The Gallstone Elimination Report

The Gallstone Elimination Ebook by David Smith

Gallstones are the most popular cause of gallbladder problems. While doctors often tell gallstone sufferers to remove gallbladder to treat their condition, David Smith, a natural health researcher, found another extremely-effective option called The Gallstone Elimination Report. With the program, people will find out the top 3 digestive conditions related to gallbladder disease and how to relieve them easily. Besides, the program guides people on how to prevent gallstones from coming back. Users will also know how to boost their energy levels and how to slow down the aging process. Using this step-by-step and comprehensive guide, users will get to know how to get rid of gallstones in 24 hours or less, without drugs, surgery, or pain. This method is safe and very affordable also. More here...

The Gallstone Elimination Report Summary


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Contents: 99 Page EBook
Author: David Smith
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Symptoms associated with gall stones

There may be difficulty when symptoms are less clear. In a year about 25 of the adult population consults a general practitioner for dyspeptic symptoms. As nearly 8 of these individuals will have asymptomatic gall stones, many patients with dyspeptic symptoms are given the label gallstone dyspepsia. A pattern of symptoms supposedly associated with gall stones has been described, but several careful studies of patients before and after cholecystectomy have failed to show any clear association with either a good or poor outcome. Since asymptomatic gall stones and dyspepsia are so common in the general populations, they often coexist. Dyspeptic symptoms may be too readily attributed to the presence of gall stones, leading to inappropriate and ineffective surgery. Not surprisingly, therefore, symptoms may persist in up to 20 of patients after cholecystectomy.

Burden Of Gallstone Disease

Gallstones are an ancient entity, having occurred more than 3500 years ago according to autopsies performed on Egyptian and Chinese mummies. Gallbladder disease today is a common problem 20 to 25 million Americans harbor gallstones, representing 10 to 15 of the adult population.1 It constitutes a major health burden, with direct plus indirect costs of approximately 6.2 billion annually in the United States.4 This burden has increased more than 20 since the 1980s and accounts for an estimated 1.8 million ambulatory care visits. Gallstone disease is now a leading cause of hospital admissions for gastrointestinal problems,5 yielding 622,000 discharges (according to the most responsible diagnosis) each year in the United States.4 This hospital burden is actually an underestimate most admissions occur for laparoscopic cholecystectomy, commonly done without an overnight stay and thus not included in hospitalization statistics. Gallstone disease has a low mortality rate of 0.6 , but...

Guidelines For Management Of Gallstone Disease

Gall Bladder

Gallbladder stones are frequently found in asymptomatic patients during routine abdominal ultrasonography, because in most cases (60 -80 ) gallstones do not generate symptoms.43,48,49 Previous observations have shown that the average risk of developing symptomatic gallstones is 2.0 to 2.6 per year.45,50 By contrast, the presence of microstones and sludge in the gallbladder is a major risk factor for the development of biliary pain and complicated gallstone disease, and also plays a main role in the cause of acute otherwise idiopathic pancreatitis.51-53 Nevertheless, the yearly incidence of complications is low (0.3 ), and the annual risk for gallbladder cancer is as low as 0.02 .54,55 Treatment of asymptomatic patients with gallstones, therefore, is not routinely recommended, as the overall risk of biliary colic, complications, and gallbladder cancer is low.56-58 Expectant management is considered the appropriate choice in most asymptomatic patients with gallstones (grade A). The...

Gallstone Exporters Mail

Could also affect intestinal cholesterol absorption. The bile salt export pump (current nomenclature ABCB11) pumps bile salts over the membrane into bile.53 Severe mutations in ABCB11 lead to progressive intrahepatic cholestasis in the first decade of life that rapidly leads to liver failure (PFIC2), whereas less severe mutations may lead to benign recurrent cholestasis (BRIC2) and intermittent intractable pruritus. A considerable number of patients with BRIC2 exhibit associated gallstones, supposedly caused by insufficient amounts of biliary bile salts.54 The human MDR3 (multidrug resistance 3) P-glycoprotein (current nomenclature ABCB4) functions as a floppase, translocating phosphatidylcholine molecules from the inner to the outer leaflet of the canalicular membrane, enabling their secretion into bile.55 Recently, a subset of gallstone patients has been identified with intrahepatic and bile duct stones at young age (

Ethnicity And Gallstone Disease

The highest prevalence of gallstone disease has been described in North American Indians 64.1 of women and 29.5 of men have gallstones (Table 1).1,12 This apparent epidemic reaches a high of 73 in Pima Indian women over age 30.13 Similar high occurrences have been reported among the aboriginal populations of South America.14 In the native Mapuche of Chile, gallstone disease afflicts 49.4 of women and 12.6 of men, exceeding 60 in women in their 50s. Mexican Americans are also at an increased risk when compared with white Americans.15 As elsewhere in the Americas, this risk is directly related to the degree of Amerindian admixture. White Americans have a prevalence of 16.6 in women and 8.6 in men.15,16 In Northern Europe, prevalence is somewhat higher at 20 , whereas lower rates are evident in Italy at 11 .8,17 Intermediate prevalence rates occur in Asian populations and black Americans (13.9 of women 5.3 of men).16 The lowest frequencies occur in sub-Saharan black Africans (85 )...

Is there any medication that can help prevent gallstones from forming during rapid weight loss

One large multicenter study reported that treating patients with ursodiol (a medication that prevents gallstone formation) at a dose of 600 mg per day was highly effective in preventing gallstone formation during the rapid weight loss phase immediately following surgery. In this study gallstones formed in 32 percent of people who received placebo (sugar pill) versus 2 percent of those treated with ursodiol at 600 mg per day. Based on this data some centers routinely use 600 mg of ursodiol per day for about six months following surgery.

Pathophysiology Of Cholesterol Gallstone Formation

It is not surprising, that in a polygenetic disorder as cholesterol gallstone disease, several underlying mechanisms may be involved in its pathogenesis. Nevertheless, the common theme remains excess biliary cholesterol compared with solubilizing bile salts or phospholipids. In Chilean patients (especially of Amerindian descent), increased bile salt and cholesterol synthesis have been reported.42 The defect was supposed to be secondary to increased intestinal loss of bile salts, and preceded gallstone formation. Interestingly, decreased expression of ileal bile salt transport proteins apical sodium-dependent bile acid transporter, cytosolic ileal lipid binding protein, and basolateral organic solute transporter a and b were recently described in female nonobese patients as a possible explanation of these findings.43,44 It has also been reported that high dietary cholesterol increases biliary cholesterol secretion and decreases bile acid synthesis and pool in cholesterol gallstone...

Symptomatic gall stones are usually treated by laparoscopic cholecystectomy

Gall stones are common but often do not give rise to symptoms. Pain arising from the gall bladder may be typical of biliary colic, but a wide variety of atypical presentations can make the diagnosis challenging. After a period of uncertainty in the 1980s, when operative techniques were challenged by drug treatment and lithotripsy, it is now widely accepted that symptomatic gallbladder stones should be treated by laparoscopic cholecystectomy. Clinical judgment and local expertise will greatly influence the management of bile duct stones, particularly if cholecystectomy is also required.

Epidemiology of gall stones

In the United Kingdom about 8 of the population aged over 40 years have gall stones, which rises to over 20 in those aged over 60. Fortunately, 90 of these stones remain asymptomatic, but cholecystectomy is the most commonly performed abdominal procedure. The incidence of gall stones varies widely, being greatly influenced by dietary intake, particularly of fat. For example, in Saudi Arabia gallstone disease was virtually unheard of 50 years ago, but, with increasing affluence and a Western type diet, gall stones are now as common there as in many Western countries. Genetic factors also contribute. The native Indian populations of Chile and Peru are highly susceptible, with a close to 100 lifetime risk of gall stones in their female population. Several risk factors have been identified, which relate to the two major stone types, cholesterol stones and pigment stones.

Of Cholesterol Gallstone Formation

Hussain and Chandrasekhara studied the efficacy of curcumin in reducing the incidence of cholesterol gallstones induced by feeding a lithogenic diet in young male mice (83). Feeding a lithogenic diet supplemented with 0.5 curcumin for 10 weeks reduced the incidence of gallstone formation to 26 , as compared to 100 incidence in the group fed with the lithogenic diet alone. Biliary cholesterol concentration was also significantly reduced by curcumin feeding. The lithogenic index, which was 1.09 in the cholesterol-fed group, was reduced to 0.43 in the 0.5 curcumin-supplemented group. Further, the cholesterol phospholipid ratio of bile was also reduced significantly when 0.5 curcumin-supplemented diet was fed. A dose-response study with 0.2 , 0.5 , and 1 curcumin-supplemented lithogenic diets showed that 0.5 curcumin was more effective than a diet with 0.2 or 1 curcumin. How curcumin mediates antilithogenic effects in mice was further investigated by this group (84). For this purpose, the...

Nuclear Receptors And Cholesterol Gallstone Formation

And bile salt homeostasis.58 The primary bile salt chenodeoxycholic acid is the highest affinity endogenous ligand characterized for FXR in the enterohepatic system.59 In the liver, the activation of FXR by endogenous bile salts inhibits through intermediate small heterodimer partner the transcription of the gene encoding cholesterol 7a-hydroxy-lase, the rate-limiting enzyme in the major synthetic pathway of bile salts.60 The FXR-small heterodimer partner signaling pathway is an important molecular basis for the feedback repression of bile salt synthesis. FXR has also been shown to regulate expression of ABCB11 and ABCB4, affecting amounts of solibilizing bile salts and phospholipids in bile. As expected, FXR knockout mice are highly susceptible to gallstone formation on a lithogenic diet, because of low relative amounts of biliary bile salts and phospholipids. Also, gallstone formation can be prevented in wildtype mice by the synthetic FXR agonist GW4064, because increased amounts of...

