gallstone

gallstone

 [gawl´stōn]

a stonelike mass (calculus) in the gallbladder; the presence of gallstones is known medically as cholelithiasis. The cause is unknown, although there is evidence of a connection between gallstones and obesity; an excess of cholesterol in the bile appears to be of major importance. Gallstones are most common in women after pregnancy, and in both men and women past age 35. They may be present for years without causing trouble. The usual symptoms, however, are vague discomfort and pain in the upper abdomen. There may be indigestion and nausea, especially after eating fatty foods. X-rays will generally reveal the presence of gallstones, either directly or by use of a dye introduced into the gallbladder (cholecystography).

The most common complication of gallstones occurs when one of the stones escapes from the gallbladder and travels along the common bile duct, where it may lodge, blocking the flow of bile to the intestine and causing obstructive jaundice. This condition should be corrected by surgery before the liver is damaged or problems with infection ensue.

When a gallstone travels through or obstructs a bile duct it can cause biliary colic, with severe pain. The pain is located in the upper right quadrant of the abdomen and radiates as far as the scapula. morphine is usually not given to relieve the pain because it increases spasm of the biliary sphincters. meperidine, which does not have this side effect, is the preferred medication for pain. Treatment may also include insertion of a nasogastric tube for the purpose of gastric suction to relieve distention in the upper gastrointestinal tract. ursodiol is a drug that can dissolve gallstones and reduce the need for surgery.

Laparoscopic surgery is the usual method of treatment and is performed as soon as the patient is able to withstand it. In most cases the gallbladder is removed and a tube is inserted to establish drainage of bile that has been dammed up by the stone. (See also discussion of surgery at gallbladder.) For those patients unable to withstand cholecystectomy (gallbladder removal) but who still require drainage, cholecystostomy is indicated.

Common anatomic locations of gallstones. From Malarkey and McMorrow, 2000.

gall·stone

(gawl'stōn),

A concretion in the gallbladder or a bile duct, composed chiefly of a mixture of cholesterol, calcium bilirubinate, and calcium carbonate, occasionally as a pure stone composed of just one of these substances.

Synonym(s): biliary calculus, cholelith

gallstone

(gôl′stōn′)

n.

A small, hard, pathological concretion, composed chiefly of cholesterol, calcium salts, and bile pigments, formed in the gallbladder or in a bile duct.

gallstone

Gastroenterology A concrement in the gallbladder or the cystic duct Epidemiology 10% of adults have gallstones–GS; ↑ with age; ♀:♂ = 2:1; highest in Scandinavia, Chile, Native Americans; ↑ risk with childbearing, ERT, OCs, obesity, rapid weight loss Types Cholesterol, bilirubin, calcium salts; cholesterol GSs constitute 75% of total in Western nations; up to 80% of the volume is cholesterol; non-cholesterol GSs are either black or brown GSs Clinical Biliary colic, recurrent upper-quadrant pain; fatty food intolerance, while suggestive, is nonspecific; GSs may be associated with acute cholecystitis which causes severe abdominal pain, N&V, fever, leukocytosis Diagnosis Ultrasonography, cholescintigraphy, cholecystography Management Laparoscopic cholecystectomy, percutaneous dissolution of gallstones by MTBE–methyl- tert-butyl ether, via a percutaneous transcutaneous catheter, shock-wave lithotripsy. See Black gallstone, Brown gallstone, Soluble fiber.

gall·stone

(gawl'stōn)

A concretion in the gallbladder or a bile duct, composed chiefly of a mixture of cholesterol, calcium bilirubinate, and calcium carbonate, occasionally as a pure stone composed of just one of these substances.
Synonym(s): cholelith.

gallstone

(gol'ston) [AS. gealla, sore place, + stan, stone]

GALLSTONES: Seen endoscopically (orig. mag. ×3)

A concretion formed in the gallbladder or bile ducts. Gallstones are found in about 15% of men and 30% of women in the U.S., i.e. in about 20 million Americans. They may cause pain in the right upper quadrant of the abdomen (biliary colic) or they may be clinically silent. Gallstones typically are made either of crystallized cholesterol deposits or calcium crystals ionized with bilirubin. Cholesterol stones are about four times as common as calcium-containing stones (also known as pigment stones). Either type of stone may cause biliary symptoms such as pain or inflammation of the gallbladder; the two types of stones differ in that cholesterol stones are nonradiopaque and may on occasion be dissolved by medication, whereas calcium-containing radiopaque stones are not amenable to chemical dissolution and are therefore visible on plain x-rays of the abdomen. illustration; Synonym: biliary calculus

Symptoms

Intense pain in the right upper quadrant of the abdomen that may radiate to the right flank, back, or shoulder is typical of biliary colic due to gallstones. The symptoms may occur after a fatty meal and may be associated with nausea or vomiting or fever. Jaundice may be present on physical examination.

Treatment

Asymptomatic gallstones are neither removed nor treated. Symptomatic gallstone disease is treated primarily in the U.S. by laparoscopic cholecystectomy which, when successful, avoids prolonged hospitalization. Drug therapy for gallstones may include the use of ursodiol. Stones found in the extrahepatic bile ducts are treated surgically according to the presentation. Cholecystotomy is reserved for patients who are judged to be too ill to tolerate cholecystectomy, usually as a temporizing procedure. Gallstone lithotripsy is infrequently used because it is technically more complex than laparoscopic cholecystectomy (and relatively equipment and labor is intensive, and less universally effective).

CAUTION!

Ursodiol (ursodeoxycholic acid), taken orally, is sometimes effective in treating cholesterol gallstones. Treatment may need to be continued for 1 year. A similar agent, chenodiol, is no longer available as it caused unacceptable incidence of hepatotoxicity.

Patient discussion about gallstone

Q. What arethe pros and cons of removingmy gallbladder due to gallstones

A. Pro - solves the problem (gallstones usually don't form in the absence of gall bladder

Cons - operation, with its complications: anesthesia, incision, hernia in the incision, infection etc.
Usually there are no chronic consequences for the absence of gallbladder.

However, this is only general advice - if you have any questions regarding this subject, you should consult a doctor (e.g. general surgeon).

You may read more here:
http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/002930.htm

Q. What is a cholecystectomy and how is it done? My Doctor diagnosed me with gallstones and said I have to have a cholecystectomy surgery. What is this and how is it done?

A. Cholecystectomy is a surgery in which the gallbladder is removed. Don't be alarmed since you can live without your gallbladder. When the gallbladder is gone, bile flows directly from the liver into the small intestine.
You will probably have a laparoscopic cholecystectomy, which means a surgeon will make a small slit in your abdomen, then insert a tubelike instrument which has a camera and surgical instruments attached. This is used to take out the gallbladder with the stones inside it.
This procedure causes less pain than open surgery, is less likely to cause complications, and has a faster recovery time. This surgery is performed in an operating room and you will be under general anesthesia. It usually takes 20 minutes to one hour.