Gallstones

In medicine, gallstones (choleliths) are crystalline bodies formed within the body by accretion or concretion of normal or abnormal bile components. Dieting may temporarily increase the chances of gallstone formation although this is a less common risk.

Cholesterol stones are usually green, but are sometimes white or yellow in color and account for about 80 percent of gallstones. They are made primarily of cholesterol.

Pigment stones are small, dark stones made of bilirubin and calcium salts that are found in bile. They account for the other 20 percent of gallstones. Risk factors for pigment stones include cirrhosis, biliary tract infections, and hereditary blood cell disorders, such as sickle cell anemia. Stones of mixed origin also occur.

Gallstones can occur anywhere within the biliary tree, including the gallbladder and the common bile duct. Obstruction of the common bile duct is choledocholithiasis; obstruction of the biliary tree can cause jaundice; obstruction of the outlet of the pancreatic exocrine system can cause pancreatitis. Cholelithiasis is the presence of stones in the gallbladder - chole- means "gall bladder", lithia meaning "stone", and -sis means "process".

Gallstones vary in size and may be as small as a grain of sand or as large as a golf ball. The gallbladder may develop a single, often large, stone or many smaller ones, even several thousand.

Gallstones are, oddly, a valuable by-product of meat processing, fetching up to $900 US an ounce in their use as a purported aphrodisiac in the herbal medicine of some cultures. The finest gallstones tend to be sourced from old dairy cows. Much as in the manner of diamond mines, slaughterhouses carefully scrutinise offal department workers for gallstone theft.

Causes
Progress has been made in understanding the process of gallstone formation. Researchers believe that gallstones may be caused by a combination of factors, including inherited body chemistry, body weight, gallbladder motility (movement), and perhaps diet.

Cholesterol gallstones develop when bile contains too much cholesterol and not enough bile salts. Besides a high concentration of cholesterol, two other factors seem to be important in causing gallstones. The first is how often and how well the gallbladder contracts; incomplete and infrequent emptying of the gallbladder may cause the bile to become overconcentrated and contribute to gallstone formation. The second factor is the presence of proteins in the liver and bile that either promote or inhibit cholesterol crystallization into gallstones.

In addition, increased levels of the hormone estrogen as a result of pregnancy, hormone therapy, or the use of birth control pills, may increase cholesterol levels in bile and also decrease gallbladder movement, resulting in gallstone formation.

No clear relationship has been proven between diet and gallstone formation. However, low-fiber, high-cholesterol diets, and diets high in starchy foods have been suggested as contributing to gallstone formation.

Weight loss and gall bladder disease
Being overweight or obese may increase your chances of having stones in gallbladder, especially if you are female. Researchers have found that people who are obese may produce high levels of cholesterol. This may produce bile having more cholesterol than it can dissolve. When this happens, stones in gallbladder can form. People who are obese may also have large gallbladders that do not work well. Some studies have shown that men and women who carry large amounts of fat around their waist may be more likely to develop stones in gallbladder than those who carry fat around their hips and thighs.

Although rapid weight loss may increase your chances of developing stones in gallbladder (see the next section), obesity may be a bigger problem. In addition to stones in gallbladder, obesity is linked to many serious health problems, including diabetes, heart disease, stroke, and certain types of cancer.

For those who are overweight or obese, even a small weight loss of 10 percent of body weight over a period of 6 months can improve health. In addition, weight loss may bring other benefits such as better mood, increased energy, and positive self-image.

Rapid weight loss and stones in gallbladder
losing weight very quickly may increase your chances of forming stones in gallbladder. If you have silent stones in gallbladder, you may also be more likely to develop symptoms. People who lose more than 3 pounds per week may have a greater chance of getting stones in gallbladder than those who lose weight more slowly.

Weight cycling and gallstones
Weight cycling, or losing and regaining weight repeatedly, may also lead to stones in gallbladder. The more weight you lose and regain during a cycle, the greater your chances of developing stones in gallbladder. When trying to lose weight on your own, stay away from "crash diets" that promise to help you drop the pounds quickly. Aim for losing weight at a slower pace and keeping it off over time.

Some ways of treating obesity, such as weight-loss surgery and Very low calorie diets (VLCDs), may increase your chances of developing stones in gallbladder by promoting rapid weight loss.

Weight-loss surgery is an operation on the stomach and/or intestines to help people lose weight by limiting food intake and/or by affecting how food is digested.

A very low-calorie diet is a very restrictive diet that uses a commercially prepared formula providing about 800 calories per day. A health care provider closely supervises these types of diets.

