Management of Gallstones and Their Complications

**trimurtulu** · 02-14-2009 07:07 PM

Gallstones

Definition

Gallstones are solid deposits of cholesterol or calcium salts that form in your gallbladder or nearby bile ducts. They often cause no symptoms and require no treatment. But some people with gallstones have a gallbladder attack that can cause symptoms, such as nausea and an intense, steady ache in their upper middle or upper right abdomen. In some cases, the pain can be severe and intermittent.

You're at greater risk of developing gallstones if you're older, female or overweight. Rapid weight loss or eating a very low calorie diet also can put you at risk of gallstones.

Complications from gallstones can be serious, and even fatal, if left untreated. Fortunately, treatment for gallstones is usually straightforward, and newer techniques often allow faster recovery time.

Symptoms

You may not know you have gallstones until they're discovered during tests done for other reasons. But sometimes gallstones may cause certain signs and symptoms. Gallstone symptoms include:

• Chronic indigestion. Signs and symptoms of indigestion may include nausea, gas, bloating and sometimes abdominal pain. These signs and symptoms may occur or be made worse after you eat high-fat foods. But even if you have gallstones, they often aren't the cause of your digestive problems. A number of other conditions — including gastroesophageal reflux disease (GERD) and peptic ulcers of the stomach or small intestine (duodenum), or irritable bowel syndrome — also can cause chronic indigestion. For that reason, it's important to discuss your symptoms carefully with your doctor.

• Upper abdominal pain. Sudden, steady and moderate to intense pain in your upper middle or upper right abdomen may signal a gallbladder attack. The pain may occur one to two hours after eating but may also occur at other times — even at night. It can last about 30 minutes to several hours. Gallbladder pain usually starts in your upper middle or upper right abdomen and, on occasion, may shift to your back or right shoulder blade. After the pain subsides, you might have a mild aching or soreness in your upper abdomen that can last for up to a day or so. If you've had one gallbladder attack, the odds are about seven in 10 that you'll have additional attacks.

• Nausea and vomiting. These signs and symptoms may accompany a gallbladder attack.

• Fever. Gallstones sometimes get trapped in the neck of the gallbladder and can cause persistent pain that lasts more than several hours and is accompanied by fever. If you experience this type of persistent pain or you have a fever with the pain, seek medical attention right away.

Symptoms of bile duct obstruction

Sometimes small gallstones escape the gallbladder and enter the duct leading from your liver and gallbladder to your small intestine (common bile duct). They may also occasionally enter the duct leading to your pancreas. In some cases, a stone may block this duct — a condition called pancreatitis, which can be fatal if you don't receive treatment. You'll likely have pain and sometimes fever due to inflammation at or near the site of the blockage.

Other signs and symptoms of bile duct obstruction include:

• Yellowing of your skin and the whites of your eyes (jaundice)
• Clay-colored stools
• Fever

If you experience any of these signs and symptoms, seek medical treatment right away. Keep in mind that sometimes you may have jaundice and changes in the color of your urine or stools without also having much pain or indigestion.

Causes

Gallstones

Your gallbladder is a pear-shaped sac about 3 inches long that's tucked just below your liver on your right side. It serves as a reservoir for bile produced by your liver. Bile is a greenish-brown fluid that helps digest fats. After you eat, your gallbladder contracts and empties bile into your small intestine (duodenum). Gallstones are made up of various components of bile. Most are made up, in part at least, of crystallized cholesterol. These are often yellow in color.

Your liver produces bile — a greenish-brown fluid composed of bile salts, fatty compounds, cholesterol and other chemicals. This fluid is concentrated and stored in your gallbladder you need it to help digest fats in your small intestine.

When you eat, your gallbladder contracts and releases bile through the cystic duct and into the common bile duct. The common bile duct then carries bile to the upper part of your small intestine (duodenum), where it begins to help break down the fat in your food. But if bile within your gallbladder becomes chemically unbalanced, it can form into particles that eventually grow into stones.

Gallstones can be as small as a grain of sand or as large as a golf ball and may be smooth and round or irregular with a number of edges. You can have just one stone or hundreds of them.

Complications

Pancreatitis

Pancreatitis often is caused by gallstones leaving the gallbladder and lodging near the pancreatic duct, obstructing the duct. This can cause digestive juices produced by the pancreas to move into the pancreas tissue itself, causing potentially severe damage.

Gallstones At A Glance

• Gallstones are "stones" that form in the gallbladder or bile ducts.

• The common types of gallstones are cholesterol, black pigment, and brown pigment.

• Cholesterol gallstones occur more frequently among several ethnic groups and are associated with female gender, obesity, pregnancy, oral hormonal therapy, rapid loss of weight, elevated blood triglyceride levels, and Crohn's disease.

• Black pigment gallstones occur when there is increased destruction of red blood cells, and brown pigment gallstones occur when there is slow flow and infection of bile.

• The majority of gallstones do not cause symptoms.

• The most common symptoms of gallstones are biliary colic and cholecystitis. Gallstones do not cause intolerance to fatty foods, belching, abdominal distention, or gas.

• Complications of gallstones include cholangitis, gangrene, jaundice, pancreatitis, sepsis, fistula, and ileus.

• Gallbladder sludge is associated with symptoms and complications of gallstones; however, like gallstones, sludge usually does not cause problems.

• The best single test for diagnosing gallstones is transabdominal ultrasonography. Other tests include endoscopic ultrasonography, magnetic resonance cholangio-pancreatography (MRCP), cholescintigraphy (HIDA scan), endoscopic retrograde cholangio-pancreatography (ERCP), liver and pancreatic blood tests, duodenal drainage, oral cholecystogram (OCG), and intravenous cholangiogram (IVC).

• Gallstones are managed primarily with observation (no treatment) or removal of the gallbladder (cholecystectomy). Less commonly used treatments include sphincterotomy and extraction of gallstones, dissolution with oral medications, and extra-corporeal shock-wave lithotripsy (ESWL). Prevention of cholesterol gallstones also is possible with oral medications.

• Symptoms of gallstones should stop following cholecystectomy. If they do not, it is likely that gallstones were left in the ducts, there is a second problem within the bile ducts, or there is sphincter of Oddi dysfunction.

• Continuing research is directed at uncovering the genes that are responsible for the formation of gallstones.