In the Human Digestive System, for digesting ‘fat’ in the intestine, liver produces bile. Bile circulates in various directions and pass through various ducts including Gallbladder, which is a small bag-shaped organ just below liver.
Bile treats Cholesterol, Bile Salts and various other waste products. The Excess Cholesterol produced by liver and the dead Red Blood Cells will be dissolved in bile and sent in the blood stream.
When Cholesterol gets accumulated more than the normal limit Cholesterol Gall Stones will get formed by the undissolved cholesterol.
‘Gall Stones’ are solid lumps / stones which get formed in the Gallbladder or Bile Ducts. They are formed when some of the chemicals stored in the Gallbladder harden into a mass.
When the dead Red Blood Cells gets accumulated more than the limit Pigment Gallstones get formed.
Mostly women are affected by gall stones than men. About 35% of Women and about 20% of men above 75 years get Gallstones. Different types Gall Stones are:-
There are two basic types of gall stones:
- Cholesterol Gall Stones
- Pigment Gall Stones
- Black pigment Gall Stones
- Brown pigment Gall Stones
Cholesterol Gall Stones:-
Cholesterol is a type of fat and the human liver produces cholesterol. The excess cholesterol produced by liver will be dissolved in bile. To help bile to dissolve cholesterol liver secrets into the bile, two detergents:-
- Bile acids
- Lecithin
- Abnormal rapid formation and growth of Cholesterol particles into Gall Stones
- Reduced Contraction and Emptying of the Gallbladder allowing bile to remain in the Gallbladder longer when cholesterol particles form into Gall Stones
Pigment is a waste product formed from the blood’s Hemoglobin, the oxygen-carrying chemical in ‘red blood cells’. The hemoglobin from old red blood cells that are being destroyed is changed into a chemical called Bilirubin and released into the blood. Bilirubin is removed from the blood by the liver. The liver modifies the Bilirubin and secretes the modified Bilirubin or into bile.
Black pigment gallstones:
If there is too much Bilirubin in bile, it combines with other constituents in bile, such as Calcium, to form pigment dark brown/black in color. Pigment dissolves poorly in bile and, like cholesterol, it sticks together and forms particles that grow in size and eventually form gallstones. The pigment gallstones that form in this manner are called a black pigment gallstones because they are black and hard.
Brown pigment gallstones:
If there is reduced contraction of the gallbladder or obstruction to the flow of bile through the ducts, bacteria may ascend from the duodenum into the bile ducts and Gallbladder. The bacteria alter the Bilirubin in the ducts and gallbladder, and the altered bilirubin then combines with calcium to form pigment. The pigment then combines with cholesterol and fatty acids from lecithin/ fats in bile to form particles that grow into gallstones. This type of gallstone is called a brown pigment gallstone because it is more brown than black. It also is softer than black pigment gallstones.
Other types of gallstones:-
Other types of gallstones are very rare. Ceftriaxone an antibiotic taken in by the patient is eliminated from the body in bile in high concentrations. It combines with calcium in bile and becomes insoluble. Like cholesterol and pigment, the insoluble Ceftriaxone and calcium form particles that grow into gallstones. Most of these gallstones disappear when consumption of the antibiotic is discontinued. Another rare type of gallstone is formed from Calcium Carbonate.
The Causes and Risk Factors of GallStones:-
There is no relation between Cholesterol in blood and the Cholesterol Gall Stones. Gall Stone formation is not due to the intake of food. The Risk factors of Gall Stones formation are:-
- Race: Gall Stones are common only in some race of people in the world
- Gender: Gall Stones are more common in Women than in Men
- Age: Gall Stones prevalence increases with age
- Obesity
- Pregnancy
- Birth Control Pills
- Rapid Weight Loss
- Increased Triglycerides
In the initial stages there will not be any symptom of Gall Stones. During X-rays and Ultra-sound tests done for some other reasons the presence of Gall Stones will be found in many cases.
Only in the later stages, the symptoms will appear:-
- A chronic pain called Biliary Colic ,which will last for a period of 15 minutes to 4 or 5 hours continuously. The pain may be felt at the middle of the upper abdomen or in the back at the right lower side. The movements of the body like walking will not increase the pain
- Nausea (Vomitting and Giddiness)
If stones are suspected, your doctor will do an ultrasound examination. Ultrasound uses sound waves to create images of the internal organs and pinpoint the location of any stones.