Epidemiologic Evidence And Genetic Consideration Of Cholesterol Gallstones In Humans

Because cholesterol cholelithiasis is likely to result from a complex interaction of environmental factors and the effects of multiple undetermined genes, the genetic evidence of this disease in humans is mostly indirect and is based on geographic and ethnic differences, as well as on family and twin studies.75-83 Epidemiologic investigations have found that a genetic predisposition is clearly present in the Pima Indians, certain other North and South American Indians, and Chileans, all of whom display the highest age-adjusted incidences of gallstones (48 ) in the world.76-79 By contrast, the overall age-adjusted incidences in other American (white) and European populations are approximately 20 .48,84-86 The lowest incidences (

Asymptomatic Gallstones

The distinction between symptomatic and asymptomatic gallstones can be difficult, as symptoms can be mild and varied. The different symptoms attributable to gallstones include upper abdominal pain, biliary colic, and dyspepsia.7,8 About 92 of patients with biliary colic, 72 of patients with upper abdominal pain, and 56 of patients with dyspepsia have relief of symptoms after cholecystectomy.8 Cholecystectomy for asymptomatic gallstones is a matter of frequent debate in the management of gallstones. The annual incidence of complications of gallstones in asymptomatic patients is 0.3 acute cholecystitis, 0.2 obstructive jaundice, 0.04 to 1.5 of acute pancreatitis,9 and rarely gallstone ileus.10 As mentioned previously, the causative association between gallstones and gallbladder cancer has not been proven. As gallbladder surgery can be associated with life-threatening or life-changing postoperative complications, cholecystectomy for asymptomatic gallstones is not recommended routinely in...

Candidate Genes For Cholesterol Gallstones In Mice

On the basis of the pathophysiology of cholesterol gallstones, Table 1 summarizes major classes of candidate genes for Lith genes,7 which could have an important effect on gallstone formation in mice. Lithogenic actions of some candidate genes have not yet been identified, and their roles in cholelithogenesis need to be investigated further. Genetic factors contributing to cholesterol gallstones include candidate genes that encode (1) hepatic and intestinal lipid transporters on the apical and baso-lateral membranes (2) hepatic and intestinal lipid regulatory enzymes (3) hepatic and intestinal intracellular lipid transporters (4) hepatic and intestinal lipid regulatory transcription factors (5) hepatic lipoprotein receptors and related proteins (6) nuclear receptors in the liver and small intestine (7) hormone receptors in the gallbladder and (8) biliary mucins. Fig. 2 illustrates the locations of Lith genes and the candidate genes on mouse chromosomes. The liver is a main organ...

Gallbladder Disease

Gallstones and inflammation of the gallbladder, which rarely happens without the presence of gallstones, are most common in women. Pain felt in the upper-right quarter of the abdomen, then often moving to the back, is frequently the result of a stone blocking the bile duct. Stones are formed when there is an excess of cholesterol in the bile or a deficiency of substances such as lecithin needed to disperse the fat. Gallstones are primarily composed of cholesterol that crystalizes and hardens into stones ranging from the size of tiny seeds to one inch in diameter. They are formed usually as a result of too much saturated fat and cholesterol in the diet, and it is recommended that consumption of saturated fats be reduced and cholesterol containing foods kept at 300 mg daily. Too much sugar and too little fiber in the diet have been shown in studies to promote gallbladder attacks. Coffee, regular or decaffeinated, stimulates gallbladder contractions and can bring on an attack. Skipping...

Gall stones

Ultrasonography will detect gall stones in a minority of patients with apparently unexplained dyspepsia. However, gall stones are common and often incidental in the absence of biliary symptoms. Biliary colic is characteristically severe, episodic, and constant (rather than colicky) pain in the epigastrium or right upper quadrant typically lasting one to several hours. This can usually be easily distinguished from the pain or discomfort of functional dyspepsia. While many patients with gall stones also complain of bloating, nausea, and other vague upper abdominal symptoms, these complaints are just as common in patients without gall stones. Moreover, cholecystectomy does not reliably result in long term relief of any of these vague complaints and cannot be recommended. Cholecystectomy in a patient with non-biliary type pain is likely to result in the patient at a later date being labelled as having the post-cholecystectomy syndrome.


The risk of gallstones increases with adult weight. Risk of either gallstones or cholecystec-tomy is as high as 20 per 1,000 women per year when BMI is above 40, compared with 3 per 1,000 among women with BMI 24. 14 According to NHANES III data, the prevalence of gallstone disease among women increased from 9.4 percent in the first quartile of BMI to 25.5 percent in the fourth quartile of BMI. Among men, the prevalence of gallstone disease increased from 4.6 percent in the first quartile of BMI to 10.8 percent in the fourth quartile of BMI. 15

Gut Size Gallstones

In a study of nearly 30,000 men, those with at least a 40-inch waist had more than double the risk of developing gallstones compared to those with a waist measuring less than 34 inches. The risk was 40 percent higher in men with a 37 or 38-inch waist and 80 percent higher in men with a 39-inch waist. Earlier studies had shown that being overweight also raises the risk of gallstones in women.41 Natural Prescription for Health Roughly 10 to 25 percent of U.S. adults get gallstones.43 If you're overweight, lose those excess pounds. Eating nuts may help lower the risk of gallstones, but nuts are calorie-dense, so don't overdo it.

Goodbye Gallstones

Being overweight, female, and over 40 years of age are some of the classic risk factors for getting gallstones. Spending more than 40 hours a week on your fanny may be another, say researchers at the Harvard School of Public Health. Michael Leitzmann and coworkers followed more than 60,000 women who had participated in the Nurses' Health Study since 1986. Between 1986 and 1996, 3,257 of the women had surgery to remove a gallstone. Those who engaged in any exercise for two to three hours a week had about a 20 percent lower risk of gallstone surgery than sedentary women. In contrast, women who spent more than 60 hours a week sitting while at work or in their cars had more than twice the risk of women who spent no more than 40 hours a week on their sitting.

Acute Acalculous Cholecystitis

Cholecystitis Mri

Some 5 to 10 of patients with acute cholecystitis develop gallbladder perforation.67 It occurs most commonly in the setting of gangrenous cholecystitis with other risk factors including gallstones, impaired vascular supply, infection, malignancy, and steroid use. The fundus of the gallbladder is the most common site of perforation because it has the most tenuous blood supply.68,69 This rare complication of acute cholecystitis results from hemorrhage secondary to mucosal ulceration and necrosis and has been reported in the presence and absence of gallstones. Atherosclerosis of the gallbladder wall is a major predisposing factor. Classically the patient presents with biliary colic, jaundice, and melena.2-4

Novel Medical Treatments


Intestinal absorption of cholesterol (ie, EZT) are potentially able to influence the formation of cholesterol gallstones and to promote dissolution of gallstones. Statins are competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, the rate-limiting step in cholesterol biosynthesis. They occupy a portion of the binding site of HMG CoA, blocking access of this substrate to the active site on the enzyme.124 Currently available statins in the United States include lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin, and rosuvastatin. Statins seem also to reduce cholesterol secretion and concentration in bile independently of their ability to block hepatic cholesterol synthesis.125-128 Such combined effects of statins on cholesterol homeostasis in the liver and bile might be able to lower the risk of cholesterol gallstones.129-131 Beneficial effects of statins in preventing gallstone formation have been reported in animal studies.132,133 In humans...

Chronic Cholecystitis

Gallstone Ileus Gallstone ileus occurs in the setting of chronic cholecystitis and results from erosion of a gallstone into the gastrointestinal tract, with subsequent development of bowel obstruction. The patient usually has symptoms of only chronic colic without evidence of acute cholecystitis before the obstruction. The stone, which needs to be larger than Radiographically, gallstone ileus manifests as gas in the biliary tract, intestinal obstruction, and the presence of a radiopaque gallstone (Fig. 13) surrounded by fluid or gas in the obstructed bowel.11

Clinical Presentation

Gallbladder polyps are generally thought not to cause any symptoms, though most of the prevalence studies did not assess symptoms.9 Polyps are sometimes identified on transabdominal ultrasounds done for right upper quadrant pain. In the absence of other findings, the gallbladder polyp may be considered a source of biliary colic.10 Terzi and colleagues11 reported that, in a series of 74 patients undergoing cholecystectomy for gallbladder polyps, 91 had symptoms, most commonly right upper quadrant pain, nausea, dyspepsia, and jaundice. However, about 60 of the patients also had gallstones, so it is unclear whether the polyps were primarily driving the symptoms. There was no difference in presenting symptoms between patients with benign versus malignant polyps. In another large retrospective analysis of 417 patients found to have gallbladder polyps on abdominal ultrasound, 64 of these polyps were diagnosed during a work-up of unrelated illness. Twenty-three percent had abdominal...

Acute Cholecystitis

Cholecystitis Patient

Acute cholecystitis results from obstruction of the gallbladder neck or cystic duct by a gallstone in 80 to 95 of patients.34 Acute acalculous cholecystitis (AAC) composes 5 to 15 of cases of acute cholecystitis and is typically caused by diminished gallbladder emptying (eg, in patients with severe trauma surgery, burns, shock, anesthesia, diabetes) by decreased blood flow in the cystic artery because of obstruction, hypotension, or embolization or by bacterial infection.35,36 Although most patients present with typical right upper quadrant symptoms, this diagnosis may be challenging in patients with complicated systemic disease and sepsis. The sonographic findings of acute uncomplicated cholecystitis include gallstones often impacted in the cystic duct or gallbladder neck (Fig. 6), mural thickening ( 3 mm), a 3-layered appearance of the gallbladder wall, hazy delineation of the gallbladder, localized pain with maximal tenderness elicited over the gallbladder (sonographic Murphy's...

