CHOLELITHIASIS

●​ Cholelithiasis is a condition in which hard stones composed of cholesterol or

bile pigments form in the gallbladder .
●​ Gallbladder is a small, pear-shaped organ on the right side of the abdomen,
just beneath the liver. The gallbladder holds a digestive fluid called bile
that's released into the small intestine.

●​ Gallbladder stores and releases bile, a fluid made in the liver, to help in
digestion. Bile also carries wastes like cholesterol and bilirubin, which the
body makes when it breaks down red blood cells. These things can form
gallstones.
●​ The gallstones range in size from as small as a grain of sand to as large as a
golf ball. Some people develop just one gallstone, while others develop
many gallstones at the same time.

●​ Most stones are composed of cholesterol.

●​ In bile, cholesterol is in equilibrium with bile salts and phosphatidylcholine.

●​ When the concentration of cholesterol rises to the point of supersaturation,

crystallization occurs.
●​ A sludge containing cholesterol, mucin, calcium salts, and bilirubin forms
and, ultimately stones develop.
Types of gallstones

Types of gallstones that can form in the gallbladder include:

●​ Cholesterol gallstones:
✔​The most common type of gallstone, called a cholesterol gallstone,
often appears yellow in color.
✔​These gallstones are composed mainly of undissolved cholesterol, but
may contain other components.
●​ Pigment gallstones:
✔​These dark brown or black stones form when the bile contains too
much bilirubin.

Risk Factors​

●​ Family history:
Gallstones are more than twice as common in first-degree relatives of
individuals with gallstones.
●​ Increasing age:
Gallstones are most common in individuals over age 40.

●​ Female sex:
Females are more likely to develop gallstones in all age groups, probably due
to the effects of estrogens.
This increased risk is most notable in young women, who are affected 3-4
times more often than men of the same age.

●​ Elevated estrogen and progesterone:

During pregnancy, oral contraceptive use, or hormone replacement therapy,
estrogen and progesterone induce changes in the biliary system that
predispose to gallstones.

●​ Obesity:
Obesity is a significant risk factor for the development of cholesterol
gallstones due to elevated production and secretion of cholesterol.

●​ Rapid weight loss:

Bariatric surgery and very-low-calorie diets increase risk of gallstone
formation, possibly due to increased concentrations of bile constituents.

●​ Diabetes mellitus:
High triglycerides, gallbladder stasis, and hepatic insulin resistance may
increase risk of gallstones.

●​ Gallbladder stasis:
When bile remains in the gallbladder for an extended period, supersaturation
can occur.
 Gallbladder stasis is associated with diabetes mellitus, total parenteral
nutrition (probably due to lack of enteral stimulation), vagotomy, rapid
weight loss, celiac sprue, and spinal cord injury.

●​ Cirrhosis:
Cirrhosis leads to as much as a 10-fold increased risk of gallstones.

●​ Ileal disease or resection:

Changes in enterohepatic cycling of bile salts increases risk of gallstone
formation.

●​ Hemolytic states:
The rapid destruction of red blood cells in sickle cell disease and other
hemolytic conditions causes the release of bilirubin, which in turn increases
the risk of pigment gallstones.

●​ Medications:
Drugs implicated in the development of cholelithiasis include clofibrate,
octreotide, and ceftriaxone.

●​ Physical inactivity:
Exercise may reduce gallstone risk.

Causes:

It's not clear what causes gallstones to form. Doctors think gallstones may result
when:

●​ Bile contains too much cholesterol. Normally, bile contains enough chemicals
to dissolve the cholesterol excreted by liver. But if the liver excretes more
 cholesterol than the bile can dissolve, the excess cholesterol may form into
crystals and eventually into stones.
●​ Bile contains too much bilirubin. Bilirubin is a chemical that's produced
when the body breaks down red blood cells. Certain conditions cause the liver
to make too much bilirubin, including liver cirrhosis, biliary tract infections
and certain blood disorders. The excess bilirubin contributes to gallstone
formation.
●​ Gallbladder doesn't empty correctly. If the gallbladder doesn't empty
completely or often enough, bile may become very concentrated, contributing
to the formation of gallstones.

Complications:

Complications of gallstones may include:

●​ Inflammation of the gallbladder. A gallstone that becomes lodged in the neck

of the gallbladder can cause inflammation of the gallbladder (cholecystitis).
Cholecystitis can cause severe pain and fever.
●​ Blockage of the common bile duct. Gallstones can block the tubes (ducts)
through which bile flows from the gallbladder or liver to the small intestine.
Severe pain, jaundice and bile duct infection can result.
●​ Blockage of the pancreatic duct. The pancreatic duct is a tube that runs from
the pancreas and connects to the common bile duct just before entering the
duodenum. Pancreatic juices, which aid in digestion, flow through the
pancreatic duct.
A gallstone can cause a blockage in the pancreatic duct, which can lead to
inflammation of the pancreas (pancreatitis). Pancreatitis causes intense,
constant abdominal pain and usually requires hospitalization.

