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What are Gall Stone Symptoms ?
A small, hard, pathological mass
composed of cholesterol, calcium salts, bile pigments that forms
in the gall bladder or nearby bile duct is referred to as a
gallstone. Gallstones can be found in the gall bladder or in the
bile duct that connects gall bladder to the small intestine.
Gallstones usually form in the gallbladder; however, they also
may form anywhere there is bile--in the intrahepatic, hepatic,
common bile, and cystic ducts. Gallstones are alternatively
called cholelithiasis.
Gallstones form when liquid stored in the gallbladder hardens
into pieces of stone-like material. Gallstones can be as small
as a grain of sand or as large as a golf ball. There can be just
one large stone, hundreds of tiny stones, or any combination.
Bile is a watery liquid made by the cells of the liver that is
important for digesting food in the intestine, particularly fat.
The gall bladder is a small pear-shaped organ on the underside
of the liver that is used to store bile. Bile is made in the
liver and is stored in the gall bladder until it is needed to
help the digestion of fat. Hepatic ducts carry bile out of the
liver; the cystic duct takes bile to and from the gallbladder;
and the common bile duct takes bile from the cystic and hepatic
ducts to the small intestine. When body needs to digest fats
gallbladder contracts and pushes the bile into the small
intestine to aid in fat digestion. Gallstones can block the
normal flow of bile if they lodge in any of the ducts that carry
bile from the liver to the small intestine. Gallstones may be
present in the gall bladder and is then referred to as
cholecystolithiasis, or it
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may be present in the common bile
duct when it known as choledocolithiasis. Bile contains water,
cholesterol, fats, bile salts, and bilirubin. If bile contains
too much cholesterol, bile salts, or bilirubin, it hardens into
stones. There are two major types of gallstones which seem to
form due to distinctly different pathogenic mechanisms.
Cholesterol Stones - About 90% of gallstones are
of this type. The stones may be composed purely of cholesterol
or mixtures of cholesterol and substances like mucin. Stones
range in size from 5-25 mm in diameter. Cholesterol gallstones
are usually yellowish green in colour. The key event leading to
formation and progression of cholesterol stones is precipitation
of cholesterol in bile. Stone formation is favoured when bile
becomes supersaturated with cholesterol. Factors that favours
cholesterol precipitation include hypersecretion of cholesterol
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bile, hyposecretion of bile salts or
impaired gall bladder function such that there occurs incomplete
emptying. There may also be genetic determinants for cholesterol
stone formation. The prevelance in adult females is two to three
times that seen in males, presumably because the female sex
hormones, progesterone and also probably estrogen impair gall
bladder emptying and are associated with hypersecretion of
cholesterol into bile.
Pigment
Stones - Roughly 10% of human gallstones are
pigment stones composed of large quantities of bile pigments eg
bilirubin, along with lesser amounts of cholesterol and calcium
salts.
Pigment stones may develop as a
result of chronic hemolysis, since bilirubin is found to be a
major constituent of these stones. Pigment stones have also been
reported in people suffering from liver cirrhosis. Evidence also
suggests that bacteria or other microorganisms may trigger
pigment stone formation.
Symptoms of Gallstones
About 90% of gallstones provoke no symptoms at all, and are said
to be asymptomatic and these stones are called "silent stones."
They do not interfere in gallbladder, liver, or pancreas
function and do not need treatment. Symptoms usually occur as
complications develop. Symptoms of gallstones are often called a
gallstone "attack" because they occur suddenly. Gallstone
attacks often follow fatty meals, and they may occur during the
night.
• Biliary Pain: The mildest
and most common symptom of gallbladder disease is intermittent
pain called biliary colic, which occurs either in the mid- or
the right portion of the upper abdomen. The pain may last from
30 minutes to several hours. Sometimes patients experience pain
behind the breast bone. At times pain may be experienced in the
back between the shoulder blades, or under the right shoulder.
Changes in position, pain relievers, and passage of gas do not
relieve the symptoms. Episodes of pain may occur every few days,
weeks, or months; they may even be separated by years. Large or
fatty meals can precipitate the pain, but it usually occurs
several hours after eating and often wakes the patient during
the night.
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• Nausea or vomiting may occur.
• Recurring intolerance for fatty or greasy foods.
• Indigestion, belching, bloating.
Chronic gall bladder disease(Chronic cholecystitis) is
characterized by gallstones and low-grade inflammation. In such
cases the gallbladder may become scarred and stiff. Patients may
complain of gas, nausea, and abdominal discomfort after meals.
Chronic diarrhea (four to 10 bowel movements every day for at
least three months) is seen in some patients.
Inflammation and infection of gall bladder(Acute cholecystitis)
may sometimes result due to gallstones. Symptoms may be severe
than biliary pain, acute pain and tenderness in the abdomen,
shoulder blades, behind breast bone. |
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Pain is felt even while drawing breath.
This is accompanied by fever and chills. Acute cholecystitis can
progress to gangrene or perforation of the gallbladder if left
untreated. Acute cholecystitis is often seen as a complication in
patients suffering from diabetes. Complications of acute
cholecystitis include septicemia(spreading of infection to other
parts of the body), a life threatening condition. It is
characterized by fever, rapid heartbeat, fast breathing, and mental
confusion. If acute cholecystitis is untreated and becomes severe,
inflammation can cause destruction of tissue in the gallbladder
(called necrosis) to lead to gangrene. Formation of stones in the
common bile duct is referred to as choledocholithiasis. About 15% of
people with gallstones will develop stones in the common bile duct.
The common bile duct is a small tube that carries bile from the
gallbladder to the duodenum. Obstruction of the common bile duct may
also lead to obstruction of the pancreatic duct because these ducts
are usually connected. If the pancreatic duct is also obstructed,
pancreatitis may also develop.
Some of the
symptoms include
• Jaundice(yellowing of the skin or the whites of the eyes)
• Dark urine, or clay-colored stools, or both.
• Rapid heart beat, drop in blood pressure.
• Fever, chills, nausea and vomiting, and severe pain in the upper
right abdomen. These symptoms suggest an infection in the bile duct
(called cholangitis).
Choledocholithiasis is responsible for most cases of pancreatitis
(inflammation of the pancreas), a condition that can be
life-threatening. This is so because the pancreatic duct joins the
common bile duct before entering the intestine.
Rarely, gallstones may result in gall bladder cancer, with symptoms
like weight loss, anemia, recurrent vomiting, and a lump in the
abdomen, which show up at an advanced stage. Gallstones are
diagnosed by ultrasound or other imaging techniques.
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Article Contributed By: Shaonli
Dasgupta
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