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Gallstones

Gallstones, also known as bilestones or biliary calculi, are lumps of solid matter which harden out of liquid bile. They are composed of cholesterol, bile pigments, bile salts, calcium salts, and excretory elements, in varying proportions. Gallstones are typically green, yellow, brown, or black in color, depending on the proportions of their content. Other physical properties like hardness, size, and density may also vary accordingly.

As the name suggests, gallstones or biliary calculi can develop anywhere along the biliary tract where bile is present - in the gallbladder, in the various bile ducts, and in the liver (intrahepatic stones). They range in size from a grain of sand to a golf ball, so the gallbladder and liver can hold thousands of small stones, or a few big stones, or both.

The formation of gallstones (cholelithiasis) occurs when bile contains more cholesterol than it can keep in liquid form, or when chemical imbalances cause normal cholesterol levels in bile to become less soluble and crystallize.

Cholesterol crystallization into stones may be the result of a high-cholesterol diet, excretion of certain drugs into bile, stagnant bile, an unhealthy liver producing unhealthy bile, or simply a person's natural tendency. Drugs which suppress cholesterol in blood actually transfer the excess cholesterol into bile, thus increasing the risk of gallstones.

Gallstone Symptoms

The majority of people with gallstones remain free of symptoms for many years, and may never know they have gallstones. However, when symptoms do develop, they tend to recur. Some of the straightforward symptoms of gallstones are:
  • pain in the upper abdomen
  • pain between the shoulder blades, sometimes up to the nape
  • enlarged and tender area below the right rib cage
  • abdominal bloating after meals
  • yellow skin and eyes (jaundice)
  • nausea or vomiting
  • fever or chills
Gallstone colic, the pain caused by gallstones, is severe and steady. It arises when a stone moves out of the gallbladder or liver and enters the bile ducts. Each attack can last from 1 to 4 hours, followed by a lingering soreness that persists for about a day. The pain can be so intense that people become desperate enough to get rid of their gallbladder.

Gallstone Diagnosis

The major component of most gallstones is cholesterol, which is not radio-opaque. This explains why many gallstones do not show up on a plain X-ray; only stones with high calcium content are radio-opaque and visible. Oral cholecystogram, an X-ray of the gallbladder after ingesting a radio-opaque material, is reasonably effective but is rarely used because of possible adverse reactions.

Ultrasound scanning is the most common method for detecting stones in the gallbladder. It uses sound waves which will bounce off solid objects to show their presence. Ultrasound is non-invasive, painless, does not involve radiation, and has no known side effects.

However, a drawback of ultrasound scanning is that excess fatty tissue surrounding the gallbladder can block the sound waves, and produce false negative results. This means that obese people may not be easily diagnosed with gallstones. Ultrasound scanning also has difficulty in detecting stones lodged in the bile ducts and liver.

When strong symptoms of gallstones cannot be cannot be confirmed by ultraound or X-ray, more expensive techniques like computed tomography (CT scan), endoscopic retrograde cholangiopancreatography (ERCP), or magnetic resonance cholangiopancreatography (MRCP) can be used.

Gallstone Effects on Health

In the long-term, gallstones can congest and damage the all-important liver, slowly and indirectly causing health problems which seem unrelated, such as high blood cholesterol, high blood pressure (portal hypertension), atherosclerosis, enlarged spleen, heart attack, stroke, excessive uric acid, kidney stones, gout, headache (liver encephalopathy), general fatigue, loss of appetite, hormone imbalance, abnormal growths, and many more.

In order to understand the effects of gallstones on the rest of the body, it is necessary to look at areas which are physically related to gallstones:
  • bile, the source of gallstones
  • the biliary tract, where gallstones can form
  • organs attached to the biliary tract - liver, gallbladder, and pancreas.
Bile
Bile is the thick digestive fluid produced by the liver. Like gallstones, it consists of cholesterol, bile pigments, bile salts, calcium salts, and excretory elements. It is usually green, yellow, or brown in color, while other physical properties like viscosity and density may also vary, depending on the proportions of its content. Bile is needed for the following functions:
  1. to emulsify fats so that they can be digested and absorbed by the intestines
  2. to excrete certain waste products from the body, such as destroyed red blood cells, excess cholesterol, drugs, and chemical by-products
  3. to stimulate peristalsis in the intestines so that the contents can be moved along easily and finally evacuated as feces.
The Biliary Tract
The biliary tract is a system of ducts which carry bile from the liver to the gallbladder and the intestines. There are thousands of bile capillaries inside the liver which join like the twigs and branches of a tree to form two large ducts outside the liver, the left hepatic duct and the right hepatic duct. These two ducts unite to form the common hepatic duct, which joins the cystic duct from the gallbladder to form the common bile duct. The common bile duct merges with the pancreatic duct just before entering the duodenum at the sphincter of Oddi.

biliary tract
stone keyGallstones can form anywhere along the biliary tract
The Liver
The liver is the largest and arguably the most complex and important organ in the body. The ancient Chinese considered the liver, not the heart or brain, as the center of the body which governs health.

