Gall stones or cholelithiasis

Stones in the gallbladder are one of the most common causes world wide for damage to the gall bladder. The gallbladder is a small pear like structure located below the liver which produces bile that is responsible for metabolizing fats in the body. Gallstones are concretions formed due to abnormal constituents of bile. They can form in the gall bladder, common bile duct or anywhere in the biliary tree (bile carrying system). Gall stones may be of cholesterol or pigment or may be mixed in composition. Gall stones can occur at any age from 18 to 65 years but are more common in the middle aged. In developed countries they are being seen more in young adults. In younger age groups it is 3 times more common in women, while with advanced age it is almost equal in the 2 genders. In fact Cholelithiasis is said to have a high association with 4 F – i.e. female, fat, forty, fertile. Stones forming in the gall bladder are composed of cholesterol or pigment, though in majority of cases they are mixed in composition. They also contain some amount of calcium salts. One of the basic underlying causes for formation of cholesterol gall stones is increased cholesterol production in the body. This is more in elderly, in women and obese people. If obese people loose weight rapidly there is a risk of gall stones. Impaired emptying of the gall bladder as in pregnancy, fasting states, also leads to stasis of bile in the gall bladder and increased risk of cholesterol gall stone. In these conditions stone formed is composed of cholesterol. Pigment stones are formed in conditions where there is haemolysis (break down of red blood cells) inside the body as in certain type of anemias. Bacterial and parasitic infections of the biliary tree also lead to formation of pigment stones. Hepatic cirrhosis also makes one more prone to gall stones. Some individuals have genetic susceptibility for having gall stones. Most of the times gall stones cause no symptoms and may be detected accidentally. About 10% stones cause problems and need treatment. Presence of gall stones causes pain, commonly in the right upper half of the body. Pain can be radiated to the right shoulder, even upper back. But it can be felt in the central upper part or even the right flank, thus mimicking other diseases. This pain commonly appears after meals, more so after a fatty meal. In acute cases it is severe, excruciating and associated with nausea and vomiting. Stones in the biliary tree or gall bladder may get infected causing high fever with chills. Stones in the common bile duct cause obstruction to flow of bile. Thus along with pain, one develops jaundice, loss of appetite, vomiting, itching all over body and white colored stools. Due to presence of gall stones getting infected, there may be inflammation of the gall bladder (cholecystitis), causing severe intermittent pain. Untreated it may perforate leading to peritonitis and shock. On suspicion of gall stones diagnosis is established by X-rays and ultra sound of the abdomen. Medical treatment consists of drugs which tend to dissolve the gall stones like ursodeoxycholic acid. Along with it antibiotics are given for the infection, pain killers for pain and fluid therapy is needed if there is dehydration due to vomiting and poor intake due to anorexia. Drug therapy is useful if stones are less than 15 mm, problem is mild to moderate and intermittent and person is lean. But, obese individuals or those having recurrent persistent or severe symptoms need surgical interventions. A fat free diet, good physical exercise, less of alcohol and addicting substances are useful to prevent gall stones. Obese persons need to reduce weight but, slowly. Those who already have symptomatic gall stones are advised to take fat free diet and frequent small meals to take off the load from the gall bladder. E-mail – rachna212002@yahoo.co.uk