Blood and/or urine tests will be done to check for signs of infection, inflammation, jaundice or problems with the pancreas.
Complications of Gall Stones:-
- Cholecystitis
- Cholangitis
- Gangrene
- Jaundice
- Pancreatitis
- Sepsis
- Fistula
- Ileus
- Gallbladder Cancer
Cholecystitis:
If the Gallbladder gets inflammated the Gall Stones disease becomes complicated, which is called Cholecystitis.
The symptom of this complication will be pain in the right upper abdomen.
Unlike the Biliary Colic the pain will increase by movements of the body like walking.
Cholangitis:
Cholangitis is a condition in which the bile ducts gets infected. Like cholecystitis, the infection spreads through the ducts from the intestine after the ducts become obstructed by a gallstone.
Patients with cholangitis will be very sick with high fever and elevated white blood cell counts. Cholangitis may result in an abscess within the liver or sepsis.
Gangrene:
Gangrene of the Gallbladder is a condition in which the inflammation of cholecystitis cuts off the supply of blood to the gallbladder. Without blood, the tissues forming the wall of the gallbladder will die, and this will make the walls of the bladder very weak. The weakness combined with infection will lead to rupture of the gallbladder. Then the infection will spread throughout the abdomen, though the rupture is confined to a small area around the gallbladder.
Jaundice:
Jaundice is a condition in which bilirubin accumulates in the body. Bilirubin will be brownish-black when it is concentrate and yellow when it is not too concentrated. A build-up of bilirubin in the body will turn the colour of the skin and whites of the eye yellow.
Jaundice occurs when there is prolonged obstruction of the bile ducts. The obstruction may be due to gallstones, but it also may be due to many other causes of obstruction, such as, tumors of the bile ducts or surrounding tissues.
Other causes of Jaundice are a rapid destruction of red blood cells that overwhelms the ability of the liver to remove bilirubin from the blood or a damaged liver which cannot remove bilirubin from the blood.
Pancreatitis:
Pancreatitis is the inflammation of the pancreas.
The two most common causes of pancreatitis are alcoholism and gallstones.
The pancreas surrounds the common bile duct as the duct enters the intestine.
The pancreatic duct that drains the digestive juices from the pancreas joins the common bile duct just before it empties into the intestine.
If a gallstone obstructs the common bile duct just after the pancreatic duct joins it, flow of pancreatic juice from the pancreas is blocked.
This results in inflammation within the pancreas.
Pancreatitis due to gallstones usually is mild, but it may cause serious illness and even death.
Fortunately, severe pancreatitis due to gallstones is rare.
Sepsis:
Sepsis is a condition in which bacteria from any source within the body, including the gallbladder or bile ducts, will get into the blood stream and spread throughout the body. Although the bacteria usually remain within the blood, they also may spread to distant tissues and lead to the formation of abscesses, localized areas of infection with formation of pus. Sepsis is a feared complication of any infection. The signs of sepsis include high fever, high white blood cell count, and, less frequently, rigors/shaking chills or a drop in blood pressure.
Fistula:
A fistula is an abnormal tract through which fluid can flow between two hollow organs or between an abscess and a hollow organ or skin. Gallstones cause fistulas when the hard gallstone erodes through the soft wall of the gallbladder or bile ducts. Most commonly, the gallstone erodes into the small intestine, stomach, or common bile duct. This will leave a tract that allows bile to flow from the gallbladder to the small intestine, stomach, or common duct. If the fistula enters the distal part of the small intestine, the concentrated bile can lead to problems such as diarrhea. Rarely, the gallstone erodes into the abdominal cavity surrounding the abdominal organs. The bile then leaks from the gallbladder or bile duct throughout the abdominal cavity and causes inflammation of the lining of the abdomen.This condition is called ‘bile peritonitis’.
