is not necessary on silent stones.

Cholelithiasis Treatment
Once you experience the above mentioned symptoms, it is highly advisable that you seek immediate medical attention from a qualified physician. Initially, the health care provider will take blood samples and subject you to various tests to ascertain whether you are suffering from cholelithiasis. In some cases, gallstones will not cause any symptoms. However, if the condition displays symptoms, hospitalization may be required. If you happen to be hospitalized because of this condition, food intake will be stopped. Instead of food, intravenous fluids will be administered. This allows the digestive system to rest and heal. Additionally, you will also be given antibiotics to prevent infection. The physician may also give you medication to ease the abdominal pain associated with this condition. Other cholelithiasis treatment options include surgical and non-surgical intervention.

Surgery
If the cholelithiasis symptoms keep on recurring, surgery is normally the best treatment option. Currently, there are two main surgical methods that may be used to remove the gallbladder, including laparoscopic cholecystectomy and open cholecystectomy. In open cholecystectomy, the entire gallbladder is removed using a single surgical incision. Laparoscopic cholecystectomy, on the other hand, involves the removal of the gallbladder several incisions. After undergoing this surgical removal, many patients lead normal lives because the gall bladder is not very essential in the body. Some of the commonly used laparoscopic cholecystectomy options include:

• Lithotripsy – This is a technique that makes use of electric shock waves and is aimed at dissolving the gallstones.


• Laparoscopic cholecystectomy - This is rather less invasive surgical removal of the gallbladder, which involves the removal of the ladder in multiple small incisions.


• Endoscopic retrograde cholangiopancreatograph – This is not a treatment option, but rather an imaging procedure that enhances gallstone treatment.

In other cases, medications may be used to dissolve the gallstones. This option may take a while to fully dissolve the stones.

Nonsurgical Treatment
In rare cases, patients suffering from gallstones may have serious health conditions that may prevent them from undergoing surgery. In such a case, non surgical treatment options for gallstones are used. However, the gallstones may recur within a period of five years after the following nonsurgical treatment options.

• Contact dissolution therapy – This is an experimental procedure in which methyl tert-butyl ether is injected directly into the gallbladder to help dissolve the stones. This remedy dissolves the stones within one to three days, but may lead to irritation as well as other complications.


• Oral dissolution therapy – In this procedure, drugs that are made from bile acid are used to dissolve the gallstones. Some of the commonly used drugs with this procedure are chenodiol (Chenix) and Ursodiol (Actigall). The drugs are more effective on cholesterol stones and may take a couple of months to fully dissolve the stones.

Cholelithiasis

Cholelithiasis






Gallbladder stones are known as cholelithiasis in medical terms. During the process of digestion several chemical reactions takes place and enzymes are secreted to break down the food particles. Sometime these digestive fluids get hardened to form stones that get accumulated in the gallbladder. Gallbladder is a small organ found on the right upper portion of the stomach just below the liver. It also secretes an enzyme (bile) that helps in digestion and gets discharged into the small intestine.

Gallstones are formed if the bile (digestive enzyme) contains high cholesterol or it contains high content of bilirubin. These stones vary in size and shape. For some people there can be only one stone and for others number of stones can be formed. Choleolithiasis can be effectively treated by removing gallbladder surgically (for severe cases) or by taking medications to destroy gallstones.

Types :

There are 2 common types of cholelithiasis :

If gallstones are formed due to excess of cholesterol in the enzyme bile it is known as cholesterol stone.

If gallstones are formed due to excess of bilirubin (breaking up of RBC causes this waste product) it is known as pigment stone.

Symptoms :

Choleolithiasis do not produce any symptoms most of the time. It causes sudden pain in the abdomen only if the gallstone strikes with a duct causing a blockage. There can be sharp and sudden pain in the upper right portion of the stomach, or in the center of the abdomen beneath the breastbone. It can also cause intense pain in the right shoulder or shoulder blades.

For some people it can cause fever, chills, nausea, vomiting, tenderness in the abdomen, black colored stools and change in skin color (yellowish skin). For serious cases it can cause high fever, intense abdominal pain, bloated sensation and abdominal swelling. In that case emergency medical help is to be taken.

Causes :

The main cause of cholelithiasis is excess of cholesterol formation in the gallbladder. These particles get hard to form stone like substance that gets accumulated in various sizes and shapes. Choleolithiasis is caused when the bile contains excess of bilirubin in the gallbladder. Gallstones are formed due to blood disorders, and biliary tract infections. Sometimes gallbladder may not function properly to eliminate the substances inside. Gradually bile gets piled up and becomes hard to form gallstones.

Who are at risk?

Women are more prone to develop cholelithiasis than males (for reasons unknown). Old age, having high cholesterol in daily diet, fat diet, being obese and belonging to certain ethnic race like American Indian, Mexican American also makes one prone to gallstone formation. Pregnancy also increases the risk of developing gallstones since gallbladder is pushed inside and it may not be able to empty the contents properly. Having a history of cholelithiasis, having diabetes, taking cholesterol reducing drugs for extended period and taking estrogen supplement poses risk for developing choleolithiasis.

Complications :

Gallstones can cause serious complications if the stone gets clogged in the gallbladder neck. Sometimes many stones can block the tubes such that no liquids can flow freely from the gallbladder into the intestine. For some people gallstones can enter into the pancreatic duct blocking its flow causing inflammation of Pancreas which requires urgent medical care. In rare cases gallstones can lead to gallbladder cancer causing life threatening problem.

Diagnosis :

Ultrasound of the abdomen is done to detect the presence of gallstones. It would give exactly the number of gallstones and its position in the gallbladder. Your doctor can also use dye test for checking the bile ducts if any stone is blocking its way. Imaging tests like CT, MRI scanning may also be done for getting a clear picture. In addition he may request for blood test to rule out any infection or Jaundice in the liver.

Treatment :

Gallstones that do not cause any pain or discomfort require no treatment. For people with moderate or severe symptoms of abdominal pain treatment is given based on the intensity of pain and the patient’s age and health condition. Cholecystectomy is done for removing gallbladder if there are many gallstones. During this surgery, the surgeon will remove the entire gallbladder (a small pouch found on the upper part of the stomach) so that the bile would flow directly into the small intestine.

Removal of gallbladder does not cause any serious problem in life since it is not needed for the process of digestion. For mild symptoms the patient will be given oral medications to dissolve gallstones. However only mild symptoms can be managed by this option and the person has to take drugs for years together for getting the stones dissolved.

Prevention :

You cannot do anything to prevent cholelithiasis but you can take precautionary steps to reduce the risk of developing it. If you are obese take steps to reduce your weight. Do not skip breakfast or meals which can actually make conditions worse. Take steps to maintain healthy weight. Do not consume high cholesterol diet.