GALL STONES - CHOLELITHIASIS

Definition: Cholelithiasis is the formation of gallstones in the biliary tract.It affects about 10% of the population in developed countries. Gallstones consist of bile pigments, calcium and/or cholesterol and form due to fat-soluble endogenous waste, fat-soluble toxins and/or bile stagnating in the gallbladder. The stagnant ‘sludge’ accumulates and solids may precipitate out of solution and coalesce into gravel and/or stones.

Types of gallstones include:
• Cholesterol stones — 70% prevalence—composed of at least 70% cholesterol by weight.
• Pigmented stones — 20% prevalence—composed of calcium bilirubinate.
• Calcium stones — 10% prevalence—composed of calcium carbonate: chalky, white appearance.

Aetiology/Major causative factors and risk factors that can contribute to the incidence of gallstones include the following:
• Imbalance in the relative amounts of cholesterol, phospholipids and bile salts in bile.
• Increased biliary secretion of cholesterol due to obesity, oestrogen therapy and/or age.
• Decreased hepatic secretion of bile salts and phospholipids.
• Stone formation requires cholesterol saturation due to hypercholesterolaemia and/or dyslipidaemia.
• Biliary stasis within the gallbladder due to hepatotoxicity.
• Gallbladder motor functioning impairment can cause delayed stasis and emptying.
• Biliary tract infection due to bacteria (especially E. coli) or parasites.
• Excessive consumption of fatty foods, dairy products and fried foods.
• Production of toxic bile by the liver.
• Excessive alcohol consumption
• Viral hepatitis
• Obesity
• Risk increases with age
• Female gender
• The hormonal changes of pregnancy
• The oral contraceptive pill and some types of hormone replacement therapy

Signs and Symptoms:
Most people with gallstones never develop symptoms,but if they do, some common signs and
symptoms include:
• Digestive disorders due to fats being inadequately solubilized and absorbed: e.g., nausea, vomiting, flatulence, anorexia, constipation and/or loose stool.
• Pain immediately following meals – particularly fatty meals.
• Indigestion and nausea after eating (especially fatty foods).
• Pain in the right upper abdomen, which often radiates to the right shoulder blade and back.
• Biliary colic
• Stools that are clay-coloured and/or float
• Jaundice
• Fever
• Liver damage can be a result of poor bile flow (due to stasis of flow in the ducts).
• Stones blocking the lower end of the common bile duct where it enters the duodenum may obstruct secretion from the pancreas, producing pancreatitis.