Gallstones

"Pebbles" within the gallbladder, gallstones are formed by the abnormal composition of bile and/or cholesterol. A pear-shaped sac located under the liver, the gallbladder stores bile secreted by the liver. When the body needs to digest fats, the gallbladder contracts, delivering the bile through the bile ducts into the intestines to help with digestion. Gallstones can block the normal flow of bile if they lodge in any of the ducts that carry bile from the liver to the small intestine. This can cause inflammation in the gallbladder, the ducts, or, rarely, the liver. Other complications would include pancreatitis, an inflammation of the pancreas as a result of the gallstones blocking the pancreatic duct. If any of these ducts remain blocked for a significant period of time, severe and sometimes fatal damage can occur, affecting the gallbladder, liver, or pancreas. There are two types of gallstones, namely cholesterol stones, common in Europe and the United States, and pigment stones, accounting for 90% of gallstones in Asia. Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol and account for about 80 percent of gallstones. Pigment stones are small, dark stones made of bilirubin, a decomposed form of red blood cells. Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or almost any combination of smooth or jagged stones, which cause pain when the gallbladder contracts against them.

Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called "silent stones." They do not interfere in gallbladder, liver, or pancreas function and do not need treatment. 

Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, heated hernia, pancreatitis, and hepatitis. Many gallstones, especially silent stones, are discovered by accident during tests for other problems. Symptoms of gallstones are often called a gallstone "attack" because they occur suddenly. They often follow fatty meals, and may occur during the night. A typical attack can cause:

A sensible diet is the best way to prevent gallstones. A high-fiber, low-fat diet helps keep bile cholesterol in liquid form. However, cutting out fats abruptly or eliminating them altogether, is not recommended, as too little fat can also result in gallstone formation. Recent studies have found that moderate consumption of olive oil (about 2 tbsp. a day) may actually lower the chances of developing gallstones. An ingredient in olive oil evidently helps reduce cholesterol levels in the blood and gallbladder. Researchers have found that the incidence of gallstones is relatively low among people who live in areas where olive oil consumption is high. Lecithin, a natural substance used as a thickener in ice cream, mayonnaise and other foods may help prevent gallstones by keeping cholesterol from solidifying in the gallbladder. It is found in a number of foods, including soybeans, oatmeal, eggs, milk, peanuts, cabbage and chocolate. Coffee may stimulate gallbladder contraction along with lowering cholesterol that can form gallstones. Also, coffee or caffeine tends to make it less likely that crystals form in the bladder, the initial phase of a gallstone formation. Regular aerobic exercise has also proved effective in the reduction of gallstone formation by as much as 40%.

Gallstones are thought to form as a result of an imbalance of bile, a digestive enzyme produced by the liver and stored in the gallbladder, which include bile salts, bilirubin, and cholesterol. When they lodge in one of the ducts carrying bile to and from the gallbladder, gallstones will form. It is believed that the mere presence of gallstones may cause more gallstones to develop.

Cholesterol is normally kept in liquid form by the dissolving action of bile salts. An increased amount of cholesterol in the bile overwhelms the dissolving capacity of the bile salts, leading to the formation of cholesterol stones. Similarly, a decrease in the amount of bile salts also promotes cholesterol stone formation. Cholesterol stones can also form when the gallbladder does not empty, as it should, for some other reason. 

Pigment stones are frequently associated with chronic infections in the bile. It is more common in certain Asian countries, where parasitic infection of the bile ducts is not rare. Patients with certain blood diseases that cause excessive breakdown of red blood cells, such as sickle cell anemia, can have increased amounts of bilirubin in the bile, thus causing bilirubin stone formation. Cirrhosis could be another cause of pigment stone formation.

For cholesterol stones, some factors that contribute to its formation are commonly known as the four “F”s.

Fat. A large clinical study showed that being even moderately overweight increases one's risk for developing gallstones, especially in women. The most likely reason is that obesity tends to reduce the amount of bile salts in bile, resulting in more cholesterol. Obesity also decreases gallbladder emptying. 

Female. Women between 20 and 60 years of age are twice as likely to develop gallstones as compared to men. 

Fertile. Excess estrogen from pregnancy, hormone replacement therapy, or birth control pills appears to increase cholesterol levels in bile and decrease gallbladder movement, both of which can lead to gallstones. 

Forty. People over age 40 are more likely to develop gallstones than younger people.

Other factors that may contribute to gallstones have been identified:

Rapid weight loss. As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones. 

Diabetes. People with diabetes generally have high levels of fatty acids called triglycerides. These fatty acids increase the risk of gallstones. 

Pregnancy. Impaired contraction and emptying of the gallbladder, commonly seen in pregnancy, is another important factor in cholesterol gallstone formation. 

Fasting. Fasting decreases gallbladder movement, causing the bile to become over concentrated with cholesterol, which can lead to gallstones. 

Cholesterol lowering drugs. Drugs that lower cholesterol levels in blood actually increase the amount of cholesterol secreted in bile. This in turn can increase the risk of gallstones. 

Ethnicity. Ethnic groups have a genetic predisposition to secrete high levels of cholesterol in bile, such as the Native Indians in the US. Mexican-American men and women of all ages also have high rates of gallstones.

• Ultrasonography (usually definitive)
• Radionuclide excretion scan (HIDA) if ultrasound results are questionable
• Endoscopic retrograde cholangiopancreatography (ERCP) is sometimes utilized for suspected choledocholithiasis (stones in bile duct) or gallstone pancreatitis 
• Blood studies for:
• Elevated leukocyte count
• Mild elevation of bilirubin (higher counts suspect common duct obstruction)
• Mild elevation of alkaline phosphatase
• Mild elevation of amylase and lipase level 
• Plain film useful in only 15% of patients with enough calcium in gallstones
  

• Eat a low-fat diet high in raw foods. Emphasize yogurt, broiled fish, beets, carrots, apples, lemons, oranges, grapes, celery, garlic, onions, tomatoes, dates, melons and fiber-rich foods.
• Fiber is thought to help prevent the formation of gallstones by stimulating bile flow from the liver and by preventing bile reabsorption.
• Avoid dried foods, fatty foods, animal fat, margarine, commercial oils, chocolate and coffee. Minimize your consumption of sugar and refined carbohydrates.
• If you need to lose weight, learn to push away from the table before feeling uncomfortably full. Beet juice is good for its ability to act as a liver cleanser.
• During a bout with inflammation, drink apple and green juices and avoid solid food.

Take coffee, garlic, or catnip for relief.

A sedentary lifestyle is a major risk factor.Try to get mild to regular exercises, and reduce body fat to keep the system free and active.