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Gallstones
Overview

Gallbladder attacks can come on suddenly out of nowhere. It could be the middle of the night or just after a heavy meal. The pain can be excruciating and last for hours. Gallbladder attacks are caused by gallstones and a very common condition in the U.S.
Around 14.2 million women and 6.3 million men suffer from gallbladder disease. Hispanics and Native Americans tend to be more prone to gallbladder disease, buy anyone from any ethnic background can get it. Gallstones with no symptoms are usually not surgically treated, but can be managed with a strict diet to prevent more from forming. Untreated gallstones that have symptoms can cause complications. This article will help you understand more about gallstones and gallbladder disease.
Gallstones form in the gallbladder, just under the liver and next to your pancreas. The gallbladder secretes bile from your liver into your intestines to aid digestion. Bile fluid along with other substances forms into the stones that either sit inside the gallbladder or they can be ejected into the common bile duct. This can cause blockages in the bile duct or the opening to the pancreas.
Gallstones can be very tiny and not even noticeable, but can grow to the size of a small lime if untreated. You may have just one gallstone or several.
During a gallbladder attack, there can be intense pain with nausea and vomiting. This usually occurs after a high fat meal, caffeine intake, or even just randomly for no apparent reason. The pain can last from 20 minutes, to a few hours, and even a few days.

Gallstones Causes

Gallstones are caused by substances in the bile that form into stones. The two types of gallstones include:

Cholesterol Stones. These are very common and are formed from the cholesterol directly from what you eat and not related to blood cholesterol.
Bilirubin. When your red blood cells break down and form bilirubin, too much may be deposited in your bile and can lead to stones.

The actual causes of gallbladder disease vary and the tendency to get the disease can be familial. It is common in people who are overweight and dieting, age over 40 (but can occur in younger people), and pregnant women. Other factors include:

Use of birth control pills
Recent weight loss surgery or rapid weight loss
Cirrhosis of the liver
Diabetes
Malformation of the biliary tract that causes blockage of bile

Gallstones Symptoms

A mild case of gallstones may be symptom-less. When the stones become large or begin to spill out of the gallbladder, symptoms begin to occur including:

Severe pain in the upper right abdominal area that comes on suddenly
Pain in the middle of the abdomen that may radiate to the back
Pain in between the shoulders
Right shoulder pain
Nausea
Vomiting
Fever (a sign to get emergency medical attention)
The pain with gallbladder attacks can last a few minutes to a few days. If you have the following signs, go to your nearest emergency room:

Yellow skin and/or eyes
Severe abdominal pain that does not go away
Fever with chills
Throwing up bile (yellow and very acidic)

Gallstones Risk Factors

There are several risk factors associated with gallstones and gallbladder disease. These include:
Family History
Females
Pregnancy – Hormones cause slowing of bile duct movement
High fat diet
Obesity
Diabetes
Native American or Hispanic ethnicity

Gallstones Diagnosis

If you have symptoms of gallstones, see your doctor as soon as possible. The tests for gallstones include:
CT Scan. The doctor may order a CT scan with contrast to create a picture of your gallbladder and bile ducts for measurements.
Ultrasound. This can be used to check the measurements of your bile ducts, which will be enlarged if there are stones present.
HIDA – Hepatobiliary Iminodiacetic Acid. The radiologist will give you a tracer in your arm that hooks into the bile in the bile duct. When the scanner picks up the tracer, it can see the movement of bile.
ERCP – Endoscopic Retrograde Cholangiopancreatography. The doctor sends a scope down your esophagus, through your stomach, and into the biliary tract. They can see the actual stones and remove them if necessary.
Laboratory Tests. The doctor will run tests to check your blood count for signs of infection, liver panels, and check your pancreatic enzymes to make sure you don’t have pancreatitis.

Gallstones Treatment

Gallstones can only be treated, but once you develop gallbladder disease it is permanent. Treatments are aimed at reducing gallstones and preventing them from growing. It can also reduce symptoms. Here are the treatments for gallstones:

ESWL – Extracorporeal Shockwave Lithotripsy. The doctor can use shockwaves during ERCP to break up any large stones. They can then move easily through the biliary tract and be passed from the body. Pain may increase shortly after treatment and then subside after the stones are passed.

Medications. There are medications that can help dissolve gallstones. They take a long time to be effective and recurrence is common. This is not a common treatment, but an option for those who are at risk of complications from surgery. The stones should be the cholesterol type and medications can cause diarrhea.

Surgery. If you have severe gallbladder disease, you may need to have your gallbladder removed. The good news is you can live without it because the bile will go straight from your liver into your digestive system. This almost completely stops gallstones from forming, but they can still occur just less often.

If a gallstone blocks the opening to your pancreas and you develop pancreatitis, then you will need to wait until that clears up before surgery can be done.

Alternative Medicine for Gallstones

There are a few alternative remedies that may be helpful for gallstones. This needs to be done as part of your treatment plan that you and your doctor decide on. Alternative remedies should always be discussed with your doctor. Gallstones can have serious complications and should always be evaluated by your doctor. Here are some alternative remedies that may help:
Rowachol. Is a plant based treatment of either pine oils or rosemary oils that is said to shrink or completely dissolve gallstones. It has been effective in some cases and studies are ongoing.
Lecithin. Taking soy lecithin may be helpful in dissolving stones of the cholesterol type. It may also be more effective if taken with Rowachol together.
Gallbladder Flushing. Gallbladder flushes are done with both lubricant and acidic substances that are drank. Most recipes call for olive oil and lemon juice. Some say that it really does work, but the medical community still questions of this treatment is safe since gallstones may break free and cause blockage in other areas.

Lifestyle Changes for Gallstones

Dietary changes can relieve the pain of gallstones and prevent new ones from developing. If you still have your gallbladder and have symptoms, avoid these foods:
Foods high in cholesterol
Refined sugars
Beans
Onions or bell pepper
Fried foods
Foods high in saturated fat ie. butter, fatty meats, whole milk
Caffeine – stimulates gallbladder contractions

Most important is to not go on a diet and lose weight too quickly. This can stimulate gallbladder attacks.
Include these foods in your diet:
Foods high in fiber
Nuts
Fresh fruits and vegetables
Wine. Just 1 to 2 glasses daily can lower the risk
Healthy oils. Olive oil, fish oils

Complications of Gallstones

Untreated gallstones can cause severe complications. These include:
Infection/Gangrene. If the gallbladder becomes infected it can turn into gangrene and cause sepsis in the body. This is rare, but can happen. If you develop fever, chills and severe pain get emergency medical help.
Pancreatitis. This is a serious illness and caused by blockage of the pancreatic duct. You will need to be hospitalized and cannot have any food or fluids by mouth until your pancreas heals.
Gallbladder Cancer. This is rare, but gallstones can raise the risk of cancer in the gallbladder.

Bibliography

Mayo Clinic. (2013, July 25). Gallstones. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/gallstones/basics/definition/con-20020461
National Institute of Health. (1999, September 11). Prevalence and ethnic differences in gallbladder disease in the United States. Retrieved from PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10464139
National Institute of Health. (2013, July 18). Gallstones. Retrieved from MedLine Plus: https://www.nlm.nih.gov/medlineplus/ency/article/000273.htm
PubMed. (2009). Nutritional approaches to prevention and treatment of gallstones. Alternative Medicine Review, (3):258-67.
Simore Afamefuna, P. C., & Shari N. Allen, P. B. (2013). Gallbladder Disease. U.S. Pharmacist, 38(3):33-41. Retrieved from Medscape.

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