Gallstones

If you have gallstones, you're in good company: about 10 to 15 percent of adults have them as well. Today, newer, less-invase surgical techniques will help you banish gallstone pain and be back of your feet faster than ever before.

What is happening

Think of your gallbladder as a storage depot, a place where bile (a thick greenish-yellow digestive juice) from your liver is kept until it is needed. When your body needs bile to help it absorb fat, the
gallbladder propels it into your intestines. Bile contains a mix of cholesterol, calcium and a waste product from old blood cells called bilirubin. If too much of one of these builds up, crystals form, clump together and enlarge into gallstones. A stone can be as tiny as a grain of sand or as big as a golf ball.
  Odds are, you probably won't have symptoms and will learn about your stones during another test. Although these 'silent gallstones' are generally harmless, sometimes they can create problems. If a stone tries to squeeze through a narrow duct from your gall-bladder to your small intestine, you'll have severe pain until it passes. A more serious condition called acute cholecysitis occurs when the stone can't pass; this creates a blockage and sometimes even an infection in the gallbladder or the duct that is potentially life threatening. Acute cholecysitis will respond to anitbiotics once the stone passes or is removed.

LIKELY FIRST STEPS

• For mild symptoms, lifestyle changes (low-fat diet, exercise, weight loss if needed) to control and even eliminate the disease.
• For acute gallstone attacks, hospitalisation for treatment  with IV antibiotics, painkillers and fluids.
• If other treatments fail or complications develop, surgery to remove the gallbladder.
  

QUESTIONS TO ASK

• Is it possible that my abdominal pain  is not from gallstones, but is caused by a peptic ulcer or pancreatitis?
• If I improve my diet, will the gallstones eventually dissolve on their own?
• Should I take a painkiller such as paracetamol or aspirin when gallstone pain hits?

 If you have an infection or a blocked duct, you'll know it. symptoms start with a pain in your upper right abdomen that may radiate to your back or right shoulder; and if you breathe deeply, it gets worse. when the pain comes in waves, it may be colic, meaning your duct is struggling to pass a stone. If the pain is more constant, and the whole area tender, acute cholecystitis may be the problem.
Gall-bladder flare-ups frequently occur after eating a large or fatty meal; bloating, nausea and vomiting may also be present. Warning signs of a prolonged blockage are a high fever, jaundice and constant pain.
  Just why some people develop gallstones is a mystery. But every medical student knows the profile of an at-risk person as the five 'Fs': someone who is Fair (light complexion), Female (oestrogen boosts cholesterol secretion), Fat(excess weight also ups cholestrol output), Fertile (previous pregnancies) and older than Forty. Other risks include a history of crash dieting, diabetes or an inflammatory bowel condition.

Treatments

If you have gallstones but no symptoms, your doctor will probably recommend a wait-and-see approach. Most mild, intermittent symptoms respond to a certain lifestyle changes, namely, following a low-fat diet and losing some weight. If you have passed one  gallstone and ultrasounds show that there are more present, your doctor is

                                                                                   Treatment Options 

LIFESTYLE CHANGES                              
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Weight loss & diet                                           Trim extra kilos, excess sugar and fat.
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Stay regular                                                      Constipation adds to gallstone risk.-----------------------------------------------------------------------------------------------------------------------------------------------
Exercise                                                            Can reduce risk of attack by 20 to 40%

MEDICATIONS
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Painkillers                                                    IV Demerol or Talwin for acute pain.
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Antinausea drugs                                       IV drugs for vomiting in acute attack.
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Antibiotics                                                    IV drugs for infection.
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Oral bile-acid dissolving                            Slowly dissolves stones; rarely effective.
therapy.                                             

PROCEDURES
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Open cholecystectomy                                  Traditional abdominal surgery; rarely used.
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Laparoscopic surgery                                     Accounts for 90% of gallbladder removals ---------------------------------------------------------------------------------------------------------------------------------------------
ERCP                                                                  Removal of duct stones vial oral endoscope.

 
TAKING CONTROL

• Keep moving if you're having a gallstone attack. After you've called your doctor, you may be able to make yourself more comfortable by walking or lying on a bed and rolling from side to side.
• Be alert for abdominal pain even after your gallbladder is removed. Sometimes gallstones can still form in your bile ducts. If you feel pain in your upper abdomen, notify your doctor.
• Shun the sun. Experts don't completely understand why, but there may be a link between prolonged sun exposure and development of gallstones. So avoid sunbathing if you are in any way at risk for developing gallstones.

likely to suggest surgery. If you are having symptoms of acute cholecystitis, with constant pain and fever, your doctor will want you hospitalised for intravenous antibiotics and pain control. For recurring attacks, or after an episode of acute cholecystitis that has 'cooled down' with antibiotics, your doctor may well advise surgical removal of the gallbladder, a process now greatly simplified by laparoscopic procedures.

BEWARE OF THE LIVER 'FLUSH'
A popular home remedy for gallstones, the liver 'flush' is a drink made up of olive oil, lemon juice and herbs. It's reputed to literally flush gallstones out of your gallbladder. Don't believe it. What comes out aren't really stones at all, but chunks of a soaplike material that's formed in the intestines by mixing the oil, the lemon juice and certain minerals. Not only is this drink ineffective, but the oil
could make your gallbladder contract, which can shift a gallstone and induce a severe gallbladder attack as the stone moves down (or even blocks) your bile duct.

Lifestyle changes

The top priority of most people who've passed a gallstone is to keep it from happening again. You can reduce the number of repeat episodes (and may be event prevent them) by doing the following:

• Watch your weight. An ideal body weight can help keep gallstones from forming. If you need to shed kilos, don't lose too much too fast: rapid weight loss increases gallstone production.
• Reduce dietary fat and sugar. Both have been linked to an increased risk for gallstones. Instead, eat a diet rich in fruit and vegetables; vegetarians infrequently get gallstones.
• Drink plenty of water At least six to eight glasses a day will help you maintain the right water content for bile.
• Stay regular. Eating fibre-rich foods is always helpful. For occasional constipation, use a bulk-forming laxative, such as psyllium (Metamucil) or Normacol.
• Exercise. A study of 45,000 male health professionals found that moderate to vigorous exercise reduced the risk of gallstone attacks by 20 to 40 percent. Researchers theorise that exercise is