Gender and Female Sex Hormones

Female gender is one of the most powerful influences on gallstone disease, with women almost twice as likely as men to form stones.1 This is especially true for women in their fertile years, with the gap narrowing into the postmenopausal period when men catch up. Women are also more likely to undergo cholecystectomy. The basis for this finding seems related to the female sex hormones, because parity, oral contraceptive use, and estrogen replacement therapy are risk factors for gallstone disease.24 During pregnancy, biliary sludge can appear in 5 to 30 of women gallstones develop in 2 to 5 .25 In the puerperium, sludge disappears in two-thirds whereas small gallstones (

Gallbladder Carcinoma

Gallbladder Findings

Focal or diffuse thickening of the gallbladder wall is the least common presentation of gallbladder carcinoma and is the most difficult to diagnose, particularly in the early stages. Gallbladder carcinoma may cause mild to marked mural thickening in a focal or diffuse pattern. This thickening is best appreciated on sonography, in which the gallbladder wall is normally 3 mm or less in thickness. Carcinomas confined to the gallbladder mucosa may present as flat or slightly raised lesions with mucosal irregularity that are difficult to appreciate sonographically. In one sonographic series, half the patients with these early carcinomas had no protruding lesions, and fewer than one-third were identified preoperatively.88 More advanced gallbladder carcinomas can cause marked mural thickening, often with irregular and mixed echogenicity (Fig. 15A, B). The gallbladder may be contracted, normal sized, or distended, and gallstones are usually present.2,3,86 Two factors interfere with the...

Clinical Patterns Of

Images Gallbladder Diseases

Reports of acute cholecystitis complicating surgery, multiple trauma, or burn injury are numerous. In patients with gallstones, postoperative cholecystitis affects males and females to a similar degree. More than 80 of patients who develop non-trauma-related postoperative AAC, however, are male.6 The incidence of AAC following open abdominal aortic reconstruction is 0.7 to 0.9 ,7,8 and has also been reported to complicate endovascular aortic reconstruction.9 associated cardiomyopathy. Postoperative cholecystitis, regardless of the antecedent operation, is as likely to develop in the presence of gallstones as in their absence.11 Patients with trauma12,13 or burns14 have a striking predilection to develop AAC, again, mostly among male patients. Fasting and bile stasis may be aggravated by total parenteral nutrition (TPN) in the pathogenesis of AAC.56 Parenteral nutrition is associated with gallstone formation and AAC in both adults and children. The incidence of AAC during long-term TPN...

Searching For Human Lith Genes

Because of its multifactorial pathogenesis, it is difficult to identify human gene abnormalities that are responsible for the formation of cholesterol gallstones. Monogenic predisposition for cholelithiasis has only been ascribed to mutations in the genes in specific subgroups of patients. Table 2 summarizes human LITH genes that have been identified and updated in 2008. Missense mutations in the ABCB4 gene, which encodes the phospholipid transporter in the canalicular membrane of hepatocytes, are the basis for a particular type of cholelithiasis. The disorder is characterized by intrahepatic sludge, gallbladder cholesterol gallstones, mild chronic cholestasis, a high cholesterol phospholipid ratio in bile, and recurrent symptoms after cholecystectomy.42,43 A defect in the ABCB4 gene could constitute the basis for this highly symptomatic and recurrent form of gallstone disease. In patients with hepatolithiasis, a common disease in Asia, low expression levels of ABCB4 and...

Gallbladder And Intestinal Motility

Meal ingestion induces considerable gallbladder emptying (up to 70 -80 of fasting gallbladder volumes) by releasing the hormone cholecystokinin from the upper intestine. Impaired gallbladder emptying may prolong residence of bile in the gallbladder, allowing more time for nucleation of cholesterol crystals from supersaturated bile. Furthermore, in case of adequate emptying, cholesterol crystals that have nucleated may be ejected to the duodenum, whereas in case of impaired gallbladder emptying, these crystals may aggregate into macroscopic gallstones. Several studies have shown that gallstone patients may be divided into a group with severely impaired or even absent postprandial emptying ( bad contractors ) and a group with good postprandial gallbladder emptying ( good contractors ). Patients with good postprandial contraction often have increased fasting and residual gallbladder volumes compared with normal controls.32 Prospective studies also indicate that impaired postprandial...

Eus And Polypoid Lesions Of The Gallbladder

Adenomyomytosis The Gallbladder Eus

As pedunculated lesions with a granular surface and an internal echo pattern of a tiny echogenic spot or spots, sometimes with echopenic areas. In 1 large series,30 cholesterol polyps accounted for 62.8 of gallbladder polyps. Other polypoid lesions include adenomyomatosis, adenoma, and adenocarcinoma. Adenomyomatoses are sessile echogenic masses containing multiple microcysts or with a comet tail artifact. Adenocarcinomas, which account for 3 to 8 of polypoid gallbladder lesions,29 and adenomas are sessile or pedunculated masses with a hypoechoic to isoechoic internal echo and without echogenic spots, microcysts, or comet tail artifact. Risk factors for malignant polypoid lesions include older patient age, solitary lesions, coexistent gallstones, and presence of symptoms.29

Eus And Occult Cholecystolithiasis Or Microlithiasis

Gallstone disease is common in the United States, with a prevalence of approximately 10 to 15 among adults.4 The gold standard for evaluation for gallbladder stones is transabdominal US, which has been shown to have a sensitivity of 98 for the detection of cholecystolithiasis.5 However, US may miss gallstones in some patients, particularly those with small gallstones, and a high clinical suspicion for cholelithiasis may Liu and colleagues7 performed EUS in 18 patients with acute pancreatitis in whom no cause was identified after history, laboratory evaluation, and conventional abdominal imaging. Of these patients, all had undergone at least 1 US, 9 had multiple US, and 6 had also been evaluated with computed tomography (CT) each of these imaging studies had failed to detect biliary calculi. EUS revealed small gallstones in 14 of the 18 patients (78 ) 10 of these 14 also had gallbladder sludge (Fig. 7), and 3 had concomitant choledocholithiasis. The diagnosis of cholelithiasis was...

Dyslipidemia Diabetes Mellitus and the Metabolic Syndrome

Given that cholesterol gallstone disease is a metabolic problem, it should correlate with lipid abnormalities, diabetes mellitus, and adiposity. Although most gallstones in the Western world consist of cholesterol, there is no definite association with hypercholesterolemia.1 Rather, a low HDL cholesterol carries an increased risk of developing stones, as does hypertriglyceridemia. The association between diabetes mellitus and gallstones is confounded by age, obesity, and a family history of gallstones.1 The link between diabetes, obesity, and gallstones most likely comes through the metabolic syndrome. The metabolic syndrome characterizes a specific body phenotype (abdominal obesity), insulin resistance (type 2 diabetes mellitus), and dyslipidemia (hypertriglyceridemia), all risks for cardiovascular disease. Insulin resistance predisposes to cholesterol gallstone disease,28,29 suggesting that hepatic insulin resistance must somehow affect cholesterol and bile salt metabolism.

Evidence Against Cholecystectomy For Patients With Functional Gallbladder Disorder

Despite excellent symptom improvement after cholecystectomy for gallstone disease, the clinical improvement in patients with presumed functional biliary pain is not as good. Fenster and colleagues46 prospectively evaluated the effects of cholecystectomy on the presenting symptoms in 225 patients undergoing laparoscopic cholecystectomy. Fifteen percent of the patients were believed to have functional gallbladder disorder, while 48 described atypical pain, and 82 experienced bothersome nonpain symptoms. A key finding was a cure rate for what was described as classic biliary pain of 82 in those with gallstones compared with 52 in those without gallstones. As expected, nonpain symptoms were infrequently completely relieved, in only 46 with gallstones and 38 without gallstones (P .05), emphasizing that these symptoms should not necessarily be attributed to functional gallbladder disease, particularly in the absence of biliary-like abdominal pain. This study demonstrates that while...

Longterm Biliary Stenting

The oral administration of ursodeoxycholic acid (UDCA) (Actigall, Ursosan, Ursofalk, or Urso) may further enhance softening or disintegration of the stone.4 One report showed good results in 9 of 10 patients who became stone-free with the use of stenting plus orally administered UDCA compared with none of the 40 patients with stents alone.90 Terpene preparation (Rowachol), a well-tolerated oil preparation containing 6 cyclic monoterpenes, was also reported to have an inhibitory effect on hepatic hydrox-ymethylglutaryl coenzyme A reductase, altering biliary cholesterol saturation, thus dissolving gallstones.91 In recent study, biliary stenting with combined UDCA and terpene preparation administration for 6 months significantly reduced the stone size, and the endoscopic stone removal was successful in 92.8 .92 Another study reported that UDCA did not contribute to reduction in stone size or stone fragmentation in addition to long-term biliary stenting.93

Symptomatic Patients Without Complications

Patients with symptomatic gallstones are generally offered cholecystectomy. This is based on several longitudinal studies on the natural history of symptomatic gallstones without complications (grade B). These studies assess the hospital admissions and the complications that patients with symptomatic gallstones developed. The number of hospital admissions varied from 2.5 hospital admissions per 100 patients per month to 23 hospital admissions per 100 patients per month,45-47 possibly because of the severity of the symptoms at inclusion in the study. By 1 year, 14 of patients develop acute cholecystitis 5 of patients develop gallstone pancreatitis, and 5 of patients develop obstructive jaundice.45 Other studies report an annual complication risk of 1 in patients with mild symptoms.48,49 Of the later studies, one was a randomized controlled trial comparing cholecystectomy and observation.49 In this trial, in a mean follow-up period of 4 years, 50 of the patients in the observation group...

