Health Fo­cus

A gall­blad­der at­tack may be com­mon, but is not to be ig­nored. If the bile in your gall­blad­der be­comes chem­i­cally un­bal­anced, solid par­ti­cles can form. Over time, these par­ti­cles may grow into stones. Gall­stones can be as small as a grain of sand or as la

Health & Nutrition - - CONTENTS -

Pre­vent the at­tack of gall­stones

Over the past few months you’ve had sev­eral un­usual bouts of pain in your up­per abdomen. Now, you’re hav­ing an­other episode. But this time, the pain is more con­stant, last­ing much longer and ac­com­pa­nied by nausea. Tests show that you’ve been hav­ing gall­blad­der at­tacks due to gall­stones. Gall­stones are com­mon, and be­come more com­mon as you age. Of­ten, gall­stones don’t re­quire treat­ment. But some­times, they cause painful at­tacks and lead to more se­ri­ous com­pli­ca­tions. It’s im­por­tant to see your doc­tor promptly.

Aid­ing Di­ges­tion

Your gall­blad­der is a small, pear-shaped sac lo­cated be­low your liver in the right side of your up­per abdomen. It’s part of your bil­iary tract – the sys­tem in your body that trans­ports bile. Bile is a green­ish-brown liq­uid pro­duced by your liver that helps break down fats and re­move waste prod­ucts from your body. Your gall­blad­der con­cen­trates and stores bile un­til it’s needed for di­ges­tion. Af­ter you eat, your gall­blad­der con­tracts and re­leases bile into your small in­tes­tine through a se­ries of tubes known as bile ducts. If the bile in your gall­blad­der be­comes chem­i­cally un­bal­anced, solid par­ti­cles can form. Over time, these par­ti­cles may grow into stones. Gall­stones can be as small as a grain of sand or as large as a golf ball. You can have just one or hun­dreds. The two most com­mon types are: Choles­terol stones – These are made mainly of choles­terol that the bile is un­able to keep dis­solved. Pig­ment stones – Peo­ple with blood dis­or­ders and se­vere liver dis­eases are most likely to get this type of stones, which are formed when the bile con­tains too much biliru­bin, a waste prod­uct. Pig­ment stones are also more com­mon in Asians.

Why Do Gall­stones Form?

Many fac­tors con­trib­ute to gallstone for­ma­tion. One is too much choles­terol in bile. Choles­terol isn’t eas­ily sol­u­ble, and if bile con­tains more choles­terol than it can keep dis­solved, stones may form. In ad­di­tion, if your gall­blad­der doesn’t empty com­pletely or of­ten enough, bile may be­come too con­cen­trated and con­trib­ute to gallstone for­ma­tion. Other risk fac­tors in­clude: Your sex – Women are twice as likely as men to have gall­stones. That’s be­cause the fe­male hor­mone es­tro­gen causes more choles­terol to be ex­creted in bile. Preg­nancy, which causes es­tro­gen lev­els to rise, also in­creases the risk. In ad­di­tion, birth con­trol pills and hor­mone re­place­ment ther­apy in­crease bile choles­terol lev­els and re­duce gall­blad­der emp­ty­ing. Be­ing over­weight – This in­creases the amount of choles­terol in your bile and can pre­vent your gall­blad­der from emp­ty­ing prop­erly. Diet and di­et­ing – Di­ets high in fat and choles­terol and low in fi­bre may in­crease your risk. In ad­di­tion, low-calo­rie ‘crash’ di­ets can up­set the chem­i­cal bal­ance of bile and cause your gall­blad­der to con­tract less of­ten. Choles­terol-low­er­ing med­i­ca­tions – Drugs known as fi­brates in­clude fenofi­brate (Tri­cor) and gem­fi­brozil (Lopid), which slightly in­crease the risk of gallstone for­ma­tion,

prob­a­bly by chang­ing the choles­terol com­po­si­tion of the bile. Your age – As you age, your body tends to se­crete more choles­terol into bile. Your fam­ily his­tory – Gall­stones of­ten run in fam­i­lies, point­ing to a pos­si­ble ge­netic link.

