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GallstonesIntroduction The gallbladder is a small sac lying on the underside of the liver. The liver produces bile, a greenish-brown liquid, which is stored in the gallbladder. The bile is passed into the small intestine through bile ducts (small tubes) where it helps with digestion (mainly of fats). What are gallstones? Gallstones are hard pieces of stone-like material that are made from cholesterol, calcium carbonate (chalk), calcium bilirubinate (mineral similar to chalk), or a mixture of these. They are normally caused when the chemical balance of your bile has too much cholesterol in it. This causes the bile to form into small particles which may then grow into gallstones. Gallstones are more likely to occur if: your bile contains too much cholesterol if the outlet from your gallbladder is blocked, or infected, or if you have a family history of gallstones. Gallstones can be a variety of shapes. They can be round, oval, or faceted (have a small, smooth, flat surface), and usually occur in the gallbladder, or the bile duct. Most gallstones are usually about the size of a pea but, in some cases, they can be much smaller, like fine gravel. Sometimes, gallstones can form into a single stone so large that it completely fills the gallbladder. Symptoms Less than 20% of people with gallstones have symptoms because they usually stay in the gallbladder and cause no problems. However, sometimes gallstones may lead to your gallbladder becoming inflamed (cholecystitis) which can cause: pain below your ribs on the right hand side, pain in your back and right shoulder, nausea, and vomiting. If gallstones pass down your bile duct into your duodenum, you will experience a painful condition known as biliary colic. The pain is usually felt in the upper part of your abdomen, in the centre, or a little to the right, and often occurs about an hour after a meal that has a particularly high fat content. Gallstones can sometimes cause flu-like symptoms, such as a high temperature and shivering. This can be a sign that gallstones are causing an infection to develop in your gallbladder. Causes It is not fully understood why some people get gallstones and others do not, but they tend to be more common in the following groups of people: overweight women, women who have been pregnant, and people who have recently lost weight. Also, women who are taking an oral contraceptive, or undergoing high-dose oestrogen therapy (sometimes used to treat osteoporosis, breast cancer, and the menopause), have a higher risk of developing gallstones. In more than 80% of cases, gallstones occur when your liver produces bile with a high cholesterol content. An excess of cholesterol in your bile may be due to factors such as: a high cholesterol diet, advancing age, an excess of refined dietary carbohydrates, such as white bread, cakes, and low-fibre cereals, the use of oral contraceptives, a genetic disorder where there is an excessive amount of cholesterol in the blood, such as hypercholesterolaemia, and liver disease that reduces the levels of bile salts. In rarer cases, gallstones occur when there is too much bilirubin in your bile. Bilirubin is a waste product produced when your body breaks down old red blood cells. It is not always clear what produces this extra bilirubin. These sort of gallstones tend to appear in people with the following conditions cirrhosis (a disease of the liver), infections in the bile tube, and sickle cell anaemia (an inherited blood disorder). Diagnosis Gallstones are often discovered by chance during investigations of unrelated conditions. They are commonly detected following blood tests, cholesterol tests, or ultrasound scans (where sound waves are used to produce images of the inside of your body). Occasionally, gallstones are detected following X-rays. Cholangiography If you have gallstones, you may have a procedure, known as a cholangiography, to obtain more information about the gallstones and the condition of your gallbladder. A cholangiography involves using a dye that shows up on X-rays. The dye is either injected into your bloodstream so that it concentrates in your bile ducts, and gallbladder, or it is inserted into your bile ducts using a flexible, fibre optic camera (endoscope). This procedure is called endoscopic retrograde cholangiopancreatolography (ERCP). The main aim of ERCP is to identify gallstones in your bile ducts and gallbladder. Using an endoscope, a fine catheter is passed through your duodenum and into the shared entrance to the bile and pancreatic duct systems. The dye is then injected and images are taken. The X-ray images will reveal any abnormality in your bile or pancreatic systems, such as gallstones , bile duct disorders, pancreatitis (inflammation of the pancreas), or cancer of the head of the pancreas (an organ that helps you digest food ). If your gallbladder and bile systems are working normally, then the dye will be absorbed through all the places that bile is meant to go - your liver, bile ducts, intestines and gallbladder. If the dye does not appear in one or more of these places, it usually signifies that gallstones are causing an obstruction. By studying the X-ray images, the precise location of the gallstones can be identified. Treatment If gallstones are detected, treatment is not always required. Treatment is only needed if gallstones cause inflammation of your gallbladder, block your bile ducts, or move from your bile ducts into your intestines. As gallstones are often made from fatty substances, such as cholesterol, a well-balanced, healthy diet, that is low in saturated fat, is recommended. Surgery (cholecystectomy) Gallstones are normally treated by surgically removing your gall bladder in a procedure known as a cholecystectomy. The procedure uses minimally invasive surgery that is sometimes known as 'keyhole' surgery due to the small size of the incision that is made . However, sometimes it is not possible to remove the gallbladder using keyhole surgery, and about 10% of people need to have an open cholecystectomy, where the gallbladder is removed through a large cut in your abdomen. This type of surgery often requires a longer stay in hospital and approximately a six weeks rest period after the operation. Following the above treatments, urosdeoxycholic acid (the acid found in bile) may be used to stop gallstones reocurring (up to 25% of patients with gallstones may have recurring symptoms one year after treatment). Urosdeoxycholic acid reduces the amount of cholesterol in your bile, lowering the possibility of gallstones reocurring. Ursodeoxycholic acid Gallstones made of cholesterol can sometimes be dissolved using a medication that includes ursodeoxycholic acid. This causes the stones to slowly dissolve. You may need to take ursodeoxycholic acid for up to two years. Lithotripsy Gallstones can be broken up using a procedure called lithotripsy, which is a method of concentrating ultrasonic shock waves onto the stones to break them into tiny pieces. They are then passed safely in your faeces (stools). However, this form of treatment is only suitable when there are a small number of gallstones. Endoscopic retrograde cholangiopancreatolography (ERCP) ERCP is a type of treatment that aims to remove gallstones without removing your gallbladder. The procedure is normally carried out under a local anaesthetic, which means that you will be awake but will not experience any pain. An endoscope (a flexible fibre optic camera) is passed through your mouth, down through your digestive system and into your gallbladder. An electrically heated wire is passed through the endoscope and is then used to widen the opening to your bile duct. The stones are then removed, or left to pass into your intestine. Prevention Many of the factors that increase the risk of developing gallstones are fixed, such as age and gender, and cannot be prevented. However, due to the role cholesterol plays in the formation of gallstones , it is advisable to avoid eating fatty foods with a high cholesterol content. A low fat, high fibre diet is recommended including plenty of fresh fruit and vegetables (five portions a day) and whole grains. Being overweight also increases the amount of cholesterol in your bile, and your chances of developing gallstones. You should therefore control your weight by eating a healthy diet and taking plenty of regular exercise. However, you should avoid low calorie, rapid weight loss diets as there is evidence to suggest that it disrupts your bile chemistry, increasing the chance of gallstones. A more gradual weight loss plan is recommended. For some relief from the pain try massaging the area of the gall bladder (right hand side of the diaphragm) with Lavender and Rosemary essential oils diluted in carrier oil. |
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