Gallbladder Adenomyomatosis

Gallbladder Lumen Picture

The association of this disorder with clinical findings is controversial. More than 90 of cases are associated with gallstones, which may be responsible for biliary symptoms. There is also a higher frequency of gallbladder carcinoma in gallbladders with segmental adenomyomatosis than in those without segmental adenomyomatosis.81 Fig. 13. Gallstone ileus CT findings. Coronal reformatted CT image shows a calcified gallstone (arrow) within the lumen of the distal ileum causing obstruction and fluid-filled dilatation (double headed arrow) of the proximal small bowel. Fig. 13. Gallstone ileus CT findings. Coronal reformatted CT image shows a calcified gallstone (arrow) within the lumen of the distal ileum causing obstruction and fluid-filled dilatation (double headed arrow) of the proximal small bowel.

Evidence Supporting Cholecystectomy For Patients With Functional Gallbladder Disorder

Many retrospective, generally low-quality, studies have been published that support the performance of cholecystectomy in patients with suspected functional gallbladder disorder, particularly in patients with a GBEF less than 35 .20 To date, Yap and colleagues23 have published the only randomized controlled study of cholecystec-tomy in functional gallbladder disorder. They studied 21 patients with suspected functional biliary pain and a GBEF less than 40 based on a 45-minute infusion of CCK. Eleven patients were randomized to cholecystectomy and 10 to no surgery. Over a 3-year period, 10 patients became asymptomatic after cholecystectomy, and one reported improved symptoms after surgery. In contrast, most patients in the no surgery group reported their symptoms to be unchanged two of these requested cholecystectomy. Based on these findings, the authors concluded that CCK-CS is useful in identifying a group of patients with acalculous gallbladder disease and biliary-like pain who...

Family History and Genetics

Familial and epidemiologic studies demonstrate that genetic susceptibility is important in the formation of gallstones.44 Occurrence within families can be a product of genetic and shared environmental factors. Familial studies reveal an increased frequency in family clusters (about 5 times more common in families of affected persons) and relatives of gallstone patients, but more convincingly in monozygotic (12 ) as opposed to dizygotic twins (6 ).45 Genetic effects account for 25 , shared environmental effects for 13 , while unique environmental effects for 62 of the phenotypic variance.46 The extraordinary susceptibility of American Indians might relate to thrifty genes that conferred a survival advantage when Paleo-Indians migrated across the land bridge from Asia to the Americas during the last great ice age (50,000-10,000 years ago). This might also explain their proclivity to acquire the metabolic syndrome and its sequelae.1 The search for gene variants has implicated...

Lith gene Micelle Mucin Nucleation

Cholesterol cholelithiasis is one of the most prevalent digestive diseases, resulting in a considerable financial and social burden worldwide. In the United States, at least 20 million Americans (12 of adults) are affected.1,2 Each year, approximately 1 million new cases are discovered, and more than 700,000 cholecystectomies are performed, making this one of the most common elective abdominal operations.1 Although many gallstones are silent, approximately one-third eventually cause symptoms and complications. In addition, the unavoidable complications result in 3000 deaths (0.12 of all deaths) annually. In the year 2000, more than 750,000 outpatient clinic visits and more than 250,000 hospitalizations were the result of gallstone-induced gastrointestinal symptoms.3 As a result, there was a median inpatient charge of 11,584, and medical expenses for the treatment of gallstones exceeded 6 billion.1 Because the prevalence of gallstones is increasing because of the worldwide obesity...

Total Parental Nutrition

Total parental nutrition (TPN) is a well-known risk factor for developing microlithiasis (biliary sludge) and gallstone disease, along with acalculous cholecystitis in critically ill patients.40 In an intensive care setting, biliary sludge appears after 5 to 10 days of fasting. After 4 weeks of TPN, half of those on TPN develop gallbladder sludge after 6 weeks all show evidence of sludge. Most are asymptomatic. Fortunately, sludge resolves within 4 weeks of discontinuing TPN and resuming an oral intake, a pattern similar to sludge appearing during pregnancy and rapid weight loss sludge disappearing after the inciting event resolves.41 A possible explanation for this relates to loss of the enteric stimulation of the gallbladder in the absence of eating, leading to gallbladder stasis.40 Additionally, ileal disorders, such as Crohn disease or ileal resection, in which TPN is frequently required, can affect the enterohepatic cycling of bile acids and thus augment bilirubin absorption and...

Underlying Chronic Diseases Liver disease

Cirrhosis is a well-established risk factor for gallstones particularly in the more advanced stages.54,55 The overall prevalence is much higher than the general population at 25 to 30 .56 Increasing Child-Pugh score and obesity are more likely associated with gallstones. Most stones in cirrhosis are of the black pigment type.57 The biologic mechanism likely relates to altered pigment secretion, abnormal gallbladder motility, or increased estrogen levels.1 The threat of these stones becoming symptomatic seems higher in women, those more advanced in age, and patients with viral hepatitis compared with alcohol-related cirrhosis.58 Gallstone disease is also associated with hepatitis C virus (even when not yet cirrhotic)59 and nonalcoholic fatty liver disease, the connection being the metabolic syndrome and obesity.60

Qtl Study And Lith Genes In Mice

In 1964, Tepperman and colleagues9 first established a mouse model of cholesterol gallstones by feeding a special lithogenic diet containing 1 cholesterol and 0.5 cholic acid. Later, Fujihira and colleagues10 found that at 8 weeks on the lithogenic diet, gallstone prevalence rates varied from 0 to 100 in 7 strains of mice. Alexander and Portman11 further observed that feeding the lithogenic diet for a longer time, from 8 weeks to 12 weeks, strain differences in gallstone formation still existed in mice. Khanuja and colleagues8 also found a striking strain difference in gallstone prevalence rates in 9 strains of inbred mice. By using a mouse backcross strategy and QTL analysis, they observed that differences in gallstone susceptibility between gallstone-susceptible C57L J and resistant AKR J strains were determined by at least 2 Lith genes, with Lithl (for lithogenic gene 1) and Lith2 mapping on mouse chromosomes 2 and 19, respectively.8 These studies show that the mouse is an...

Eus And Choledocholithiasis

Choledocholithiasis is a frequent complication of gallstone disease, occurring in 15 to 20 of patients with symptomatic cholelithiasis.9 Historically, ERCP has been considered the gold standard for the diagnosis of common bile duct stones. However, ERCP is an invasive procedure that is associated with a small, but not insignificant, risk of serious complications such as pancreatitis, cholangitis, perforation, and hemorrhage,10 and thus should ideally be reserved for patients with proven common bile duct stones who require endoscopic therapy. It is therefore important to use initial safe, noninvasive diagnostic modalities for choledocholithiasis to select appropriate patients for ERCP.

Epidemiology And Risk Factors

There are many known risk factors for GBCA, including cholelithiasis, obesity, multi-parity, and typhoid fever.3-7 In addition, there are geographic variations in the prevalence of the disease, with rates highest in Chile, India, Israel, Poland, and Japan. In the United States, the disease prevails in Native American women from New Mexico.6 Gallstones are present in the majority of patients however, the relationship between causation and association is unclear. In some cases of GBCA, a focus of cancer may be found in a gallbladder adenomatous polyp however, in the majority of cases, small polyps of the gallbladder do not harbor malignancy and are non-neoplastic and may be simply observed.8-11 Polyps greater than 1 cm, those arising in the setting of primary sclerosing cholangitis, or those discovered in patients older than 50 years of age are more likely to harbor cancers and, therefore, should be treated with cholecystectomy if a patient is an appropriate candidate for surgery.12

Future Research Directions

A new concept has been proposed that interactions of 5 defects could play an important role in the formation of cholesterol gallstones (see Fig. 1), which are considered in terms of LITH genes (genetic defect), thermodynamics (solubility defect), kinetics (nucleation defect), stasis (residence time defect), and lipid sources (metabolic defect). Growing evidence from pathophysiological, physical-chemical, and genetic studies shows that disposition to the formation of cholesterol gallstones is multifacto-rial, and the overarching pathogenetic factor is hepatic hypersecretion of cholesterol into bile, and no mode of inheritance fitting to the Mendelian pattern could be found in most cases. Similar to atherosclerosis, the risk for cholesterol gallstone formation increases with aging, dyslipidemia, hyperinsulinemia, obesity, diabetes, and sedentary lifestyle. All these conditions are risk factors for the metabolic syndrome, of which cholesterol gallstone formation is just another...

Bile Salt Hydrophobicity

More hydrophobic bile salts strongly promote cholesterol crystallization, by affecting the ternary phase diagram in a similar way as bile concentration (increased micellar cholesterol solubilization, shift of crystal-containing zones to the right, cholesterol supersaturated vesicles, promotion of cholesterol crystallization5). In the animal kingdom, human bile exhibits the most hydrophobic bile salt composition, with strong propensity to gallstone formation. Nevertheless, there is considerable variation in hydrophobicity of human bile salt composition (especially amounts of deoxycholate). In gallbladder bile of cholesterol gallstone patients, increased amounts of the hydro-phobic bile salt deoxycholate are associated with fast crystallization.10 The primary bile salts cholate and chenodeoxycholate are synthesized from cholesterol in the liver, and secondary bile salts (mainly deoxycholate) are formed from primary bile salts in the intestine by bacterial 7a-dehydroxylase activity....

