Gallstones (Cholelithiasis in medical nomenclature)

Prof JC Sanasam *

Opened gall bladder containing numerous gallstones :: Pix - wikipedia/Emmanuelm

The incidence of Gallstones (Cholelithiasis in medical nomenclature) has become multifold in the last two-three decades in Manipur; of course in the general world population as well. The reason is not far to seek.
Many abdominal disorders suspected earlier to be of other diseases have turned out to be cases of Gallstone; this has enhanced with the oft-used facility of Ultrasonography (popularly known as ultrasound in the milieu). Life-style, heavy fat and meat in the diet also have added considerably in the increased incidence of this disorder.

Gallstones are stones or collection of chemical particles that develop in the gallbladder or bile duct when substances in there harden. Some of the chemicals which exist and tend to form stones in the gall bladder are: cholesterol, calcium bilirubinates, and calcium carbonate. They solidify into either one large stone or into or several small ones.
In a more technical term doctors and those in the Health Care Service centres put this way, A concretion in the gallbladder or bile duct, composed chiefly of a mixture of cholesterol, calcium bilirubinate, and calcium carbonate.

What is the gallbladder?

The gallbladder is a small sac (bag) located on the right side in the abdomen, on the underside of the liver. It is a storing pool-centre for collection of gall (bile), a greenish-brown liquid which the liver produces. This gall liquid goes into the small intestine via the bile duct to facilitate digestion, mainly of fats. Every time we eat some gall is released into the intestines. The bile duct is a narrow tube.

What are gallstones?

Cholesterol, calcium bilirubinate, and calcium carbonate the normally present chemicals in the gall liquid may go out of balance; then the liquid becomes more stagnant and gallstones may form. There are two main types of gallstones:

Cholesterol gallstones – when there is too much of cholesterol in the bile these stones form. They are the commonest of gallstones across the world.
Pigment gall stones – when the bile has too much of bilirubin, shreds of red cells of blood these stones may form. They are more commonly seen among patients who have liver disease, infection of bile ducts, blood disorders.

Symptoms of gallstones

There may be no symptoms in spite of gallstones in the gallbladder. But they sometimes cause cholecystitis (inflammation of the gallbladder) to give symptoms like pain in the right side of the upper abdomen. Just below the ribs, back pain, pain in the right shoulder, nausea (sense of tendency of vomiting, sweating, restlessness.

Biliary colic – sometimes the gallstones may pass down through the bile duct into the duodenum (the first loop like segment of small intestine continuing down from the stomach). When this happens the patient may experience a spasmodic or cramping pain known as the biliay colic in the upper part of the abdomen; at times the pain may be felt in the middle of the abdomen or a little to the right of its middle. This type of pain usually comes about one hour after food especially if the patient has had a high- fat meal. The pain will be constant and will last a few hours, and then it subsides.

Some patients will have 24-hour-non-stop pain which may come in waves.

Infection – the patient with gallbladder infection may have fever, shivering. If there is evidence of infection the patient better be hospitalized and undergo surgical operation for removal of the gallstones.

Jaundice – gallstone suck in the bile duct may obstruct the downward flow of the bile into the intestine. Then the bile may seep into the bloodstream and lead to jaundice, yellow discolouration of the skin and the white of the eyes. If such complications develop the gallstone better be removed too. In some lucky patients the stones may eventually pass into the intestine and become free of all symptoms.

Pancreatitis – if the stones, usually small ones, pass through the duct but block the pancreatic duct, or cause reflux of infected bile in the pancreas, the patient sometimes may develop pancreatitis quite a dangerous situation.

Pre-disposing factors of gallstone formation

Chemical imbalance in the gallbladder usually leads to formation of gallbladder. This condition may be created by:
Overweight/obese people, especially women. A bulging midriff in a woman is a very probable sign. Pregnant women are more vulnerable again.
People who have recently lost lots of weight.
Intentionally losing weight and regaining.
Women taking oral contraceptives.
Women undergoing high-dose estrogen therapy.
People with a close relative who has had gallstones.
Certain genetic factors.
People with high intake of dietary fat.
Females are much more prone to have gallstones than males are.
People above 40 years of age.
People who take statins (a cholesterol-lowering drug).
People with diabetes.
People with hormone replacement therapy.
People with lack of exercise.