Several factors may increase your chances of having problems with stones in gallbladder after weight-loss surgery or a VLCD. They include: existing stones in gallbladder before your surgery or VLCD, especially if they are causing symptoms


 * a large amount of excess weight before the surgery or VLCD
 * very rapid weight loss after the surgery or VLCD

Your chances of developing stones in gallbladder may vary by type of treatment. Diets or surgeries that cause very rapid weight loss may be more likely to lead to gallstone problems than diets or surgeries that lead to slower weight loss.

If you are starting a Very low calorie diet (VLCD) or having weight-loss surgery, talk to your health care provider about how to reduce your chances of getting stones in gallbladder.

Hoe to reduce to risk of gallstones while losing weight?
losing weight at a slow pace may make it less likely that you will develop stones in gallbladder. Depending on your starting weight, experts recommend losing about 1/2 to 2 pounds per week.

When making healthy food choices to help you lose weight, you can choose food that may also lower your chances of developing stones in gallbladder.


 * Eat more foods high in fiber, like brown rice, oats, and whole wheat bread.
 * Eat fewer refined grains and less sugar.
 * Eat healthy fats, like fish oil and olive oil, to help your gallbladder contract and empty on a regular basis

Symptoms
A main symptom of gallstones is commonly referred to as a gallstone "attack", in which a person will experience intense pain in the upper abdominal region that steadily increases for approximately thirty minutes to several hours. A victim may also encounter pain in the back, ordinarily between the shoulder blades, or pain under the right shoulder. Sometimes, vomiting or nausea occurs. In some cases, the pain actually develops in the lower region of the stomach, nearer to the pelvis, but this is less common.

These attacks are intensely painful, similar to that of a kidneystone attack. It is believed by some that gallstone attacks are as painful as or even surpass the intense pain of childbirth. One way to alleviate this feeling is to drink a full glass of water at the start of an attack to regulate the bile in the gallbladder, but this does not work in all cases.

Silent gallstones
Some people with gallstones are asymptomatic and are called "silent gallstones" and usually do not need to be treated.

In some situations, a gallstone may become stuck in the narrow canal, or duct, that carries bile from the gallbladder to the small intestine. The blockage may cause the gallbladder, ducts, or more rarely, the liver or pancreas to become inflamed.

Serious symptoms that may indicate gallstones

 * abdominal pain that lasts more than 5 hours
 * clay-colored stools
 * fever or chills
 * nausea and vomiting
 * yellowish color of the skin or of the whites of the eyes
 * Signs of gallstones or a gallstone attack include these:
 * severe pain in the upper-right side of the abdomen that starts suddenly and lasts from 30 minutes to many hours
 * pain under the right shoulder or in the right shoulder blade
 * indigestion after eating foods high in fat or protein, including desserts and fried foods
 * Gallstone attacks often take place during the night.

Medical options to treat gallstones
Cholesterol gallstones can sometimes be dissolved by oral ursodeoxycholic acid. This drug is very expensive, however, and the gallstones may recur once the drug is stopped. Obstruction of the common bile duct with gallstones can sometimes be relieved by endoscopic retrograde sphinceterotomy (ERS) following endoscopic retrograde cholangiopancreatography (ERCP).

Extensive information on the web suggests a gallstone sufferer can treat the problem with Lemon Juice and Olive Oil. People who have tried the proceedure painlessly pass what they believe to be the stones. Upon further analysis, however, the gallstones are found to still be in the biliary system. It has been suggested that what the patients actually passed was a soap like product of the lemon juice and olive oil. (The previous paragraph relies on no sources other than "the web.")

Surgical options
Cholecystectomy (gallbladder removal) has a 99% chance of eliminating the recurrence of cholelithiasis. Only symptomatic patients must be indicated to surgery. The lack of a gall bladder does not seem to have any negative consequences in many people. However, there is a significant proportion of the population, between 5-40%, who develop a condition called postcholecystectomy syndrome. Symptoms include gastrointestinal distress and persistent pain in the upper right abdomen.

There are two surgery options: open procedure and laparoscopic: see the cholecystectomy article for more details.
 * Open procedure: This involves a large incision into the abdomen (laparotomy) below the right lower ribs. A week of hospitalization, normal diet a week after release and normal activity a month after release.
 * Laparoscopic: 3-4 small puncture holes for camera and instruments (available since the 1980s). Typically same-day release or one night hospital stay, followed by a week of home rest and pain medication.  Can resume normal diet and light activity a week after release.  (Decreased energy level and minor residual pain for a month or two.) Studies have shown that this procedure is as effective as the more invasive open cholecystectomy, provided the stones are accurately located by cholangiogram prior to the procedure so that they can all be removed.