Biliary Nucleation Promoting And Inhibiting Proteins

During the last decades, numerous biliary proteins have been suggested to enhance or inhibit cholesterol crystallization in gallbladder bile, based on their in vitro or ex vivo effects. Immunoglobulins M and G,14,15 haptoglobin,16 a1-acid glycoprotein,17,18 aminopeptidase-N,19 a1-antichymotrypsin, and mucin20 are regarded as pronucleat-ing proteins. By contrast, human apolipoprotein A-I21 and IgA22 have been postulated to exert antinucleating activity. Cholesterol crystallization often occurs much faster in bile of patients with (especially multiple) cholesterol stones than in bile of patients with pigment stones or subjects without stones, or in model biles, even in case of comparable relative lipid composition. Excess biliary pronucleating compared with crystallization-inhibiting proteins could contribute to this phenomenon. Nevertheless, in more recent years, a growing number of publications have marshaled experimental evidence arguing against a role of most of these biliary...

Biliary Phospholipid Composition

In in vitro studies with model biles, phospholipid class and phospholipid acyl chain composition exert profound effects on cholesterol crystallization. Similar to increased bile concentration and increased bile salt hydrophobicity, phospholipids with more unsaturated acyl chains affect the ternary equilibrium bile salt-phospholipid-choles-terol ternary phase diagram by increasing the bottom one-phase (micellar) zone, expanding the cholesterol crystal-containing zones to the right and decreasing the vesicles-containing zones, with the result that cholesterol supersaturated vesicles and cholesterol crystallization occur (see Fig. 1).7 The underlying physical-chemical explanation for these findings is that phospholipids with saturated acyl chains by their trans configuration fit easily in the vesicular cholesterol-phospholipid bilayer, which is not the case for phospholipids with ci's-unsaturated acyl chains with a bend in the molecule (leading to preferential micellar containment)....


The advent of laparoscopic cholecystectomy has moved the interest away from the pharmacologic treatment of gallstones. Medical therapy is restricted to a scant group of symptomatic (colicky pain) well-selected patients, in which the unfavorable cost-benefit analyses and a high rate of gallstone recurrence play a negative role. Following early cholelitholytic therapies with the oral bile acid UDCA, recent studies indicate that the research agenda should include studies on the role of gallstone (LITH) genes, as well as the mechanisms of intestinal absorption of cholesterol and pathways of liver synthesis-secretion of cholesterol. Promising agents might include, alone or in combination, statins (competitive inhibitors of HMG CoA reductase, the rate-limiting step in cholesterol biosynthesis), EZT (specific inhibitor of the intestinal cholesterol transporter protein NPC1L1), and liver-specific agonists antagonists of the NR FXR LXR involved in biliary lipid secretion.

Obstructive Jaundice

Patients with gallstones develop obstructive jaundice if stones migrate into the common bile duct. Although common bile duct stones can be removed endoscopi-cally,73 subsequent cholecystectomy is recommended based on a systematic review of randomized controlled trials in which a policy of observation after endoscopic sphincterotomy increased the risk of mortality and gallstone-related complications compared with routine cholecystectomy65 (grade A). There are no studies investigating the natural history of patients with obstructive jaundice caused by common bile duct stones. Considering that obstructive jaundice can lead to complications such as cholangitis, renal dysfunction, cardiovascular dysfunction, and coagulopathy,74,75 obstructive jaundice caused by common bile duct stones needs to be treated as an emergency (grade B). The various options for the treatment of common bile duct stones include open cholecystectomy with open common bile duct exploration, laparoscopic...



Gallstones CT findings. (A) Multiple gas-containing stones (arrow) with peripheral calcification are present within the gallbladder. (B) Multiple calcified stones (white arrow) are present within the gallbladder. There is a distal common bile duct stone (black arrow) causing pancreatitis and upper abdominal fluid collections (open arrow). Fig. 2. Gallstones CT findings. (A) Multiple gas-containing stones (arrow) with peripheral calcification are present within the gallbladder. (B) Multiple calcified stones (white arrow) are present within the gallbladder. There is a distal common bile duct stone (black arrow) causing pancreatitis and upper abdominal fluid collections (open arrow). As with gallstones, the CT appearance of CBD stones is variable, depending on their composition and pattern of calcification.27 High-attenuation stones can be easily seen with the duct lumen even in the absence of biliary dilatation. Only 20 of common bile stones have a homogeneously high density.28...


Gallstones Contracted Gallbladder

The nature and size of a gallstone affects its imaging characteristics. Gallstones are comprised mainly of cholesterol, bilirubin, and calcium salts, with smaller amounts of protein and other materials including bile acids, fatty acids, and inorganic salts. In Western countries, cholesterol is the principal constituent of more than 75 of gallstones, with smaller amounts of calcium bilirubinate.7-9 Pure cholesterol stones contain more than 90 cholesterol and account for less than 10 of biliary calculi.7-9 The more cholesterol and less calcium a stone contains, the less likely will it be seen on CT scan, which best depicts predominantly calcified stones. Black or brown pigment stones consist of calcium salts of bilirubin and contain less than 25 cholesterol. These stones compose only 10 to 25 of gallstones in North The abdominal plain radiograph is insensitive in depicting gallstones because only 15 to 20 are sufficiently calcified to be visualized.10 Oral cholecystography was the...

Gallbladder Sludge

Dependent Portion The Gallbladder

Gallbladder sludge is thick viscous bile that consists of cholesterol monohydrate crystals and calcium bilirubinate granules embedded in a gel matrix of mucus glycopro-teins. It often develops in patients with prolonged fasting in intensive care units, trauma patients receiving total parenteral nutrition, and within 5 to 7 days of fasting in patients who have undergone gastrointestinal surgery. Sludge typically has a fluctuating course and may disappear and reappear over several months or years. Sludge may be an intermediate step in the formation of gallstones. Some 8 of patients with sludge will develop asymptomatic gallstones.11,33


Ultrasound of the gallbladder is the most accurate modality to diagnose AAC in the critically ill patient.71 Although sonography is accurate for detecting gallstones and measuring bile duct diameter, neither is particularly relevant to the diagnosis of AAC. Thickening of the gallbladder wall is the single most reliable criterion,72-74 with reported specificity of 90 at 3 mm and 98.5 at 3.5 mm wall thickness, and sensitivity of 100 at 3 mm and 80 at 3.5 mm. Accordingly, gallbladder wall thickness greater than or equal to 3.5 mm is generally accepted to be diagnostic of AAC. Other helpful sonographic findings for AAC include pericholecystic fluid or the presence of intramural gas or a sonolucent intramural layer, or halo, which represents intramural edema (Fig. 2).71 Distention of the gallbladder of more than 5 cm in transverse diameter has also been reported.71 False-positive ultrasound examinations have been reported, and may occur in particular when conditions including sludge,...

Mirizzi Syndrome

Mirizzi syndrome (MS) is an atypical presentation of gallstone disease in which the impaction of a gallstone in the cystic duct or the gallbladder neck causes stenosis of the extrahepatic bile duct by extrinsic compression or fibrosis.52 Bile duct wall necrosis and subsequent cholecystobiliary fistula caused by chronic inflammation are rare sequelae of the disease. The syndrome was first described by the Argentinean surgeon Pablo Mirizzi in 1948. It is reported to occur in 0.7 to 2.5 of all US patients undergoing cholecystectomy.53,54 Endoscopic treatment of MS can consist of establishing biliary ductal drainage by stent insertion or definitive gallstone removal from the gallbladder neck or cystic duct. Direct basketing of the stone and mechanical lithotripsy are usually not possible. Intraductal lithotripsy is most effective. Because gallbladder surgery is nearly always indicated, other alternatives, such as dissolution therapy55,57 and percutaneous transhepatic management, are...


Numerous studies have attempted to define characteristics which increase the likelihood that a given gallbladder polyp may be malignant. Polyp size has long been noted to be an important factor. Koga and colleagues29 reviewed 411 patients who underwent cholecystectomy and found 40 gallbladder polyps, 8 of which were adenocarcinomas. Ninety-four percent of the benign polyps were less than 1.0 cm, whereas 88 of the malignant polyps were larger than 1.0 cm. Therefore, 1.0 cm was their recommended size cut-off for considering malignancy. Terzi and colleagues11 found a similar size cut-off in their review of 100 patients undergoing cholecystectomy for gallbladder polyps, and they noted patient age greater than 60 and the coexistence of gallstones as risk factors for malignancy. Gallstones are known to be a major risk factor for developing gallbladder carcinoma, likely because they can lead to long-term chronic inflammation within the gallbladder.8

Diagnostic Tests

Functional assessment of gallbladder emptying before and after gallbladder stimulation using either a fatty meal or CCK is currently the most common test used to evaluate patients with suspected functional gallbladder disorder. Oral cholecystography, both with and without CCK stimulation,34 has demonstrated variable results regarding symptom outcome and is considered insufficiently reliable as a measure of gallbladder function. Presently, CCK-CS with measurement of the GBEF is the most commonly used test to aid in the diagnosis of functional gallbladder disorder.35,36 Although controversial, the use of CCK-CS has been supported by the Rome committee, which has recommended that, in the presence of biliary-like pain, an absence of gallstones on abdominal ultrasound, and normal liver and pancreatic enzymes, CCK-CS should be the next diagnostic step (Fig. 1).7

The Future

The true frequency of gallstone disease at any point in time (ie, prevalence) has advanced with the use of ultrasonographic surveys as opposed to clinical and necropsy studies. These studies have better defined important risk factors and ethnic differences. Cholelithiasis is rampant in American Indians and Hispanics, fostering the concept of a genetic basis for the racial differences. There is also an increased heri-tability in those who develop cholelithiasis early in life. The complicated pathogenesis of gallstone formation renders identification of genes causing stones difficult. Well-defined monogenic forms of gallstone disease affecting the ABC transporters are rare, or if more common, such as the ABCG8 19H gene variant (responsible for hepatic cholesterol secretion), exhibit an attributable risk that only reaches 11 . Future epidemiologic studies should, therefore, clarify genetic susceptibility factors and their frequency, leading to new means for risk assessment, prevention,...


