The gall is a small 'bag' positioned immediately
beneath the liver. It has the role of storing the bile secreted by the liver.
Bile helps digest fat and is eliminated from the system in the small intestine
through channels called bile ducts.
Gallstones are composed of cholesterol and other
constituents found in the bile. At size, they may be smaller than a grain or
larger than a golf ball. The vast majority of these gallstones do not pose
problems but if they block an excretory channel, they need treatment.
Gallstones: Causes
They occur when cholesterol and the constituents
of the bile crystallize, forming hard stones in the bile. Gallstones occur when
there is too much cholesterol in the bile or when the gall function is altered.
The vast majority of physicians believe that
including microscopic calculi may cause the symptoms. These small stones can
lead to the formation of a sediment called 'biliary sludge' which can often be
highlighted in the abdominal ultrasound examination.
Gallstones: Symptoms
The most common symptom of gallstones is pain in
the epigastric area (stomach area) and upper right part of the abdomen, right
under the ribs, medically called medical 'right hippocampus'.
Pain may have the following characteristics:
l Appears suddenly in the upper abdomen and may extend into the upper
right back and shoulder. It is difficult to find a comfortable position as the
pain does not disappear with the attempt to move around.
l Prevents normal and deep breathing
l Lasts from 15 minutes to 24 hours (frequently lasts between 1 and 5
hours)
l Appears at night, being so severe that it can interrupt sleep
l Appears after meals
Pain associated with gallstones may cause
vomiting, which can relieve some pain and abdominal pressure to some extent.
Pain associated with fever, nausea and vomiting or loss of appetite (loss of
appetite) may be a sign of an infection in the gallbladder (acute
cholecystitis).
Symptoms suggestive of obstruction of the common
biliary duct include:
l yellowing of the skin and the white portion of the eye (jaundice)
l darkening of the urine
l light feces
l fever and chills
Gallstones: Diagnostic
There are many other conditions that can cause
similar symptoms, including gastroesophageal reflux, myocardial infarction, and
liver disease.
Digestive infections (gastroenteritis) and food
poisoning can also cause symptoms similar to those produced by gallstones.
Diarrhea and vomiting are associated with food intoxication but pain tends to
be more transitory than constant.
The pain that occurs in these conditions is felt
in the abdomen rather than in one place. Abdominal tremor (rather than
constant) associated with nausea, vomiting and possibly mild fever is more
likely to be due to gastroenteritis or food poisoning than gallstones.
It is more likely that these are the cause of
the pain as the people in the environment experience the same symptoms.
Gallstones: Evolutie
The evolution of gallstones depends on the
presence or not of symptoms.
The vast majority of patients with gallstones
have no symptoms and do not require treatment.
Those who experience symptoms often suffer
surgery to remove the gallstones.
Asymptomatic gallstones
Up to 90% of people with gallstone have no
symptoms. The vast majority of asymptomatic gallstones will never experience
symptoms.
Symptomatic gallstones
The most common problem caused by gallstones is
repeated obstruction by a calculus of the biliary channel, the duct that drains
the gall bladder. This causes periodic pains that occur in the context of
bladder contraction and relaxation. Pain is usually severe and constant,
ranging from 15 minutes to 6 hours, with pain getting worse after eating.
Symptoms give up in a few days.
At first painful access, the best attitude is to
see if the pain goes away without surgery. However, if the pain is severe or if
there have been such a painful history, it may be necessary to surgically
remove the gallbladder.
Depending on the site of obstruction of the bile
duct, the symptoms may include nausea, vomiting, fever, and severe abdominal
pain lasting more than 6 hours.
If these symptoms occur, surgical removal of the
gallbladder and calculus may be necessary.
Rarely, gallstones can cause acute pancreatitis,
an inflammation of the pancreas. Stones can block the flow of digestive enzymes
secreted by the pancreas. Pancreatitis can lead to acute, severe abdominal
pain, loss of appetite, nausea, vomiting, and fever.
Need for surgery
Usually, the first symptoms of gallstones are
not severe. Serious complications (such as obstruction of a canal) occur
rarely, so after consulting with the doctor, it may be decided to postpone
treatment to see if the symptoms go away.
