Gallstone Classification and external resources
gallstones
ICD-10	K80.
ICD-9	574
OMIM	600803
DiseasesDB	2533
MedlinePlus	000273
eMedicine	emerg/97

Gall bladder opened to show numerous gallstones. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings K00-K93 - Diseases of the digestive system (K00-K14 Diseases of oral cavity salivary glands and jaws ( Disorders of Tooth development and Eruption The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors The gallbladder (or cholecyst sometimes gall bladder is a small organ whose function in the body is to store Bile and aid in the digestive process Their brownish to greenish color suggest they are cholesterol calculi. A calculus is a stone (a Concretion of material usually mineral salts that forms in an organ or duct of the body

In medicine, gallstones (choleliths) are crystalline bodies formed within the body by accretion or concretion of normal or abnormal bile components. Medicine is the art and science of healing It encompasses a range of Health care practices evolved to maintain and restore Human Health by the In Materials science, a crystal is a Solid in which the constituent Atoms Molecules or Ions are packed in a regularly ordered repeating Bile or gall is a bitter yellow or green Alkaline fluid secreted by Hepatocytes from the Liver of most Vertebrates In many species

Gallstones can occur anywhere within the biliary tree, including the gallbladder and the common bile duct. The gallbladder (or cholecyst sometimes gall bladder is a small organ whose function in the body is to store Bile and aid in the digestive process A bile duct is any of a number of long tube-like structures that carry Bile. Obstruction of the common bile duct is choledocholithiasis; obstruction of the biliary tree can cause jaundice; obstruction of the outlet of the pancreatic exocrine system can cause pancreatitis. Bile, which is synthesized in the liver is carried to the right and left hepatic ducts which converge along with the Cystic duct to form the Common hepatic duct. Choledocholithiasis is the presence of Gallstones in the Common bile duct. Jaundice, also known as icterus (attributive adjective "icteric" is yellowish discoloration of the Skin, sclerae (whites of the eyes Pancreatitis is the Inflammation of the Pancreas. See also Acute pancreatitis and Chronic pancreatitis for more details Cholelithiasis is the presence of stones in the gallbladder—chole- means "bile", lithia means "stone", and -sis means "process". In Geology, rock is a naturally occurring aggregate of Minerals and/or Mineraloids The Earth's outer solid layer the ‘ Lithosphere

The characteristics of gallstones are various. Independent of appearance, however, gallstones from animals are valuable on the market.

Characteristics

Size

A gallstone's size varies and may be as small as a sand grain or as large as a golf ball. The gallbladder may develop a single, often large, stone or many smaller ones. They may occur in any part of the biliary system.

Content

Gallstones have different appearance, depending on their contents. On the basis of their contents, gallstones can be subdivided into the two following types:

Cholesterol stones

Gallstones

Cholesterol stones are usually green, but are sometimes white or yellow in color. Cholesterol is a Lipid found in the Cell membranes and transported in the Blood plasma of all Animals It is an essential component of mammalian They are made primarily of cholesterol.

Pigment stones

Pigment stones are small, dark stones made of bilirubin and calcium salts that are found in bile. Bilirubin (formerly referred to as hematoidin) is the yellow breakdown product of normal Heme Catabolism. Calcium (ˈkælsiəm is the Chemical element with the symbol Ca and Atomic number 20 Salt is a Dietary mineral composed primarily of Sodium chloride that is essential for Animal life but toxic to most land plants They account for the other 20 percent of gallstones. Risk factors for pigment stones include hemolytic anemia, cirrhosis, biliary tract infections, and hereditary blood cell disorders, such as sickle cell anemia and spherocytosis. Hemolytic anemia is Anemia due to Hemolysis, the abnormal breakdown of Red blood cells (RBCs either in the Blood vessels (intravascular hemolysis Cirrhosis is a consequence of chronic Liver Disease characterized by replacement of liver tissue by fibrous Scar tissue as well as regenerative A bile duct is any of a number of long tube-like structures that carry Bile. Sickle-cell disease or sickle-cell anaemia (or anemia) is a Blood disorder characterized by Red blood cells that assume an abnormal rigid Spherocytosis is an auto- hemolytic Anemia (a disease of the blood) characterized by the production of Red blood cells (RBCs or erythrocytes

Mixed stones

Mixed stones account for the majority of stones. Most of these are a mixture of cholesterol and calcium salts. Because of their calcium content, they can often be visualized radiographically.