●​ Gallbladder cancer. People with a history of gallstones have an increased risk

of gallbladder cancer. But gallbladder cancer is very rare, so even though the
 risk of cancer is elevated, the likelihood of gallbladder cancer is still very
small.
Symptoms:

Gallstones may cause no signs or symptoms. If a gallstone lodges in a duct and

causes a blockage, the resulting signs and symptoms may include:

●​ Sudden and rapidly intensifying pain in the upper right portion of the abdomen
●​ Sudden and rapidly intensifying pain in the center of the abdomen, just below
the breastbone
●​ Back pain between the shoulder blades
●​ Pain in the right shoulder
●​ Nausea or vomiting
●​ An upset stomach
●​ Other digestive problems, including indigestion, heartburn, and gas
●​ Gallstone pain may last several minutes to a few hour
●​ Fever and chills
●​ Yellow skin or eyes
●​ Dark urine and light-colored poop

DIAGNOSIS:

●​ Abdominal ultrasound. This test is the one most commonly used to look for
signs of gallstones. Abdominal ultrasound involves moving a device
(transducer) back and forth across your stomach area. The transducer sends
signals to a computer, which creates images that show the structures in the
abdomen.
 ●​ Endoscopic ultrasound (EUS). This procedure can help identify smaller
stones that may be missed on an abdominal ultrasound. During EUS the
doctor passes a thin, flexible tube (endoscope) through the mouth and
through the digestive tract. A small ultrasound device (transducer) in the
tube produces sound waves that create a precise image of surrounding
tissue.

●​ Other imaging tests. Additional tests may include oral cholecystography, a

hepatobiliary imino diacetic acid (HIDA) scan, computerized tomography
(CT), magnetic resonance cholangio pancreatography (MRCP) or endoscopic
retrograde cholangio pancreatography (ERCP). Gallstones discovered using
ERCP can be removed during the procedure.

●​ Blood tests. Blood tests may reveal infection, jaundice, pancreatitis or other
complications caused by gallstones.

Treatment

Asymptomatic gallstones are generally not treated. Cholecystectomy is the

treatment of choice for symptomatic disease.
Oral bile acids (e.g., ursodeoxycholic acid) can be used to dissolve small stones
and stone fragments. However, they work in only a small percentage of cases and
stones typically recur after the treatment is discontinued.
Long-term statin use has been associated with a reduced risk of gallstone
development.
PREVENTION:

●​ Don't skip meals. Try to stick to the usual mealtimes each day. Skipping meals
or fasting can increase the risk of gallstones.
●​ Lose weight slowly. If need to lose weight, go slow. Rapid weight loss can
increase the risk of gallstones. Aim to lose 1 or 2 pounds (about 0.5 to 1
kilogram) a week.
●​ Eat more high-fiber foods. Include more fiber-rich foods in the diet, such as
fruits, vegetables and whole grains.
●​ Maintain a healthy weight. Obesity and being overweight increase the risk of
gallstones. Work to achieve a healthy weight by reducing the number of
calories you eat and increasing the amount of physical activity you get. Once
achieve a healthy weight, work to maintain that weight by continuing healthy
diet and continuing to exercise.

DIETARY MANAGEMENT:

You can lower the risk of gallstones by following a healthy eating plan and getting
regular physical activity to help reach and maintain a healthy weight.

Expert recommends the following to help prevent gallstones:

i.​
Eat more foods that are high in fiber, such as fruits, vegetables,
beans and peas. Whole grains including brown rice, oats, and
whole wheat bread.
ii.​ Eat fewer refined carbohydrate and less sugar
iii.​ Eat healthy fats, like fish oil and olive oil, to help the gallbladder
contract and empty on a regular basis.
iv.​ Avoid unhealthy fats, like those often found in desserts and fried
foods.
❖​HEALTHFUL DIET:

A high intake of fresh fruits and vegetables, fruit juice, low-fat dairy
products, whole grains, nuts, spices, and legumes.

❖​UNHEALTHFUL DIET:
 A high intake of processed meat, soft drinks, refined grains, red meat,
high-fat dairy products, sugar, tea, solid fat, baked potato, snacks, egg, salt, pickled
food, and sauerkraut.

People who followed a healthful diet pattern overall were less likely to
develop gallbladder disease.

❖​PLANT-BASED FOODS:

A healthful diet will provide a variety of nutrients. A diet that includes a range
of plant foods can provide the nutrients the body needs to stay healthy. Plant
based foods are a good source of vitamins, minerals, and antioxidants. These may
help prevent gallbladder disease.

❖​LEAN PROTEIN:

Protein is essential for the repair and growth of body tissues. Red meat and dairy
products are good sources of protein, but they can also be high in fat, and high fat
intake can put stress on the gallbladder

Low-fat protein foods are a suitable option. They include:

●​ Poultry
●​ Fish
●​ Zero fat dairy products
●​ Nuts and seeds
●​ Soy and soy products
●​ Legumes, such as beans and lentils
●​ Dairy alternatives, such as soy milk
❖​FIBER:

Fiber supports digestive health, and it may offer protection from

gallbladder disease by enhancing the movement of food through the gut and
lowering the production of secondary bile acids.

Those who followed the high fiber diet accumulated less gallbladder
sludge, which reduced their risk of developing gallbladder disease. This suggests
that fiber can help prevent gallbladder disease in people who need to lose weight
quickly, and perhaps overall.

Sources of fiber include:

●​ Fruits
●​ Vegetables
●​ Legumes
●​ Nuts and seeds
●​ Whole grains

FOODS INCLUDED:

Cereals in a soft form, cooked rice, chapathi, bread and idli, milk pudding, milk
shakes, curds, cooked or pureed vegetables, kichidi and porridge. Pulses, beans,
meat, fruits, fruit juices, fish and chicken, soft cooked eggs can also be given.
These foods are high in energy and protein and help in regeneration of liver cells.