This is all the more important as the doctor is
not sure if the symptoms are caused by gallstones. Although sometimes emergency
surgery is needed, in most cases it seems a safer approach to delaying
treatment until a second painful episode.
If two painful episodes appear, it is likely
that they will happen again in the future. In this situation, surgical
treatment for gallstones removal is usually the best solution.
Individuals experiencing symptoms associated
with gallstones have a higher risk of experiencing painful symptoms in the
future and complications in comparison to asymptomatic patients.
It is impossible to predict the frequency of
painful episodes and their severity. Many of those who decide not to treat
themselves, do not pose further problems.
Approximately 1 out of 3 people with unique painful access do not
show any other painful episodes.
Gallstones: Risk factors
The chances of developing symptomatic gall
bladder are greater for:
l Female patients - women have a 2 times higher risk than men to develop
gallstones
l People older than 55 years old
l Overweight people
l People who have rapidly lost weight - Gallstones occurs in about a
quarter of overweight people following a strict diet and about half of those
who undergo surgical treatment of obesity (gastric bypass). With this surgery,
the size of the stomach is reduced.
l People with higher than regular levels of HDL (good cholesterol) and
triglycerides (types of fat found in blood and food)
l Persons with Crohn's disease
l People with family history of gallstones
l Pregnant women
l People taking estrogen therapy (postmenopausal) or high doses of oral
contraceptives
l Hispanic or Native Americans
l People with sickle cell disease
l People taking certain medicines, such as cholesterol-lowering medicines
l People with liver cirrhosis
l People living a sedentary lifestyle
Gallstones: Treatments
In the conditions in which gallstones do not
cause pain and other symptoms, it is not necessary to institute treatment. Only
1% to 4% of individuals with gallstones develop symptoms each year.
In some situations, doctors can recap the
surgical treatment for asymptomatic calculi.
If gallstones are symptomatic, the decision to
treat should be taken with your doctor.
The best solution can be vigilant expectation to
see if the symptoms go away. It is preferable that the surgical treatment
decision be taken after a second access of gallstones pain.
Ambulatory treatment (at home)
There is no specific treatment for gallstones,
but a medical consultation is required if:
Symptoms that may be caused by gallstones. If
the doctor discovers the presence of calculi in the gall but the symptoms are
mild, it is quite certain that surgical treatment should only be considered
after a second access of pain.
Symptoms of gallstones are repeated, especially
if they are severe or accompany by fever, chills, or yellowing of the skin and
the white part of the eye (jaundice).
Sever episode of abdominal pain or other
abdominal symptoms. Abdominal pain is a common symptom for a wide range of
conditions.
Pharmaceutical treatment
Medicines are rarely used in the treatment of
gallstones. However, people who follow a fast weight loss diet can receive
medications for pain, nausea, and for the prevention of gallstones.
Bile acids that dissolve gallstones are usually
reserved for people in whom surgery is risky or those who refuse surgery.
This therapy is very rare, if ever, being an
option for those who have an inflammation or acute infection of the
gallbladder, for those who have a gallbladder that does not work normally, show
large bile calculi, calcified calculi, or calculus at the level of the bile ducts.
Surgical treatment
Surgical treatment for the removal of
gallbladder is the treatment of choice for gallstones that causes moderate to
severe pain or other symptoms.
Symptoms usually do not recur after bladder
removal. In a small number of cases, surgical treatment is performed to prevent
the occurrence of gallstones complications.
Laparoscopic surgical treatment is often the
best method for removing the gallbladder. Surgery on the open abdomen requires
longer periods of convalescence and is more painful.
Surgical treatment for gallbladder removal
should be followed by:
l Monitoring the appearance of signs of infection. The doctor should be
consulted immediately if the area around the incision is red and swollen or if
fever occurred.
l The doctor should be consulted if skin and white eye irritation,
jaundice, and dark urine occur. These symptoms may indicate the incidence of a
computation in the common bile duct.
Gallstones: Prevention
The appearance of gallstones can be prevented
if:
l Maintain an optimal weight by pursuing a balanced diet and doing regular
physical activity.
l Avoid sudden weight loss. Weight loss (diet, not loss due to illness)
followed by unwanted weight gain may increase the risk of gallstones,
especially for women.
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