Pseudolithiasis

A. K. A. "Fake stone" Sludge-like gallbladder secretions that act like a stone.

Causes

Progress has been made in understanding the process of gallstone formation. Researchers believe that gallstones may be caused by a combination of factors, including inherited body chemistry, body weight, gallbladder motility (movement), and perhaps diet. Additionally, people with erythropoietic protoporphyria (EPP) are at increased risk to develop gallstones. Erythropoietic protoporphyria (EPP is a relatively mild form of Porphyria, although very painful which arises from a deficiency in the enzyme Ferrochelatase, leading ^[1]

Cholesterol gallstones develop when bile contains too much cholesterol and not enough bile salts. Besides a high concentration of cholesterol, two other factors seem to be important in causing gallstones. The first is how often and how well the gallbladder contracts; incomplete and infrequent emptying of the gallbladder may cause the bile to become overconcentrated and contribute to gallstone formation. The second factor is the presence of proteins in the liver and bile that either promote or inhibit cholesterol crystallization into gallstones.

In addition, increased levels of the hormone estrogen as a result of pregnancy, hormone therapy, or the use of combined (estrogen-containing) forms of hormonal contraception, may increase cholesterol levels in bile and also decrease gallbladder movement, resulting in gallstone formation. Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female Hormone therapy, or hormonal therapy is the use of Hormones in medical treatment Hormonal contraception refers to Birth control methods that act on the hormonal system

No clear relationship has been proven between diet and gallstone formation. However, low-fibre, high-cholesterol diets, and diets high in starchy foods have been suggested as contributing to gallstone formation. Other nutritional factors that may increase risk of gallstones include rapid weight loss, constipation, eating fewer meals per day, eating less fish, and low intakes of the nutrients folate, magnesium, calcium, and vitamin C. ^[2] On the other hand, wine and whole grain bread may decrease the risk of gallstones. ^[3]

Symptoms

Gall stones usually remain asymptomatic initially. ^[4] They start developing symptoms once the stones reach a certain size (>8mm). ^[5] A main symptom of gallstones is commonly referred to as a gallstone "attack", also known as biliary colic, in which a person will experience intense pain in the upper abdominal region that steadily increases for approximately thirty minutes to several hours. Biliary colic is pain associated with irritation of the viscera secondary to cholecystitis and gallstones A victim may also encounter pain in the back, ordinarily between the shoulder blades, or pain under the right shoulder. In some cases, the pain develops in the lower region of the abdomen, nearer to the pelvis, but this is less common. Nausea and vomiting may occur.

These attacks are intensely painful, similar to that of a kidney stone attack. Kidney stones, also called renal calculi, are solid concretions (crystal aggregations of dissolved minerals in Urine; calculi typically form One way to alleviate the abdominal pain is to drink a full glass of water at the start of an attack to regulate the bile in the gallbladder, but this does not work in all cases. The gallbladder (or cholecyst sometimes gall bladder is a small organ whose function in the body is to store Bile and aid in the digestive process Another way is to take magnesium followed by a bitter liquid such as coffee or swedish bitters an hour later. CoFFEE is an Open source Software for computer supported collaborative learning (CSCL in a digital classroom Swedish bitters is a traditional herbal tonic said to have been formulated Bitter flavors stimulate bile flow. A study has found lower rates of gallstones in coffee drinkers. ^[6]

Often, these attacks occur after a particularly fatty meal and almost always happen at night. Other symptoms include abdominal bloating, intolerance of fatty foods, belching, gas, and indigestion. If the above symptoms coincide with chills, lowgrade fever, yellowing of the skin or eyes, and/or clay-colored stool, a doctor should be consulted immediately. In Medicine, low-grade fever is a continuous or fluctuating low Fever, typically defined as never exceeding 38 ^[7]

Some people who have gallstones are asymptomatic and do not feel any pain or discomfort. These gallstones are called "silent stones" and do not affect the gallbladder or other internal organs. The gallbladder (or cholecyst sometimes gall bladder is a small organ whose function in the body is to store Bile and aid in the digestive process They do not need treatment. ^[7]

Treatment

Medical options

Cholesterol gallstones can sometimes be dissolved by oral ursodeoxycholic acid. Ursodiol, also known as ursodeoxycholic acid and the Abbreviation UDCA, is one of the secondary Bile acids which are metabolic byproducts Gallstones may recur however, once the drug is stopped. Obstruction of the common bile duct with gallstones can sometimes be relieved by endoscopic retrograde sphincterotomy (ERS) following endoscopic retrograde cholangiopancretaography (ERCP). A common misconception is that the use of ultrasound (Extracorporeal Shock Wave Lithotripsy) can be used to break up gallstones. Not to be confused with Supersonic. Ultrasound is cyclic Sound pressure with a Frequency greater than the upper A lithotriptor is a Medical device used in the non-invasive treatment of Kidney stones (urinary calculosis and Biliary calculi (stones in the Although this treatment is highly effective against kidney stones, it can only rarely be used to break up the softer and less brittle gallstones. Kidney stones, also called renal calculi, are solid concretions (crystal aggregations of dissolved minerals in Urine; calculi typically form

