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GALL STONES

Objective

To know what is gall stones, its causes and factors favoring them

To be able to understand the features of gall stones

To be able to differentiate between the two types of gall stones

To know the diagnosis and treatment for gall stones

DEFINITION

Presence of stones in gall bladder or bile duct

A.K.A. cholelithiasis from the Greek words chol- (bile) + lith-

(stone) + iasis- (process)

CAUSES

When relative composition in bile changes, causing precipitation of normal constituents

Cholesterol level increase and bile acids level decrease ( normal: 5% cholesterol, 80% bile acids, 15% phospholipids)

May occur in severe ileal disease, obstruction to biliary tract, hepatic dysfunction

Factors that favor Gall Stone formation

Supersaturation of bile with cholesterol

Nucletion factor glycoprotein in gall bladder mucous form the nucleus surrounding which gall stones are formed

Bile stasis decrease bile flow/ gall bladder emptying

Types of Gall Stones

Mainly of two types: Cholesterol stones (85%)

when ratio of bile cholesterol to bile salt falls below 1:13.

Radiolucent (cannot be visualized on plain X-ray)

Pigment stones (15%) Mainly of calcium bilirubinate Free bilirubin combines with calcium to

form calcium bilirubinate (highly insoluble in bile)

Commonly associated with 5 F:

Female estrogen stimulates the liver to synthesise more cholesterol

Forty to fifty years old body secrete more cholesterol into bile

Fair looking individuals melatonin inhibits cholesterol secretion from the gall bladder

Fertile ladies  excess estrogen increase cholesterol levels in bile

Fat peoplethe liver over-produces cholesterol

Features

Usually silent stones (allow kidney to function normally without pain)

When gall stones come out of gall bladder and pass the biliary duct, severe colicky or spasmodic abdominal pain occur

Chronic gall stones are present with acute cholecystitis, bile stasis inducing inflammation of gall bladder and obstructive jaundice

Diagnosis

Ultrasound (cholecystography)Plain X-ray (pigment stones)

Treatment

No effective medical treatment Cholesterol gall stones can sometimes be

dissolved by oral ursodeoxycholic acid Gall stones may occur when stop using

drugs

Treated surgically by removal of gall bladder (cholecystectomy) Gall bladder not absolutely essential for

digestion Only problem arise is steatorrhea if excess

fatty food is taken

Conclusion

Gall stones can be prevented by: advisable to avoid eating fatty foods with a

high cholesterol content A low-fat, high-fibre diet is recommended Control your weight by eating a healthy diet

and taking plenty of regular exercise. avoid low-calorie, rapid weight loss diets,

they can disrupt your bile chemistry and increase your risk of developing gall stones

Reference

Textbook of Medical Physiology, 2nd Edition, GK Pal

Textbook of Physiology, 3rd Edition, AK Jain