Determine the presence of gallstones that may not have been detected initially. If gallstones are present an elective cholecystectomy is usually recommended, with the drainage tube remaining in place during the interprocedure interval. Interval cholecystectomy is usually not indicated after true AAC87 the cholecystostomy tube can be removed after tube cholangiography confirms that gallstones are absent.

Rapid Weight Loss

At least 25 of morbidly obese individuals have evidence of gallstone disease even before undergoing weight reduction surgery.30 Low calorie diets and rapid weight loss (particularly after bariatric surgery), ironically, are then associated with the development of gallstones in 30 to 71 of these obese individuals losing weight.1,31,32 Weight loss exceeding 1.5 kg week after bariatric surgery particularly increases the risk for stone formation.33 Furthermore, stones are most likely to become apparent during the first 6 weeks after surgery when weight loss is most profound.34 Such gallstones are usually clinically silent sludge in the gallbladder and small stones (microlithiasis) often disappear. Following bariatric surgery, only 7 to 16 develop symptoms, best predicted by a weight loss exceeding 25 of their preoperative body weight.30 Strategies for ameliorating this complication have ranged from routine prophylactic cholecystectomy, through regular ultrasound surveillance to detect...


Presumably, the pain associated with functional gallbladder disorder may occur due to increased gallbladder pressure caused by either structural or functional outflow obstruction. Similar to other functional GI disorders, the pathophysiology of functional gallbladder disorder remains poorly understood and may, in fact, represent a constellation of mechanisms. Multiple theories of pathogenesis have been proposed including cholesterolosis, microlithiasis, biliary sludge, chronic cholecystitis, gallbladder dysmotility, narrowed cystic duct, cystic duct spasm, sphincter of Oddi dysfunction, and visceral hypersensitivity.2,8-10 Two studies, one by Velanovich11 and one by Brugge,12 reported a significant association between crystal formation in the bile or in the walls of the gallbladder in patients with functional biliary pain who had undergone cholecystectomy, suggesting that bile saturation or gallbladder dysmotility may lead to crystal growth and eventually gallstones or chronic...

Primary Prevention

Certain groups of patients have a high risk of development of gallstones. These include patients undergoing gastrectomy for gastric malignancy (14 to 26 of patients develop gallstones within 5 years)28,29 and patients undergoing gastric bypass procedures for morbid obesity (22 to 28 of patients develop gallstones within 1 year).30,31 Some surgeons perform routine prophylactic cholecystectomy because of the high incidence of gallstones in these patients.28 Other surgeons, however, do not recommend routine prophylactic cholecystectomy, because most patients developing gallstones are asymptomatic.31-33 Currently, a randomized controlled trial is underway to investigate whether prophylactic cholecystectomy is indicated in patients undergoing gastrectomy for gastric cancer.34 Currently, prophylactic cholecystectomy to prevent gallstone formation is not recommended in any group of patients (grade B).

Crohn disease

Crohn disease, when associated with extensive ileal disease or loss, conveys a 2 to 3 fold increased risk of developing gallstones.61 Although once believed due to bile acid malabsorption and depletion leading to cholesterol gallstones, recent studies have found an increased frequency of pigment stones. Unabsorbed bile acids that escape into the colon function as a biologic detergent to solubilize bilirubin and thus increase its absorption and enterohepatic cycling. The resultant increased pigment in bile then promotes stone formation.62

Bile Concentration

Significant net water absorption occurs during bile transfer through the bile ducts and during prolonged storage in the gallbladder. As a result, bile water content decreases from 97 weight in the bile ducts to 90 weight in the gallbladder. This threefold to fourfold concentration of bile enhances cholesterol crystallization and gallstone formation considerably.8,9 During the process of bile formation, detergent bile salt monomers first induce formation of nascent choles-terol-phospholipid vesicles in the bile canalicular space. These vesicles are stable because they are relatively cholesterol-poor (cholesterol phospholipid ratio 1) and may nucleate cholesterol crystals. This sequence explains why gallstones are generally formed in the gallbladder rather than in the bile ducts.


Gallstone pancreatitis is caused by migration of stones into the common bile duct with subsequent obstruction to the bile duct, the pancreatic duct, or both.59 This causes increase in pancreatic duct pressure, resulting in unregulated activation of trypsin and pancreatitis.59 Gallstones are the most common cause for acute pancreatitis.60,61 The overall mortality of acute pancreatitis is between 3 and 10 .60,61 The role of early endoscopic sphincterotomy in the management of gallstone pancreatitis is controversial. Although the total number of complications is fewer after early endoscopic sphincterotomy for predicted severe pancreatitis,62 there is no reduction in either the local pancreatic complications or the overall mortality for predicted mild or severe pancreatitis.63 There is of no benefit of early endoscopic sphincterotomy for patients with acute gallstone pancreatitis without cholangitis.64 Irrespective of the role of endoscopic sphincterotomy in pancreatitis, endoscopic...

Dual energy Xray absortiometry DEXA A

Gallstones Constituents in the gallbladder that are not reabsorbed, including bile salts and lipid substances such as cholesterol that become highly concentrated. They can cause severe pain (obstruction and cramps) as they move into the common bile duct. Risk factors for cholesterol gallstone formation include female gender, weight gain, overweight, high energy intake, ethnic factors (Pima Indians and Scandinavians), use of certain drugs (clofibrate, estrogens, and bile acid sequestrants), and presence of gastrointestinal disease. Gallstones sometimes develop during dieting for weight reduction. There is an increased risk for gallstones and acute gallbladder disease during severe caloric restriction.

Think I am a good candidate for gastric bypass surgery What do I need to do to obtain insurance coverage for this

Ship with your primary care doctor, he or she will know about your weight loss attempts and will be treating you for any of your obesity-related illnesses or conditions (elevated cholesterol and triglycerides, gallstones, pancreatitis, abdominal hernia, fatty liver, diabetes or prediabetes, polycystic ovary syndrome, high blood pressure, heart disease, pulmonary hypertension, stroke, blood clots in the legs and lungs, sleep apnea, arthritis, gout, lower back pain, infertility, urinary incontinence, or cataracts).

Malignant Neoplasms of the Gallbladder

Tumor Gallbladder Mri

The four most important factors associated with the development of gallbladder carcinoma are genetic anomaly, gallstones, congenital abnormal choledocho-pancreatic junction, and porcelain gallbladder. With regards to genetic factors, a mutation of the k-ras gene, overexpression of the c-erbB-2 gene and decreased expression of the nm23 gene have been observed in patients with gallbladder carcinoma 13,18 . An association between gallbladder carcinoma and gallstones is well known, and this causal relationship is the reason for performing cholecystectomy for cholelithiasis as a preventive measure for gallbladder carcinoma. Gallbladder carcinoma is associated with an abnormal choledocho-pancreatic junction because in this condition pancreatic juice can reflux into the common bile duct. The mixture of pancreatic juice and bile leads to chronic inflammation of the gallbladder with subsequent metaplasia, dysplasia, and carcinoma 30 . Finally, porcelain gallbladder, which is a diffuse...

Indications Dandelion

Abscess (f CRC MAD) Acne (f VAD) Adenopathy (f JLH) Ague (f BIB) Alactea (f LMP PH2) Alcoholism (f SKY) Alzheimer's (1 FNF) Anemia (f1 AAH DEM JFM WAM) Anorexia (12 APA KOM PH2 PIP VAD) Arthrosis (f BIB) Backache (f DEM) Bacteria (1 WOI) Biliary Dyskinesia (2 PIP) Biliousness (f BIB) Bladderstones (2 KOM) Boil (f CRC LMP) Bronchosis (f12 APA BIB LAF) Bruise (f BIB CRC) Cachexia (f NAD) Cancer (f CRC) Cancer, bladder (f JLH) Cancer, bowel (f JLH) Cancer, breast (f CRC JLH) Cancer, liver (f JLH) Cancer, spleen (f JLH) Caries (f CRC LMP) Cardiopathy (f APA BIB) Catarrh (f BIB CRC) Cellulite (1 FT71 S73) Chill (f HJP) Cholecystosis (2 BGB CRC HH3 KOM PH2) Cirrhosis (SKYf ) Cold (1 APA) Colic (1 PH2) Congestion (1 PH2) Conjunctivosis (f AAH AKT) Constipation (f1 FAD SKY FT71 S73) Consumption (f BIB) Cough (f MAD) Cramp (f DEM) Cystosis (1 WAM) Dermatosis (f APA BGB KAP KOM PH2) Diabetes (f1 BIB CRC JFM KOM MAD PH2 X15704495 X14750205) Dropsy (f1 BGB BIB DEM KAP MAD) Dysentery (f AKT)...

Bile pigments in the gastrointestinal tract

Failure of the body to excrete bile pigments results in accumulation of pigments in the blood plasma, termed hyperbilirubinaemia. This can result from a disruption of the flow of bile through the common bile duct or hepatic ducts by obstruction, i.e. gallstones, allowing bile to build up in the blood. Gallstones can block the intrahepatic and extrahepatic bile ducts. This can result in jaundice as the bile is refluxed into the blood. This type of jaundice is referred to as obstructive or posthepatic jaundice.

Myocardial Infarction MI

MI is characterized by crushing chest pains that may radiate to the left arm, neck, or upper abdomen (which may feel like acute indigestion or a gallbladder attack). The affected person usually has shortness of breath, ashen color, clammy hands, and faints. Treatment within one hour of the heart attack is important and usually includes chewing aspirin and administering CPR. Many individuals die each year of their first MI.

