GALLSTONES

Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder holds a digestive fluid called bile that’s released into your small intestine.

Types of gallstones

1.Cholesterol gallstones.

Cholesterol gallstones usually contain >50% cholesterol monohydrate plus an admixture of calcium salts, bile pigments, proteins, and fatty acids.

2.Pigment gallstones.

These dark brown or black stones form when your bile contains too much bilirubin.

CAUSES

1.Obesity, metabolic syndrome: Normal bile acid pool and secretion but increased biliary secretion of cholesterol

2. Losing weight very quickly: Mobilization of tissue cholesterol leads to increased biliary cholesterol secretion while enterohepatic circulation of bile acids is decreased

3.Female sex hormones

• Estrogens stimulate hepatic lipoprotein receptors, increase uptake of dietary cholesterol, and increase biliary cholesterol secretion
• Natural estrogens, other estrogens, and oral contraceptives lead to decreased bile salt secretion and decreased conversion of cholesterol to cholesteryl esters

4.Pregnancy: Impaired gallbladder emptying caused by progesterone combined with the influence of estrogens, which increase biliary cholesterol secretion

5.Increasing age: Increased biliary secretion of cholesterol, decreased size of bile acid pool, decreased secretion of bile salts

6. Hormone therapy drugs

7.Clofibrate therapy: Increased biliary secretion of cholesterol

8.High-calorie, high-fat diet

9.Oral contraceptives or hormone therapy drugs

10.Diabetes

11.Eating a low-fiber diet

12.Having a family history of gallstones

13.Liver disease.

14.Alcohol

15.Smoking

16.Gallbladder hypomotility leading to stasis and formation of sludge

17.Prolonged parenteral nutrition

18.Fasting

19.Pregnancy

20.Use of INSECTICIDE,PESTICIDE,RODENTICIDE,WEEDICIDE in agriculture

Organophosphorus  Poison(Op Poison)-Malathoin, Tetron, Parathion,Chlorthoin,Diazion(Tik 20)

Organo Chlorines-Ddt,Aldrin,Endrin,Endosulfan,Benzene Hexa Chloride

Paraquat(Weedol)

Flourides(Sodium Flourides)

Zinc Phosphide

Aluminum Phosphide

PATHOGENESIS

Cholesterol and phospholipids are secreted into bile as unilamellar bilayered vesicles, which are converted into mixed micelles consisting of bile acids, phospholipids, and cholesterol by the action of bile acids.

First mechanism :

An excess of biliary cholesterol in relation to bile acids and phospholipids is primarily due to hypersecretion of cholesterol, but hyposecretion of bile acids or phospholipids may contribute.

Supersaturation of bile with cholesterol is an important prerequisite for gallstone formation.

Second  mechanism:

Nucleation of cholesterol monohydrate crystals. Accelerated nucleation of cholesterol monohydrate in bile may be due to either an excess of pronucleating factors (Mucin and  nonmucin glycoproteins, principally immunoglobulins),  or a deficiency of antinucleating factors(apolipoproteins A-I and A-II )

 Third mechanism:

Cholesterol gallstone formation is gallbladder hypomotility. If the gallbladder emptied all supersaturated or crystal-containing bile completely, stones would not be able to grow.

Biliary sludge is a thick, mucous material that, upon microscopic examination, reveals lecithin-cholesterol liquid crystals, cholesterol monohydrate crystals, calcium bilirubinate, and mucin gels.

The presence of biliary sludge implies two abnormalities: (1) the normal balance between gallbladder mucin secretion and elimination has become deranged, and (2) nucleation of biliary solutes has occurred. That biliary sludge may be a precursor form of gallstone disease.

SYMPTOMS

Gallstones usually produce symptoms by causing inflammation or obstruction following their migration into the cystic duct or CBD.

• Obstruction of the cystic duct or CBD by a stone produces increased intraluminal pressure and distention of the viscus that cannot be relieved by repetitive biliary contractions. The resultant visceral pain is characteristically a severe, steady ache or fullness in the epigastrium or right upper quadrant (RUQ) of the abdomen with frequent radiation to the interscapular area, right scapula, or shoulder.
• Vague epigastric fullness,
• Dyspepsia,
• Eructation
• Flatulence, especially following a fatty meal
• Nausea and vomiting

COMPLICATIONS

1. Cholecystitis( 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.
2. Blockage of the common bile duct. Gallstones can block the tubes (ducts) through which bile flows from your gallbladder or liver to your small intestine. Severe pain, jaundice and bile duct infection can result.
3. Blockage of 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.
4. Gallbladder cancer.

Prevention

• Quit smoking
• Avoid drinking alcohol
• Drink plenty of water 3-4liters
• Reduce your weight gradually
• Avoid using contraceptive pills
• Reduce high cholesterol diet
• Avoid deep fried oily food
• Avoid cakes and confectionery
• Regular exercise
• Maintain ideal body weight
• Avoid chemical pesticides, chemical fertilizer for farming
• Avoid herbicides
• Avoid weedicides
• Avoid rodenticide

DIAGNOSIS

• Ultrasound abdomen
• CT abdomen

TREATMENT

HOMEOPATHY MEDICINE