GALLSTONES

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GALLSTONES

• (Cholelithiasis)
• JB

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Statistics

• 10-15 of the population in the United States are
  diagnosed with gallstones
• 1 million new cases are diagnosed a year in the
  U.S
• 1 in 5 people who live to be 90 have gallstones
• 90 of gallstones appear with no symptoms
• 80 of gallstones are cholesterol gallstones

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Definition and History

• chemical and mechanical disease
• Hard stone like materials that are smooth or
  sharp
• Vary from the size of a grain of sand to the size
  of a golf ball
• You could have just one gallstone or up to
  hundreds
• They develop in the gall bladder when a liquid in
  the gall bladder called bile hardens into pieces
  which is when components of the bile precipitate
  out of it and form crystals just as sugar does in
  a syrup jar
• Can form if the gallbladder does not empty the
  bile regularly

4
Definition and History Continued

• There are two types of gallstones
• 1) Pigment gallstone
• Small
• Dark
• Made of bilirubin from bile
• 2) Cholesterol gallstones
• Yellow-green colour
• Hardened cholesterol from bile

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Definition and History Continued

• Bile
• watery substance
• Composed of, cholesterol, fats, bilirubin (dark
  brown gives colour too stool), lecithin (breaks
  up fats for easy digestion)
• Brownish in colour
• 3 cups a day are produced by the liver

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Definition and History Continued

• Gallbladder
• digestive organ
• sac like shape, and the size of pear
• located underneath of the liver in the upper
  right hand portion of the abdominal cavity
• connected to the liver and intestine by small
  tubes called ducts
• stores bile for digestion, and can hold 1 cup at
  a time
• after a meal the gallbladder contracts and
  releases the bile being stored into the intestine
  to help digest food

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Causes

• Scientists have yet to fully understand why
  exactly some people get gallstones and others
  dont. There are many factors that contribute to
  the formation on gallstones ranging from dietary,
  hereditary and hormonal.

One single tiny gallstone could create more
gallstones to develop.
Pigment stones more often occur in people with
liver cirrhosis, or hereditary blood disorders
(sickle cell anemia, liver makes too much
bilirubin)
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Causes

• Contributors to gallstones more so cholesterol
  stones include

Factors How do these factors contribute to developing gallstones
Sex (pregnancy, birth control, hormone replacement pills) increasing cholesterol levels in bile which decrease gallbladder movement
Family History genetic link
Over weight moderately overweight decreases the amount of bile salts in bile therefore leaving more cholesterol
Diets Ones that are high in fat and cholesterol and low in fiber create higher levels of cholesterol in bile and decrease gallbladder emptying
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Causes continued...
Rapid Weight loss during crash diets and fasting your body metabolizes fat which creates the liver to produce extra cholesterol for bile and causing irregular emptying of the gallbladder
Age As you age you body emit more cholesterol into your bile
Ethnicity Some races have a genetic tendency to emit higher levels of cholesterol into their bile
Cholesterol-lowing drugs The level of cholesterol increases in bile is drugs are taken to lower the levels in blood
Diabetes There are higher levels of fatty acids (triglycerides) in people with diabetes increases risk of gallstones
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Effects/Symptoms

• Symptoms appear when a large stone is blocking
  the cystic duct (bile duct)
• Symptoms
• most common is pain in the mid to upper right
  abdomen this is called biliary colic
• pain between shoulder blades
• pain under the right shoulder
• jaundice (yellowish skin and eyes)
• dark urine
• light stools (clay colour)
• rapid heartbeat
• abrupt blood pressure drop
• fever or chills
• Nausea, vomiting and sweating
• abdominal indigestion or fullness

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Effects/Symptoms

• Attacks could last 15 minutes to 7 hours and
  occur weeks, months or years apart
• A lot of the times people with gallstones dont
  even know it because no symptoms occur and they
  are found in tests or surgeries for other
  problems. These gallstones are given the nickname
  silent gallstones. A gallbladder attack
  occurs when there is a blocked bile duct. This
  occurs most often after eating a meal high in
  fat.

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Effects/Symptoms

• Effects that gallstones could have
• inflammation or damage to the gallbladder, liver
  or pancreas
• death if a blockage lasts to long
• irritation to the lining of the gallbladder
• infection if the stone becomes stuck in the bile
  duct for a long time bacteria will grow behind it
  eventually causing you to be hospitalized
• gallbladder rupturing
• Some times gallstones could be completely
  harmless if they pass through the crystal and
  bile ducts and then the intestine.
• Symptoms are very similar to those of heart
  attacks, appendicitis, ulcers, irritable bowel
  syndrome, hernia, pancreatitis and hepatitis.