Food Pyramids Obesity And Diabetes

High Iron Saturation Level

According to the World Health Organization, obesity has become a worldwide problem that has significant effects on health. Problems that were once considered limited to developed or industrialized countries now affect everyone. Because of obesity, the incidence of diseases such as heart disease, type 2 diabetes mellitus, and hypertension has increased around the world. Obese individuals are also prone to pulmonary disease, varicose veins, and gallbladder disease. They have an increased risk of breast, uterine, and colon cancers.

Prickly Pear Tooth Decay Caries

Gout Flour Oxalic Acid

Acid ingredient of baking powder and self-raising flour, since it reacts with bicarbonate to liberate carbon dioxide. Calcium phosphates are permitted food additives (E-341). calculi (calculus) Stones formed in tissues such as the gall bladder (biliary calculus or gallstone), kidney (renal calculus) or ureters. Renal calculi may consist of uric acid and its salts (especially in gout) or of oxalic acid salts. Oxalate calculi may be of metabolic or dietary origin and people at metabolic risk of forming oxalate renal calculi are advised to avoid dietary sources of oxalic acid and its precursors. Rarely, renal calculi may consist of the amino acid cystine.

Indications Milk Thistle

HHB) Fibrosis (1 CGH) Food Allergies (1 WAM) Gallstones (1 HHB MAB SKY HC020444-262 NP9(2) 6) Gastrosis (f APA) Hematuria (f HC020444-262 NP9(2) 6) Hemoptysis (f BIB) Hemorrhage (f KAB MCK) Hemorrhoid (f BIB HHB MAB WOI) Hepatosis (f12 KOM PH2 SHT WAM) Hepatosis A (1 BGB) High Blood Pressure (1 MCK HC020444-262) High Cholesterol (1 MAB) High Triglycerides (1 CGH X15177299) Hydrophobia (f BIB GMH) Hypereme-sis (f1 NP9(2) 6) Hypotonia (f HH3) Infection (f HHB) Inflammation (f1 APA HC020444-262 X15617879) Intoxication (1 FAD) Insulin Resistance (1 SYN) Itch (1 MAB) Jaundice (f2 BIB HH3 MAB PH2 PNC WAM) Leukemia (f1 HC020444-262 NP9(2) 6) Leukorrhea (f BIB) Malaria (f1 BIB HHB PHR PH2 HC020444-262) Menopause (f HHB) Metastasis (1 X15224346) Metrorrhagia (f HHB) Migraine (f HH3) MS (f ACT9 251) MS (1 HC020444-262) Mushroom Poisoning (2 FAD SHT) Myalgia (1 HC020444-262) Nausea (f1 MAB Cyto-protective (1 NP9(2) 6) Nephrosis (f12 BGB NP9(2) 6) Neurosis (f ACT9 251) Obesity (1 PNC) Oligolactea...

Pathophysiology of Stone Formation

There are three kinds of gall stone cholesterol, black pigment, or brown pigment stones. Cholesterol stones constitute 75-90 of all gall stones. They are composed purely of cholesterol or have cholesterol as the major chemical constituent. Most cholesterol gall stones are of mixed composition. Pigmented stones get their color and their name from precipitated bilirubin. Increased production of unconjugated bilirubin causes black pigmentation. Formation of black pigment stones is typically associated with chronic hemolysis, cirrhosis, and pancreatitis. Brown pigment stones are usually associated with infection. Cytoskeletons of bacteria can be seen microscopically in brown pigment stones, Major risk factors predisposing to gall stones are age, sex, genetic profile, nutritional status (including the route of nutrition), hormones, drugs, and some other diseases such as diseases of the terminal ileum. A summary of these elements is provided in Table 1. body mass index and the reported...

What is an obesityrelated illness

Obesity-related illnesses and conditions include elevated cholesterol and triglycerides, gallstones, pancreatitis, abdominal hernia, fatty liver, diabetes and prediabetes, polycystic ovary syndrome, high blood pressure, heart disease, pulmonary hypertension, stroke, blood clots in the legs and lungs, sleep apnea, arthritis, gout, lower back pain, infertility, urinary incontinence, and cataracts. If you have one of these conditions gastric surgery can be considered when the BMI is 35 or higher. In many cases gastric bypass surgery can dramatically improve obesity-related conditions. I have had many patients who after gastric bypass surgery were able to give up their blood pressure, diabetes, and cholesterol lowering medications. Many young women who have been unable to become pregnant conceive and go on to have healthy babies (more on this later).

Indications Purple Star Thistle

Amenorrhea (f BOU) Anorexia (f BOU VAD) Bacteria (1 MPG) Brucella (1 MPG) Cancer (f BIB JLH) Cold (f VAD) Corns (f JLH) Diabetes (f1 MPG VAD) Dyskinesia (f VAD) Fever (f BIB EFS) Fistula (f BIB WO2) Flu (f VAD) Gallstone (f HJP) Gravel (f BIB WO2) Headache (f BOU) High Blood Pressure (1 MPG) Hyperglycemia (f VAD) Infection (1 MPG) Jaundice (f BIB) Kidney stone (f HJP) Malaria (f BOU) Mycobacterium (1 MPG) Nephrosis (f BOU HJP) Ophthalmia (f BOU) Pain (f BOU) Pseudomonas (1 MPG) Salmonella (1 MPG) Staphylococcus (1 MPG) Stone (f BIB BOU WO2) Wound (f BOU) Worm (f BOU).

Rationale for Guidelines Development

An estimated 97 million adults in the United States are overweight or obese, 1 a condition that substantially raises their risk of morbidity from hypertension, 2-6 type 2 diabetes, 7-10 stroke, 11-13 gallbladder disease, 14, 15 osteoarthritis, 16-18 sleep apnea and respiratory problems, 19-21 and endometrial, breast, prostate, and colon cancers. 22-24 As a major contributor to preventive death in the United States today, 25 overweight and obesity pose a major public health challenge. Not only is the prevalence of this serious medical condition soaring among adults (between 1960 and 1994, overweight increased from 30.5 to 32 percent among adults ages 20 to 74 and obesity increased from 12.8 percent to 22.5 percent), but it is also affecting ever greater numbers of American youth and exacting a particularly harsh toll from low income women and minorities. The Third National Health and Nutrition Examination Survey (NHANES III) estimated that 13.7 percent of children and 11.5 percent of...

How can I rationalize surgically changing my insides and risking significant complications even death just to lose

An article in the Journal of the American Medical Association (January 8, 2003) reported that marked obesity in a man aged twenty to thirty could reduce his life expectancy by up to thirteen years. An extremely obese woman in this same age range might expect to lose up to eight years compared to her normal-weight friends. These are not small numbers. People who are overweight are more likely to develop obesity-related illnesses such as heart disease, pulmonary hypertension, stroke, diabetes, sleep apnea, and arthritis. And obese people are much more likely than lean people to develop blood clots in the legs and lungs, gallstones, pancreatitis, abdominal hernia, fatty liver, polycystic ovary syndrome, high blood pressure, arthritis, gout, lower back pain, infertility, urinary incontinence, and cataracts.

Effects of Excess Dietary Fat Intake

Besides the cholesterol implications due to high fat intake, obesity is a factor in the causation of disease. Being overweight or obese is highly associated with increasing the risk of type II diabetes, gallbladder disease, cardiovascular disease, hypertension, and osteoarthritis.

Vitamin C in Cardiovascular Disease

Scorbutic guinea pigs develop hypercholesterolemia, which may lead to the development of cholesterol-rich gallstones. This is largely the result of impaired activity of cholesterol 7-hydroxylase, which is an ascorbate-dependent enzyme (Section 13.3.8), resulting in reduced oxidation of cholesterol to bile acids. There is no evidence that increased intakes of vitamin C above requirements result in increased cholesterol catabolism.

Obesity and Overweight

According to a review of studies that link risk behaviors and mortality (Mokdad, Marks, Stroup, & Gerberding, 2004), poor diet and lack of physical activity are soon to surpass tobacco use as the number one killer of Americans. Obesity, strongly linked to poor diet and lack of physical activity, has been associated with a host of conditions including hypertension, type 2 diabetes, dyslipidemia, gallbladder disease, cardiovascular disease, osteoarthritis as well as breast, colon, and prostate cancer, and all

What about overall satisfaction A year after surgery how do people feel about their decision to have gastric bypass

Before surgery you will almost certainly undergo an ultrasound of your gallbladder. If you have existing gallstones then your gallbladder will be removed at the time of surgery. The reason this is done is that the rapid weight loss you will experience following gastric bypass can increase the risk of developing symptomatic gallstones. If you already have gallstones the risk is high enough that preventive removal of your gallbladder is warranted. What if I don't have my gallbladder removed at the time of surgery What is the chance I will require a second operation due to gallbladder disease Because rapid weight loss results in gallstone formation in up to 40 percent of people, many who were not found to have gallstones at the time of surgery will develop them during the first postoperative year. Fortunately only about 15 percent of people will develop symptoms related to gallstones. In general, following surgery the gallbladder is only removed in symptomatic people.

Differential diagnosis

FD functional dyspepsia, Oes oesophagitis and reflux without oesophagitis, DU duodenal ulcer, GU gastric ulcer, IBS irritable bowel syndrome, GS gallstone disease, ARD alcohol related dyspepsia, GCa gastric cancer. *Significant difference from other diseases FD functional dyspepsia, Oes oesophagitis and reflux without oesophagitis, DU duodenal ulcer, GU gastric ulcer, IBS irritable bowel syndrome, GS gallstone disease, ARD alcohol related dyspepsia, GCa gastric cancer. *Significant difference from other diseases dyspepsia and irritable bowel syndrome. Gastric ulcer, gastro-oesophageal reflux, gastric cancer, and gall stones account for 5-10 each, and rarer diseases such as diverticular disease, small intestinal Crohn's disease, colon cancer, and pancreatitis make up the rest.