Ileus:
Ileus is a condition in which there is an obstruction of flow of digesting food, gas, and liquid within the intestine. It may be due to a mechanical obstruction, for example, a tumor within the intestine, or a functional obstruction, such as, inflammation of the intestine or surrounding tissues which prevents the muscle of the intestine from working normally and propelling its contents. If a large gallstone erodes through the wall of the gallbladder and into the stomach or small intestine, it will be propelled through the small intestine. The narrowest part of the small intestine is the ilea-cecal valve, which is located where the small intestine joins the ‘colon’. If the gallstone is too large to pass through the valve, it can obstruct the small intestine and cause an ileus.
Cancer:
“Cancer of the Gallbladder” is associated with Gall Stones but it arises in very much less percentage of individuals with Gallstones. Sometimes in patients who have developed Gallbladder Cancer Gall Stones will be formed.
Treatment for Gall Stones:-
Watchful Waiting:
Sometimes Gallstones will be found during medical tests such as Scanning and X-rays for other diseases/conditions. If the Gall Stones found are not causing any symptoms, they can be left untreated . This "wait and see" approach is called expectant management or "watchful waiting".
Surgery for Removing Gall Stones/ Gallbladder:
People can normally live without a Gallbladder, and the most common treatment for complicated Gallstones that are causing problems is Surgical removal of the Gallbladder. This is known as “Cholecystectomy”.
There are two methods of Surgery for Gallbladder Removal:
- Laparoscopic Cholecystectomy/Keyhole Gallbladder Removal
- Open surgery
This is the most common Surgical Treatment for Gallbladder Removal. Under general anesthesia, a hollow needle is inserted through or near the navel. This is used to inflate the abdomen with Carbon-dioxide(CO2) gas.
The laparoscope, a long and thin telescope with a light and camera lens at the tip is then inserted through a small cut at the same spot. This gives the surgeon a view of the internal organs on a video monitor.
To remove the gallbladder, specially adapted surgical instruments are then inserted through three more small incisions. Each one of the incisions will be s only 5mm to 10mm long. The operation will take 60 to 90 minutes time.
After removing the gallbladder, the instruments will be removed and the opened wounds will be with stitches or clips.
Open surgery:-.
Sometimes, keyhole surgery will not be possible and an ‘Open Cholecystectomy’ will be needed which involves the removal of the gallbladder under general anaesthesia through a larger cut in the abdomen.
These operations are generally safe, and for most people the benefits will be more than any potential problems. However, all surgery does carry some risk.
The most common complication in gallbladder surgery is damage to the bile ducts.
Non-surgical treatment options:
In some cases, where general anesthesia cannot be administered to the patient one of the following non-surgical treatments will be done:-
- Dissolution:- In this method medicines will be used to dissolve the gallstones. But this treatment will not suitable for everyone and will be time consuming.
- Shock Wave Lithotripsy: In this method high energy sound wave will be used to break the Gall Stones into tiny particles. Medicines will be used to disslove the broken particles. This method will not be suitable for all types of Gall Stones.
- Endoscopic Retrograde Cholangio-Pancreatography (ERCP):- In this method Gallstones will be removed without removing the Gallbladder. This procedure will be done under sedation and the patient will be awake but relaxed and comfortable during the procedure. A thin, flexible telescope called an endoscope will be inserted into the mouth and down through the digestive system upto and inside the gallbladder. Special instruments will be passed inside the endoscope to help the doctor see the gallstones, and remove them. Sometimes, ERCP is done in addition to surgical removal of the gallbladder.
On a detailed perusal on the causes or the risk factors of getting "Gall Stones", you will understand that if the avoidable risk factors include 'obesity' and 'use of birth control pills'.
Many of the risk factors for gallstones, namely, the race, gender and age are obviously not in our control.
It is also found that vegetarians develop fewer gallstones, compared to non-vegetarians.
However, as the disease appears normally, only for people above 70, you can decide whether you must switch over from non-vegetarian to vegetarian food habit only for avoiding 'Gall Stones'.
You do have some other better reasons, why you should be a 'Vegetarian'. Anyway, it is advisable to add more vegetables, greens and fruits in your food and take moderate quantities of the non-vegetarian food, at any cost, avoiding fat completely.
You must also understand that,'Gall Stones' are entirely different from "Kidney Stones".
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