When To Seek Help

When your gall­blad­der con­tracts to ex­pel bile, one or more stones may es­cape. Small stones may pass through with­out any prob­lem, but larger stones can get stuck at the en­trance to the duct that con­nects the gall­blad­der to the main bile duct, or they can lodge at the en­trance of the small in­tes­tine. Signs and symp­toms of prob­lems in­clude: Sud­den and mod­er­ate to in­tense pain in your up­per abdomen, pos­si­bly spread­ing to your back or right shoul­der blade and last­ing from 15 min­utes to sev­eral hours. Nausea and vom­it­ing. Fever. Chills. Jaun­dice (yel­low­ing of your skin and the whites of your eyes). Dark-coloured urine. Pale-coloured stools. If you ex­pe­ri­ence any of these signs and symp­toms, seek treat­ment right away. Al­though gall­blad­der at­tacks of­ten pass, your gall­blad­der can be­come in­fected and could rup­ture if a block­age re­mains. In ad­di­tion, an ob­struc­tion could block the nearby pan­cre­atic duct, caus­ing in­flam­ma­tion of the pan­creas (pan­cre­ati­tis), a po­ten­tially life-threat­en­ing con­di­tion. Rarely, gall­stones may also be re­lated to cancer. Di­ag­no­sis of gall­stones of­ten in­cludes a blood test to de­tect in­fec­tion or in­di­ca­tions that bile has backed up into the blood­stream. Ul­tra­sonog­ra­phy is the most com­monly used test to find stones within the gall­blad­der. En­do­scopic ret­ro­grade cholan­giopan­cre­atog­ra­phy (ERCP) is an imag­ing process of­ten used to lo­cate stones lodged in the bile ducts. This pro­ce­dure in­volves pass­ing a flex­i­ble tube with an at­tached cam­era (en­do­scope) down your throat and up­per di­ges­tive tract to the com­mon bile duct. A dye is then in­jected into your bile ducts so that they can be seen on X-ray. If a stone is dis­cov­ered in a duct, it usu­ally can be im­me­di­ately ex­tracted with tools passed through the en­do­scope. Bile duct stones also may be di­ag­nosed by mag­netic res­o­nance imag­ing (MRI) or en­do­scopic ul­tra­sound.

Be­cause of the many fac­tors that con­trib­ute to gall­stones, it’s hard to pre­vent them from form­ing. But, you may be able to lower your risk by main­tain­ing a healthy weight.

Treat­ment Op­tions

Gall­stones that aren’t symp­to­matic typ­i­cally re­quire no treat­ment be­cause, for many peo­ple, the risk of tak­ing them out is greater than the risk they’ll cause prob­lems. These stones are called ‘silent stones’, and they’re of­ten dis­cov­ered dur­ing tests for other health con­di­tions. For prob­lem­atic gall­stones, re­mov­ing the gall­blad­der is the most com­mon treat­ment. Your gall­blad­der isn’t an es­sen­tial or­gan, and new stones usu­ally form if just the stones are re­moved. Gall­blad­der re­moval surgery, (chole­cys­tec­tomy) of­ten per­formed la­paro­scop­i­cally, re­quires sev­eral small in­ci­sions in your abdomen through which a tiny video cam­era and sur­gi­cal in­stru­ments are passed. You’ll likely be able to re­turn to most nor­mal ac­tiv­i­ties within a few days. An open chole­cys­tec­tomy, in which your gall­blad­der is re­moved through a larger ab­dom­i­nal in­ci­sion, gen­er­ally re­quires three to five days in the hospi­tal fol­lowed by sev­eral weeks of re­cov­ery at home. It may be the best choice for cases in which the gall­blad­der is se­verely in­flamed or if you have scar tis­sue from pre­vi­ous ab­dom­i­nal op­er­a­tions.

Liv­ing With­out A Gall­blad­der

Af­ter gall­blad­der re­moval, your liver still pro­duces enough bile to di­gest a nor­mal diet. But in­stead of be­ing stored in your gall­blad­der, bile emp­ties di­rectly into the small in­tes­tine. You may no­tice that you have more bowel move­ments than you used to, and that your stools are softer. These changes are of­ten tem­po­rary. But if di­ar­rhoea per­sists, talk to your doc­tor.

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