Acalculous biliary pain

The symptoms of biliary colic are characteristic but may occur in the absence of gall stones. In such cases a specialist must decide whether an operation to remove the gall bladder is appropriate, in the belief that symptoms are due to microscopic crystals (microlithiasis) or to a structural abnormality of the cystic duct.

Surgery for Weight Loss

Rationale Since surgical procedures result in some loss of absorptive function, the long-term consequences of potential nutrient deficiencies must be recognized and adequate monitoring must be performed, particularly with regard to vitamin B12, folate, and iron. Some patients may develop other gastrointestinal symptoms such as dumping syndrome or gallstones. Occasionally, patients may have postoperative mood changes or their presurgical depression symptoms may not be improved by the achieved weight loss. Thus, surveillance should include monitoring of indices of inadequate nutrition and modification of any preoperative disorders. Table IV-7 illustrates some of the complications that can occur following gastric bypass surgery.

Presentday Cultivation And Usage

Milk thistle is indigenous to Kashmir, Southern Europe, Southern Russia, North Africa, and Asia Minor. It was introduced to most areas of Europe, North and South America, and Southern Australia, and is cultivated mainly in the dry rocky soils of European countries, Australia, Canada, China, North and South America as a medicinal plant. It is also grown as ornamental plant for its attractive foliage. The seeds are collected when ripe, during late summer. Presently, milk thistle seed, its purified extracts and its active constituents are mainly used in liver diseases. It is the most widely used hepatoprotective agent in chronic inflammatory hepatic disorders, including hepatitis, jaundice, alcohol abuse, fibrosis, cirrhosis, and fatty infiltration and in hepatotoxicity by mushroom poisoning and by industrial pollutants. It is also widely used as nutraceutical agent. In homoeopathy, the seed tincture is used in liver disorders, jaundice, gall stones, peritonitis, hemorrhage, bronchitis,...

Historical Cultivation And Usage

Milk thistle was once cultivated in Europe as a vegetable. The de-spined leaves were used in salads, and similarly to spinach. The stalk, root, and flowers were also consumed, and the roasted seeds were used as a coffee substitute. Preparations of milk thistle seeds have been used medicinally since as early as 4 BC, and were first reported by Theophrastus. Traditionally, the seeds have been used in Europe as a galactogogue in nursing mothers, as a bitter tonic, and as antidepressant and in liver complications (including gallstones), dyspepsia, splenic

Clinical Manifestations and Diagnosis of Gall Stone Disease

Approximately 80 of people with gall stones are asymptomatic. The presentation of gall bladder disease can be episodic pain when a brief cystic duct obstruction occurs or acute cholecystitis when the obstruction lasts longer and results in local and relatively extensive inflammation and edema. The complications include infection of the biliary system (cholangitis) and pancreatitis.

What sort of medications can I expect to receive while in the hospital

Because gastric bypass puts you at risk for infection, your doctor will most likely order prophylactic (preventive) antibiotics. This preventive measure may save you from developing pneumonia or a wound infection. You will also be treated with blood thinners to prevent blood clots. Most people are also given medicines to prevent ulcer formation and to decrease the risk of developing nausea. You will be given pain medication. This medication is crucial. You want enough to prevent pain but not so much that you fail to breathe deeply or are too groggy to get up and walk. Finally, as mentioned earlier some centers will ask patients to initiate ursodiol aimed at the prevention of gallstones.

Mechanisms of biofilm formation by Salmonella enterica species

While S. enterica serovar Typhi causes systemic infections in humans by traversing the intestinal epithelium and invading and growing within macrophages, it is well known that bacteria can also be carried to the gallbladder where a carrier state can develop (Dutta et al., 2000 Prouty et al., 2002). Patients in a carrier state can asymptomatically shed bacteria for years, even when administered antibiotics. To determine if biofilm formation might contribute to the carrier state of S. Typhi, Prouty et al. (2002) grew Salmonella spp. in media containing human gallstones, in the presence or absence of bile. Interestingly, both S. Typhi and S. Typhimurium formed biofilms on gallstones within 14 days of inoculation and biofilm formation was dependent on the presence of bile in the growth medium. To determine what bacterial products were necessary for biofilm formation, Prouty et al. created knockouts in biosynthetic genes for capsule, flagella, fimbriae (Pef, Csg, Lpf, Fim), LPS, and the...

Improvement of cholesterol and lipid metabolism

Oats, the grain of which is rich in water-soluble fiber, have been known to lower serum lipid and cholesterol concentrations in humans since 1960s. The effects of buckwheat diets on the concentrations of serum lipid and cholesterol were also studied in humans, and the results suggested that buckwheat intake was associated with lower serum concentrations of total cholesterol and low-density lipoprotein (LDL) cholesterol (He et al., 1995). The reduction of the total serum cholesterol concentrations by buckwheat diets has also been observed in rats, and the decrease in the serum cholesterol concentrations is associated with a decrease in high-density lipoprotein (HDL) cholesterol concentration without affecting the LDL cholesterol concentration (Prestamo et al., 2003). Many investigators have confirmed the buckwheat diet-dependent decrease in the serum cholesterol concentration, although there are some discrepancies. The protein present in buckwheat flour is suggested to have a...

Gastrointestinal System Involvement in SLE

Other organs in the GI tract that may be irritated are the liver and the gallbladder. Gallbladder disease is particularly common in children with hemolytic anemia. This is easily detected on abdominal ultrasound. Usually it can be followed conservatively, but if the gallbladder is very involved or has a lot of stones, it may need to be removed. Children with liver involvement often have an enlarged liver that can be felt on examination and may be tender. Elevation of the liver enzymes on the blood tests will confirm this (see Chapter 22).

Conflicts of Interest

Who saw their rights violated by Bier's strivings. Bier described how he was asked in the rudest possible way to keep his mouth shut because he could not understand homoeopathy its evaluation was up to internal medicine and pharmacology.528 He and his assistants had met with even worse spite when, in 1929, he had reported about remedies for Graves' disease, tabes, paralytic dementia, sclerosis islets, neuralgia, liver and bile duct disorders.529 It had been pointed out to him that as a surgeon these illnesses were not his concern, as they belonged to the field of internal medicine.530 The conflict between the two specialist areas was nothing new the surgeon Theodor Kocher (1841-1917) had pointed out, with a touch of irony, when the internal physicians and surgeons were arguing about whose realm gallstones belonged to Gentlemen, you are wrong the gallstones belong to the patient.'551


A methanolic extract of baical skullcap has been shown to inhibit fibrosis and lipid peroxidation induced by bile duct ligation or carbon tetrachloride in rat liver. Bile duct ligation in rodents is an experimental model for extrahepatic cholestasis caused by, for example, cholelithiasis (gall stones). Liver fibrosis was assessed by histological observation and by measuring levels of liver hydroxyproline, lipid peroxidation based on malondialdehyde production, and serum enzyme activities. Treatment with baical skullcap significantly reduced the levels of liver hydroxyproline and malondialdehyde, with improved histological findings (Nan 2002).

Cholesterol stones

Cholesterol stones contain cholesterol, calcium salts, bile acids, fatty acids, proteins and phospholipids. If the concentration of bile acids or phospholipids drops, cholesterol will not be held in micelles. This results in the bile becoming supersaturated with cholesterol. When the cholesterol is not soluble in this supersaturated system, it forms microcrystals. These microcrystals grow and cluster with one another and with other bile constituents to form gallstones. Cholesterol gallstones are more prone to develop when there is a high ratio of cholesterol to bile acids or lecithin in the bile. This can be due to high cholesterol levels related to a high fat diet. Gallstones also form when there is a reduction in bile acid secretion, as a consequence of bile acid malabsorption or reduced lecithin secretion. Table 8.2 Risk factors for formation of gallstones. Table 8.2 Risk factors for formation of gallstones. Cholesterol gallstones Pigment gallstones


Overweight is caused most often by overeating and underexercising. An individual is considered overweight if 20 over ideal weight. A medical examine is advisable to determine if there is any underlying health condition. Excessive weight can increase the risk of heart disease, high blood pressure, some forms ofcancer, diabetes, osteoarthritis, and gallstones. Eating high-fiber foods, complex carbohydrates, low-fat foods, and exercising on a regular basis is a healthful way to lose weight. Changing food habits and keeping excess weight off will be easier to maintain if a weight reduction program is undertaken on a gradual basis.

Diagnostic procedure

In non-jaundice patients it is appropriate to start with upper endoscopy or radiographic upper gastrointestinal studies. In a jaundiced patient ultrasound would establish or rule out gallstones, but also make large tumors and liver metastases obvious. Computerised Tomography, especially the helical form would best confirm the extent of tumor mass and growth beyond the boundaries of the gland. MRI, EUS or ERCP would further delineate the extent of the disease. Angiography and a PET scan are of lesser value (Bipat 2005).

Biliary infection

Impaired gallbladder emptying predisposes to gall stones by increasing the time that material stays in the gall bladder, allowing excessive crystal growth. In addition, the dilating and flushing effect of fresh hepatic bile is lost when the gall bladder contracts poorly.

Gallbladder cancer

Gallbladder cancer is rare and usually asymptomatic until at an advanced stage. Usually it is associated with gall stones and may be discovered incidentally at operation. Suspicious features in a patient with biliary symptoms include weight loss, anaemia, persistent vomiting, and a palpable mass in the right upper quadrant. Such patients require urgent investigation. The prognosis is good if the disease is diagnosed at an early stage, but complete resection is often not possible because of the advanced stage at presentation.

Get Rid of Gallstones Naturally

Get Rid of Gallstones Naturally

One of the main home remedies that you need to follow to prevent gallstones is a healthy lifestyle. You need to maintain a healthy body weight to prevent gallstones. The following are the best home remedies that will help you to treat and prevent gallstones.

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