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Diagnosis

• 1) Most of the time gallstones are found when a
  patient goes to get tests for other health
  conditions or problems
• 2) The doctor will press down below the rib cage
  while the patient takes a deep breath so see if a
  sharp pain occurs.
• 3) Blood tests
• - To determine if liver enzymes are backed up
  into the liver
• -signs for infection, obstruction, pancreatitis
  or jaundice
• 4) Ultra sounds will tell the size and location
  of the stones. Sound waves bounce off the
  gallbladder, liver, organs and gallstones the
  echoes are then converted into electrical
  impulses which create a picture of the
  gallbladder on a screen

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Diagnosis

• 5) Gallbladder test- a dye is injected into the
  patients arm, as the dye moves threw your liver,
  bile ducts, gallbladder and intestine x-rays are
  being taken
• 6) Computerized tomography (CT) scan
• -noninvasive x-ray
• -produces cross-section images of body
• -shows gallstones or complications ex) infection
  rupture gallbladder or ducts
• 7) Cholescintigraphy (HIDA) scan
• -injected with small amount of non-harmful
  radioactive material which is absorbed by the
  gallbladder the stimulated to contract

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Treatment

• You can live with out your gallbladder. This
  means that the bile your liver produces flows out
  of the liver and right through to the hepatic
  ducts then to the bile duct and into the small
  intestine with out being stored.
• Surgical
• 1) Laparoscopy
• sedated
• several small incisions are made into abdomen
• a laparoscope and miniature video camera is
  inserted through incisions
• camera sends magnified images to a monitor so
  the surgeon is able to see the tissues and organs
  inside better
• separates gallbladder from liver, bile ducts and
  organs
• cuts cystic duct
• removes gallbladder through small incision

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Treatment

• Recovery
• 1 night at hospital
• normal activity resumed after a few days rest at
  home
• less pain full and less complications then open
  sugary because no incisions are made into the
  abdominal muscle
• Open sugary takes 3 to 5 days of hospital
  recovery as well several weeks at home. Only 5
  of people with gallstones need open surgery.
• Consequences to surgery are that the bile ducts
  could get damaged and leak bile causing
  infections
• If gallstones are located somewhere in the bile
  duct, ERCP is used to help locate them during the
  operation. An ERCP is a endoscope in put down
  your throat threw the stomach and into the small
  intestine which then releases a special dye to
  help the bile ducts appear on the monitor during
  laparoscopy.

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Treatment

• Non-surgical Treatment
• only if medical condition preventing surgery
• only for cholesterol stones
• reappear within 5 years if treated this way
• Oral dissolution therapy
• - dissolve stones with a drug created from bile
  acid.
• -months to years before stones disappear
• -effects diarrhea, raised blood cholesterol
  and liver enzyme transaminase
• Contact dissolution therapy
• -injection of methyl tert-butyl ether into
  gallbladder
• -cholesterol stones
• -1 to 3 days dissolves stones
• -effects irritation, complications reported

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Future outlook/research

• Seven genes have been discovered in humans that
  are more prone to gallstones through animal
  research.
• We are looking for genes that may identify
  susceptibility for humans for gallstones.
• The growing of obesity in out world has
  researchers to believe that this increases the
  rates of gallbladder disease.

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References

• Anil, M. Christine, A.(2004). Gallstones. In The
  Digestive System and Digestive Disorders(125-127).
  New York, NY Facts On File, Inc.
• Bunch, Bryan.(2003). Gallstones. In Diseases
  (Vol.4, pp.22-25) Danbury CT Scientific
  Publishing, INC.
• Gallstones. Retrieved April 13, 2008, from AGA
  Patient Center Medical Information from the
  American Gastroenterological Association Website
  http//www.gastro.org/wmspage.cfm?parm1688
• (2007). Gallstones. Retrieved April 13th, 2008,
  from National Digestive Diseases Information
  Clearinghouse (NDDIC) Website http//www.liu.edu/
  cwis/cwp/library/workshop/citapa.htm
• Harvey, S.(2008). Gallstones and gallbladder
  disease. Retrieved April 13, 2008, from
  University of Maryland Medical Center. Website
  http//www.umm.edu/patiented/atricles
• Lehrer, J. (2007). Gallstones. Retrieved April
  13, 2008, from Medline Plus Website
  http//www.nlm.nih.gov/medlineplus/ency/article/00
  0273.htm
• William, Kane. (2002). Gallstones. In Health
  Matters (vol.8,pp.85-86). Danbury, CT Grolier
  Educational.
• Rhodes, Monica.(2007). Gallstones. Retrieved
  April 13, 2008, from BCHealth Guide Website
  http//www.bchealthguide.org/kbase/topic/major/hw1
  07151/descrio.htm