Dr. Tariq Jagnarine
Family Medicine, Endocrinology and Diabetes

Gallstones are stones or bumps that develop in the gallbladder or bile duct when certain substances harden. The gallbladder is a small sack located on the right side of the body, on the lower side of the liver. Some of the chemicals present in the gallbladder can solidify into one large stone or several small stones.
A study revealed that the incidence of gallstones in adults in industrialized countries is around 10 percent and appears to be increasing.

People at risk include:
* Women who have been pregnant
* Previous family members with a history of gallstones
* People who have lost a lot of weight recently
* Deliberately losing weight quickly and then regaining it can increase men’s risk for gallstones later in life
* Women taking oral contraceptives
* Being sedentary
* Women receiving high-dose estrogen therapy
* People whose dietary fat intake is high
* Twice as many women get gallstones than men
* People over 60 years of age
* People who take cholesterol lowering drugs called statins
* People with diabetes
In addition, hormone replacement therapy (HRT) for women during menopause is associated with an increased risk of gallbladder problems. A study found that HRT administered by skin patches or gels poses a lower risk than orally administered HRT.

Gallstones can form when the chemicals in the gallbladder are out of balance, such as cholesterol, calcium bilirubinate, and calcium carbonate.
There are two main types of gallstones:
* Cholesterol gallstones: These can form if there is too much cholesterol in the gall. They are the main type of gallstones.
* Pigment gall stones: These form when the gall has excess bilirubin. They are more common in people with liver disease, infected gall tubes, or blood disorders, such as sickle cell anemia.
Experts are not quite sure why some people develop the chemical imbalance in their gallbladder that causes gallstones, while others do not. However, gallstones are known to be more common in people with obesity, especially women. In fact, a recent study revealed that a swollen middle belly almost doubles a woman’s chances of developing gallstones and the need for surgery to remove them.

Most people with gallstones experience no symptoms at all. This is because the stones stay in the gallbladder and cause no problems.
* Sometimes, however, gallstones can lead to cholecystitis, or an irritable gall bladder.
* Symptoms of gallstones can include sudden and rapid pain on the right side of the body that can get worse over time.
Back pain between the shoulder blades
* Right shoulder pain
* Nausea
* Disturbance

In many cases, gallstones are accidentally discovered when an individual is being treated for a different condition. A doctor may suspect gallstones after a cholesterol test, ultrasound scan, blood test, or even an X-ray. Blood tests can be used to look for signs of infection, blockage, pancreatitis, or jaundice including:
* Cholangiography
* CT scan
* Cholescintigraphy (HIDA scan)
Gallstones are only treated if they have caused gallbladder irritation, bile duct obstruction, or if they have moved from the bile ducts to the intestines.
* Ursodeoxycholic Acid – dissolves gall stones made of cholesterol over a period of 12 months.

* Surgeries: Cholecystectomy – involves surgical removal of the gall bladder.
Post-endoscopic cholangiopancreatolography – removal of the stones using a camera and oral tube.
* Lithotripsy – shock waves to break up the stones and allow them to pass out better in the stool.
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If gallstones block the bile duct or duodenum, the flow of digestive juice into the pancreas can be blocked. This can cause jaundice and acute pancreatitis. Treatment usually involves surgical removal of the gallbladder.
It is common for people who have had their gallbladder removed to experience feelings of bloating and indigestion, especially when they have a high fat meal. Some may pass sewage more often than before.
* Bust colic: When a stone is stuck in the gallbladder opening and does not pass easily, the gallbladder contraction can cause severe pain. When this happens, an individual may experience a painful condition called gallbladder colic. The pain is felt in the upper abdomen, but can also occur in the middle or right of the abdomen. Pain is more common about an hour after eating, especially if an individual has had a high-fat meal. The pain will be constant and last for a few hours, then subside. Some people experience non-stop pain for 24 hours, while others experience waves of pain.
* Infection: If the gallstones have caused a gallbladder infection, the person with the condition may have a fever and experience tremor. In most limestone infection cases, people will be hospitalized to remove the gallstones.
* Jaundice: If the gallstone leaves the gallbladder and becomes stuck in the bile duct, it can obstruct the passage of the gall to the bowel. The gall will then enter the bloodstream, causing signs of jaundice. In most cases, this complication will require surgical removal of the boulder stone. For some people, gallstones eventually go to the intestine.
* Pancreatitis: If a small gallstone passes through the bile duct and blocks the pancreatic duct, or causes a reflux of liquids and bile into the duct, an individual may develop pancreatitis.

A person can survive without a gallbladder. The liver produces enough bile to digest a normal diet. A small proportion of people who have had their gallbladder removed will experience softer and more frequent stools because their bile is more frequent in the small bowel.

Some factors that increase the risk of developing gallstones, such as age, sex and ethnic origin, cannot be changed.
* However, following a vegetarian diet may reduce the risk of gallstones. Vegetarians have a significantly lower risk of developing gallstones, compared to meat eaters.
* Many experts say that a diet low in fat and high in fruit and vegetables, including enough dietary fiber, could help protect people from developing gallstones.
* Body weight management can also help prevent gallstones from forming. However, fast dieting and crash diets increase the risk of gallstones.
* Moderation of weight and diet is important.
It used to be the case that people with gallstones who were not yet ready for surgery would have a very low fat diet to prevent stone growth. This has recently been shown to be less useful than previously thought, because rapid weight loss can cause gallstones. A balanced diet with regular meals is recommended. This will not cure gallstones, but can have a positive effect on any symptoms and pain experienced.
Avoiding foods high in saturated fats can help reduce the risk of gallstones developing, such as butter, hard cheese, cakes and biscuits. Cholesterol is thought to have a role in the formation of gallstones. Dietary measures can be taken to help prevent the condition, such as eating more nuts and taking a small amount of alcohol.

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