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2014 1E3 Group 2 - Gallstones

Page history last edited by 2014class1e3group2 8 years, 8 months ago









      Gallbladder Disease

The gallbladder is a small, pear-shaped organ beneath your liver. The gallbladder holds a digestive fluid called bile, bile helps you digest fats, your gallbladder releases bile through a tube called the common bile duct. The duct joins your gallbladder and liver to your small intestine.

Gallbladder disease is a term for certain types of conditions that can affect your gallbladder. In most cases, Gallbladder Diseases is caused by gallstones that block the tube leading out of your gallbladder. This results in a build-up of bile that can cause inflammation. Other causes of Gallbladder Diseases include bile duct problems and tumours.

If left untreated, Gallbladder Diseases can become to serious complications, such as a gallbladder that becomes enlarged or that ruptures. Many gallbladder problems will improve with removal of the gallbladder. Fortunately, you can live without a gallbladder. Bile has other ways of reaching your small intestine.



Gallstones are pieces of solid substance that form in the gallbladder. They can be smaller than a grain of sand or as big as a golf ball. Some people have just one gallstone, while others develop many gallstones at the same time. Most gallstones do not cause problems. But if they block a duct, they usually need treatment.





Causes and Effects


Gallstones may form when


1. The bile contains too much cholesterol

Normally, your bile contains enough chemicals to dissolve the cholesterol excreted by your liver. But if your liver excretes more cholesterol than your bile can dissolve, the excess cholesterol may form into crystals and eventually into stones.


2. The bile contains too much bilirubin

The bile contains too much bilirubin, which is a chemical that's produced when your body breaks down red blood cells. Certain conditions cause your liver to make too much bilirubin, including liver cirrhosis, biliary tract infections and certain blood disorders. The excess bilirubin contributes to gallstone formation.


3. The gallbladder doesn't empty correctly

If the gallbladder doesn't empty completely or often enough, the  bile may become very concentrated and this lead to the contribution of forming gallstones.





Gallstones can lead to the development of abdominal pain in some people. Pain caused by gallstones often occurs in the middle or right side of the upper abdomen beneath the ribcage. Depending upon the size and location of the gallstone, abdominal pain can radiate into the upper back. Certain people notice that these symptoms worsen after eating a meal that is high in fat, such as a cheeseburger or pizza. Some people also experience episodes of abdominal gas, nausea or discomfort after eating. Chronic diarrhea can also develop in people with gallstones. Abdominal pain caused by gallstones is typically intermittent and can last for about an hour. Episodes of abdominal pain caused by gallstones can be recurrent but often do not reappear for several months or years following the first attack.


Signs and Symptoms


Signs of Gallbladder Disease 


                 1. Severe abdominal pain.

2. Jaundice (yellowing of the skins and eyes)

3. Vomiting/nausea

4. Chest pain


There are other indicators that aid in determining if gallstones are present. These markers can be classified into following categories:





Symptoms of Gallstones Disease


                 1. Sudden and rapidly increasing pain in the upper right part of the abdomen

2. Sudden pain in the centre of the abdomen just below the breastbone

3. Back pain in between the shoulder blades

4. Pain in the right shoulder


Some indicators connected with gallstone formation can be recognized quite readily while other symptoms of gallbladder can be more indefinable. Please refer to the following diagram: 



Prevention and Treatment



Ways to prevent gallstones:


1. Control your weight




Avoid fast weight loss as doing so may cause’s gallstones. Weight loss should be slow and steady.  To prevent fast weight loss, try losing one or two pounds each week until you’ve reached your objective. Also, regular weight loss trailed by weight gain (known as weight cycling) could cause gallstones too, hence try to maintain your weight once you lose it.



2. Exercise




Doing regular exercises can help to reduce your weight, and also may prevent gallstones.  Do thirty minutes of exercise five times a week is needed to make a difference.



3. Eat many fruits and vegetable 




Eating many different types’ fruits and vegetables may help to prevent gallstones.



4. Sugar




Too much sugar in your diet could actually cause gallstones. Hence do not eat so much sweets and also choose low-sugar food if possible. 



Some treatment to treat gallstones:



1. Surgery




Many people have gallbladder surgery to lighten the pain and to avoid serious conditions causes by gallstones.


2. Extracorporeal shock wave lithotripsy (ESWL)




Another treatment is that gallstones need to meet certain criteria is extracorporeal shock-wave lithotripsy. It is the best effective on solitary gallstones that are less than 2 centimetres in diameter. The goal of this treatment is to break up the gallstones by sending shock waves through soft tissues of the body.


3. Oral Bile Acids





In some cases, gallstones can be treated by medicine. Certain chemicals have shown to dissolve some gallstones, are existing in oral bile acid pills. These medicines work by thinning the bile, hence allowing the gallstones to dissolve.


4. Contact Dissolution Therapy



This treatment choice include injecting a solvent (called methyl tertiary-butyl ether) into the gallbladder to dissolve the gallstones. Initial studies have shown that MTBE rapidly dissolves the gallstones.





Link to Other Illnesses or Diseases


Liver Disease




Advanced cirrhosis is a fixed risk factor for gallstones. Usually the stones contain the black pigment type in patients with cirrhosis. This is likely linked to altered pigment secretion, abnormal gallbladder motility and or increased estrogen levels.


Gallstone Disease




Gallstone disease is related with chronic hepatitis C viral infection and non-alcoholic fatty liver disease; other factors for this are metabolic syndrome and obesity.


Crohn's Disease







There is some fold increased risk of developing gallstones in patients with extensive Crohn’s disease. The reason for this is the loss would lead to bile acid malabsorption and depletion, reducing hepatic secretion of bile acids and bile that is supersaturated with cholesterol, hence leading to cholesterol stone creation. Failure of terminal  deliver of this disease allow additional bile acids to leak to the colon, where these biological detergents solubilize unconjugated bilirubin and  allow their absorption and return to the liver. The liver will secretes the unnecessary pigment and become gallstones.


Cystic fibrosis





Similar to Crohn’s disease, cystic fibrosis is related to bile acid malabsorption as it required undigested dietary nutrients. Gallstone status in cystic fibrosis is increased from 10% to 30%.


Other diseases




In sickle cell disease, chronic hemolysis leads to unnecessary bilirubin excretion with the formation of black pigment stones composed of calcium bilirubinate. These tend to be small in size, permitting some to travel into the common duct; the resultant obstruction is low-grade, not necessarily accompanied by duct dilation or cholangitis. Due to possible complications and the trouble in distinguishing biliary-type pain from other complications of sickle cell disease, prophylactic cholecystectomy should be considered.













Comments (1)

tan_wei_zhi@moe.edu.sg said

at 7:15 am on Jul 4, 2014

Good job in doing up the wiki, but one section is missing!

Some suggestions:
1. Do use a consistent font type or size so that it doesn't seem like it is done by different people.

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