Surgical options

Cholecystectomy (gallbladder removal) has a 99% chance of eliminating the recurrence of cholelithiasis. Cholecystectomy (/ˌkɔləsɪsˈtɛktəmi/ plural cholecystectomies is the surgical removal of the Gallbladder. Only symptomatic patients must be indicated to surgery. The lack of a gall bladder does not seem to have any negative consequences in many people. However, there is a significant proportion of the population, between 5-40%, who develop a condition called postcholecystectomy syndrome. The term Postcholecystectomy syndrome ( PCS) describes the presence of abdominal symptoms after surgery to remove the Gallbladder ( Cholecystectomy) ^[8] Symptoms include gastrointestinal distress and persistent pain in the upper right abdomen. 20% of patients develop chronic diarrhea. ^[9]

There are two surgery options: open procedure and laparoscopic: see the cholecystectomy article for more details. Cholecystectomy (/ˌkɔləsɪsˈtɛktəmi/ plural cholecystectomies is the surgical removal of the Gallbladder.

• Open cholecystectomy procedure: This involves a large incision into the abdomen (laparotomy) below the right lower ribs. A laparotomy is a surgical procedure involving an incision through the Abdominal wall to gain access into the Abdominal cavity. A week of hospitalization, normal diet a week after release and normal activity a month after release.
• Laparoscopic cholecystectomy: 3-4 small puncture holes for camera and instruments (available since the 1980s). Laparoscopic surgery, also called Minimally invasive surgery (MIS, bandaid surgery, Keyhole surgery, or pinhole surgery The 1980s was the decade spanning from January 1 1980 to December 31 1989. Typically same-day release or one night hospital stay, followed by a week of home rest and pain medication. Can resume normal diet and light activity a week after release. (Decreased energy level and minor residual pain for a month or two. ) Studies have shown that this procedure is as effective as the more invasive open cholecystectomy, provided the stones are accurately located by cholangiogram prior to the procedure so that they can all be removed. The procedure also has the benefit of reducing operative complications such as bowel perforation and vascular injury.

Alternative medicine

A regimen called a "gallbladder flush" or "liver flush" is a popular remedy in alternative medicine. ^[10] In this treatment, often self-administered, the patient drinks four glasses of pure apple juice (not cider) and eats five apples (or applesauce) per day for five days, then fasts briefly, takes magnesium, and then drinks large quantities of lemon juice mixed with olive oil before bed. The next morning, they painlessly pass a number of green and brown pebbles purported to be stones flushed from the biliary system.

A New Zealand hospital analyzed stones from a typical gallbladder flush and found them to be composed of fatty acids similar to those in olive oil, with no detectable cholesterol or bile salts,^[11] demonstrating that they are little more than hardened olive oil. Despite the gallbladder flush, the patient still required surgical removal of multiple true gallstones. The note concluded: "The gallbladder flush may not be entirely worthless, however; there is one case report in which treatment with olive oil and lemon juice resulted in the passage of numerous gallstones, as demonstrated by ultrasound examination. "^[12]

In the case mentioned, ultrasound confirmed multiple gallstones, but after waiting months for a surgical option, the patient underwent a treatment with olive oil and lemon juice resulting in the passage of four 2. 5 cm by 1. 25 cm stones and twenty pea-sized stones. Two years later symptoms returned, and ultrasound showed a single large gallstone; the patient chose to have this removed surgically. ^[12]

Value

Gallstones are, oddly, a valuable by-product of meat processing, fetching up to US$32 per gram in their use as a purported antipyretic and antidote in the herbal medicine of some cultures, particularly in China. Antipyretics are Drugs that reduce body temperature in situations such as Fever. The finest gallstones tend to be sourced from old dairy cows, which are called Niu-Huang (yellow thing of oxen) in Chinese. Those got from dogs, called Gou-Bao (treasure of dogs) in Chinese, are also used today. Much as in the manner of diamond mines, slaughterhouses carefully scrutinize offal department workers for gallstone theft. ^[13]

References

External links

• Public domain NIH/NIDDK e-pub on gallstones
• Gallbladder removal - series from Nuggets Medical Encyclopedia
• "Gall Stones and Gall Bladder Surgery" Information for this article was located from the University of Florida, Medical Library in Gainesville, Florida, and researched by Richard Pressinger (M. Ed. ) and Jerry Abraham (M. B. A)