Located in the upper right portion of the abdomen, beneath the lungs, above the stomach and intestines, this dark reddish-brown organ weighs between 1.2 to 1.6 kg and acts as the body's chemical factory. Among the hundreds of liver functions that have been identified, some of the better-known functions are:
  1. Digestion - it secretes bile which flows into the intestines to help digest fats.
  2. Metabolism - it converts nutrients from the stomach and intestines into fats, carbohydrates (sugar), amino acids (proteins) and vitamins, forms that are easier for the rest of the body to use. Heat is released in the process.
  3. Synthesis - it produces cholesterol, some of which becomes bile. The rest of the cholesterol is used by other parts of the body to build cell membrane and certain hormones like estrogen, testosterone and adrenal hormones. The liver also produces blood-clotting fibrinogen and prothrombin, as well as the anticoagulant heparin.
  4. Regulation - it regulates the amount of sugar, amino acids, hormones and other chemical levels in the blood. Excess blood sugar is converted to glycogen for storage in the liver. Excess amino acids and hormones are broken down and excreted from the body.
  5. Storage - it stores nutrients like glycogen, fats and vitamins, releasing them into the bloodstream when needed.
  6. Recycling - it extracts bile salts from the small intestine, and secretes them again into bile.
  7. Detoxification - it breaks down toxic substances and worn-out red blood cells, then excretes them as harmless by-products into the bile and the blood. Chemicals from processed foods, drinks, and prescription drugs are broken down this way.
  8. Excretion - it removes waste products from the body. By-products in the bile enter the intestines, then leave the body through the feces. By-products in the blood are filtered out by the kidneys, then leave the body through the urine.
The Gallbladder
The gallbladder is a pear-shaped muscular storage sac which holds bile, situated below the right lobe of the liver. Bile secreted between meals flows from the liver through the cystic duct into the gallbladder.

During a meal, the hormone cholecystokinin-pancreozymin causes the gallbladder to contract and squeeze bile into the duodenum to help digest fats and certain vitamins. After the food has been digested, the gallbladder relaxes and is ready to store bile again.

Bile is continuously produced by the liver, and its viscosity changes according to its chemical and excretory content. Bile flows easily when it is thin, and the gallbladder serves as a good storage area so that it does not constantly drip into the duodenum when no food is present.

Bile does not flow easily when it is thick, and the gallbladder helps to squirt enough of it into the duodenum when food is present. In other words, the gallbladder has a regulatory function to ensure that the right amount of bile is released into the duodenum at the right time.
Gallstone Complications
Complications caused directly by gallstones are usually accompanied by severe episodes of abdominal pain. The following are some of these complications.

Cholecystitis - inflammation of the gallbladder when the flow of bile from the gallbladder is stopped. This occurs when a stone blocks the exit of the gallbladder or enters the cystic duct.

Cholestasis - a more serious stoppage of the flow of bile from the liver into the duodenum. This occurs when a stone enters and blocks the common bile duct, and can further lead to the following complications.

Jaundice - yellow coloration of the skin and eyes, with dark urine. Even though the flow of bile has stopped, the liver continues to produce bile. Dead blood cells or bilirubin, which is normally excreted through bile, backs up into the bloodstream, and is then deposited in the skin and passed into the urine.

Cholangitis - inflammation of the bile ducts outside the liver, due to bacterial infection of the stagnant bile. If not overcome, this inflammation can spread to the liver.

Biliary cirrhosis - inflammation and obstruction of the bile ducts inside the liver. As the inflammation spreads to the rest of the liver, normal liver cells die and are replaced by fibrous scar tissue. The scarring disrupts the function of the liver, and in severe cases can lead to death. Cirrhosis is also a major risk factor for cancer.

Pancreatitis
- inflammation of the pancreas when a stone blocks the pancreatic duct or the sphincter of Oddi. Not only is the flow of bile obstructed, pancreatic secretions into the duodenum containing digestive enzymes are also blocked. The blockage is usually temporary and will clear by itself; but if it continues, the blocked enzymes will start to digest the cells of the pancreas.

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Disclaimer: This website is intended to provide general information about gallstone disease and management. It is not a substitute for medical advice from a qualified medical practitioner. Please use the information at your own discretion. Yong An Alternative Treatment will not be liable for unsatisfactory results arising from decisions based on the information in this website. Online December 2005.
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