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In medicine, gallstones (choleliths) are crystalline bodies formed within the body by accretion or concretion of normal or abnormal bile components. Cholesterol stones are usually green, but are sometimes white or yellow in color and account for about 80 percent of gallstones. They are made primarily of cholesterol.
Gallstones can occur anywhere within the biliary tree, including the gallbladder and the common bile duct. Obstruction of the common bile duct is choledocholithiasis; obstruction of the biliary tree can cause jaundice; obstruction of the outlet of the pancreatic exocrine system can cause pancreatitis. Cholelithiasis is the presence of stones in the gallbladder — chole- means "gall bladder", lithia meaning "stone", and -sis means "process". Gallstones' size varies and may be as small as a sand grain or as large as a golf ball. The gallbladder may develop a single, often large, stone or many smaller ones, even several thousand. Gallstones are, oddly, a valuable by-product of meat processing, fetching up to US$900 per ounce in their use as a purported aphrodisiac in the herbal medicine of some cultures. The finest gallstones tend to be sourced from old dairy cows. Much as in the manner of diamond mines, slaughterhouses carefully scrutinise offal department workers for gallstone theft.[1]
Causes
In addition, increased levels of the hormone estrogen as a result of pregnancy, hormone therapy, or the use of birth control pills, may increase cholesterol levels in bile and also decrease gallbladder movement, resulting in gallstone formation. No clear relationship has been proven between diet and gallstone formation. However, low-fiber, high-cholesterol diets, and diets high in starchy foods have been suggested as contributing to gallstone formation. Other nutritional factors that may increase risk of gallstones include rapid weight loss, constipation, eating fewer meals per day, eating less fish, and low intakes of the nutrients folate, magnesium, calcium, and vitamin C. (J Am Coll Nutr 1997 Feb;16(1):88-95). On the other hand, coffee, wine, fish, and whole grain bread may decrease the risk of gallstones. (Eur J Gastroenterol Hepatol 1996 June;8(6):585-93.) SymptomsA main symptom of gallstones is commonly referred to as a gallstone "attack", in which a person will experience intense pain in the upper abdominal region that steadily increases for approximately thirty minutes to several hours. A victim may also encounter pain in the back, ordinarily between the shoulder blades, or pain under the right shoulder. In some cases, the pain develops in the lower region of the stomach, nearer to the pelvis, but this is less common.[citation needed] Nausea and vomiting may occur. These attacks are intensely painful, similar to that of a kidneystone attack. One way to alleviate the abdominal pain is to drink a full glass of water at the start of an attack to regulate the bile in the gallbladder, but this does not work in all cases.[citation needed] Another way is to take magnesium followed by a bitter liquid such as coffee or swedish bitters an hour later.[citation needed] Bitter flavors stimulate bile flow, and studies have found lower rates of gallstones in coffee drinkers.[3] Often, these attacks occur after a particularly fatty meal and almost always happen at night. Other symptoms include abdominal bloating, intolerance of fatty foods, belching, gas, and indigestion. If the above symptoms coincide with chills, lowgrade fever, yellowing of the skin or eyes, and/or clay-colored stool, a doctor should be consulted immediately.[4] Some people who have gallstones are asymptomatic and do not feel any pain or discomfort. These gallstones are called "silent stones" and do not affect the gallbladder or other internal organs. They do not need treatment.[4] Medical optionsCholesterol gallstones can sometimes be dissolved by oral ursodeoxycholic acid. This drug is very expensive, however, and the gallstones may recur once the drug is stopped. Obstruction of the common bile duct with gallstones can sometimes be relieved by endoscopic retrograde sphinceterotomy (ERS) following endoscopic retrograde cholangiopancreatography (ERCP). A common misconception is the use of Extracorporeal Shock Wave Lithotripsy which is a non-invasive treatment that uses ultrasound to break up kidney, not gall, stones. A regimen called a "gallbladder flush" or "liver flush" is a popular remedy in alternative medicine. In this treatment, often self-administered, the patient fasts briefly, takes magnesium, and then drinks large quantities of lemon or grapefruit juice mixed with olive oil or other oil before bed; the next morning, they painlessly pass a number of green and brown pebbles purported to be stones flushed from the biliary system. A New Zealand hospital analyzed stones from a typical gallbladder flush and found them to be composed of fatty acids similar to those in olive oil, with no detectable cholesterol or bile salts [5]. Surgical optionsCholecystectomy (gallbladder removal) has a 99% chance of eliminating the recurrence of cholelithiasis. Only symptomatic patients must be indicated to surgery. The lack of a gall bladder does not seem to have any negative consequences in many people. However, there is a significant proportion of the population, between 5-40%, who develop a condition called postcholecystectomy syndrome [1]. Symptoms include gastrointestinal distress and persistent pain in the upper right abdomen. There are two surgery options: open procedure and laparoscopic: see the cholecystectomy article for more details.
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