GALLSTONES

1. GALLSTONES (Cholelithiasis) JB

2. Statistics • 10-15% of the population in the United States are diagnosed with gallstones • 1 million new cases are diagnosed a year in the U.S • 1 in 5 people who live to be 90 have gallstones • 90% of gallstones appear with no symptoms • 80% of gallstones are cholesterol gallstones

3. Definition and History • chemical and mechanical disease • Hard stone like materials that are smooth or sharp • Vary from the size of a grain of sand to the size of a golf ball • You could have just one gallstone or up to hundreds • They develop in the gall bladder when a liquid in the gall bladder called bile hardens into pieces which is when components of the bile precipitate out of it and form crystals just as sugar does in a syrup jar • Can form if the gallbladder does not empty the bile regularly

4. Definition and History Continued There are two types of gallstones 1) Pigment gallstone • Small • Dark • Made of bilirubin from bile 2) Cholesterol gallstones • Yellow-green colour • Hardened cholesterol from bile http://wonghongweng.blogspot.com/feeds/posts/default http://www.ener-chi.com/num_one.htm

5. Definition and History Continued Bile: • watery substance • Composed of, cholesterol, fats, bilirubin (dark brown gives colour too stool), lecithin (breaks up fats for easy digestion) • Brownish in colour • 3 cups a day are produced by the liver

6. Definition and History Continued Gallbladder: • digestive organ • sac like shape, and the size of pear • located underneath of the liver in the upper right hand portion of the abdominal cavity • connected to the liver and intestine by small tubes called ducts • stores bile for digestion, and can hold 1 cup at a time • after a meal the gallbladder contracts and releases the bile being stored into the intestine to help digest food http://www.nlm.nih.gov/medlineplus/ency/imagepages/8790.htm

7. Causes Scientists have yet to fully understand why exactly some people get gallstones and others don’t. There are many factors that contribute to the formation on gallstones ranging from dietary, hereditary and hormonal. One single tiny gallstone could create more gallstones to develop. Pigment stones – more often occur in people with liver cirrhosis, or hereditary blood disorders (sickle cell anemia, liver makes too much bilirubin) http://homepage.mac.com/billsart/radiationsemester3/ahs266lecture18.htm

8. Causes Contributors to gallstones more so cholesterol stones include:

9. Causes continued...

10. Effects/Symptoms Symptoms appear when a large stone is blocking the cystic duct (bile duct) Symptoms: • most common is pain in the mid to upper right abdomen this is called biliary colic • pain between shoulder blades • pain under the right shoulder • jaundice (yellowish skin and eyes) • dark urine • light stools (clay colour) • rapid heartbeat • abrupt blood pressure drop • fever or chills • Nausea, vomiting and sweating • abdominal indigestion or fullness

11. Effects/Symptoms • Attacks could last 15 minutes to 7 hours and occur weeks, months or years apart • A lot of the times people with gallstones don’t even know it because no symptoms occur and they are found in tests or surgeries for other problems. These gallstones are given the nickname “silent gallstones”. A gallbladder “attack” occurs when there is a blocked bile duct. This occurs most often after eating a meal high in fat.

12. Effects/Symptoms Effects that gallstones could have: • inflammation or damage to the gallbladder, liver or pancreas • death if a blockage lasts to long • irritation to the lining of the gallbladder • infection if the stone becomes stuck in the bile duct for a long time bacteria will grow behind it eventually causing you to be hospitalized • gallbladder rupturing Some times gallstones could be completely harmless if they pass through the crystal and bile ducts and then the intestine. Symptoms are very similar to those of heart attacks, appendicitis, ulcers, irritable bowel syndrome, hernia, pancreatitis and hepatitis.

13. Diagnosis 1) Most of the time gallstones are found when a patient goes to get tests for other health conditions or problems 2) The doctor will press down below the rib cage while the patient takes a deep breath so see if a sharp pain occurs. 3) Blood tests: - To determine if liver enzymes are backed up into the liver -signs for infection, obstruction, pancreatitis or jaundice 4) Ultra sounds will tell the size and location of the stones. Sound waves bounce off the gallbladder, liver, organs and gallstones the echoes are then converted into electrical impulses which create a picture of the gallbladder on a screen

14. Diagnosis 5) Gallbladder test- a dye is injected into the patients arm, as the dye moves threw your liver, bile ducts, gallbladder and intestine x-rays are being taken 6) Computerized tomography (CT) scan: -noninvasive x-ray -produces cross-section images of body -shows gallstones or complications ex) infection rupture gallbladder or ducts 7) Cholescintigraphy (HIDA) scan: -injected with small amount of non-harmful radioactive material which is absorbed by the gallbladder the stimulated to contract

15. Treatment You can live with out your gallbladder. This means that the bile your liver produces flows out of the liver and right through to the hepatic ducts then to the bile duct and into the small intestine with out being stored. Surgical: 1) Laparoscopy: • sedated • several small incisions are made into abdomen • a laparoscope and miniature video camera is inserted through incisions • camera: sends magnified images to a monitor so the surgeon is able to see the tissues and organs inside better • separates gallbladder from liver, bile ducts and organs • cuts cystic duct • removes gallbladder through small incision

16. Treatment Recovery: • 1 night at hospital • normal activity resumed after a few days rest at home • less pain full and less complications then open sugary because no incisions are made into the abdominal muscle Open sugary takes 3 to 5 days of hospital recovery as well several weeks at home. Only 5 % of people with gallstones need open surgery. Consequences to surgery are that the bile ducts could get damaged and leak bile causing infections If gallstones are located somewhere in the bile duct, ERCP is used to help locate them during the operation. An ERCP is a endoscope in put down your throat threw the stomach and into the small intestine which then releases a special dye to help the bile ducts appear on the monitor during laparoscopy.

17. Treatment Non-surgical Treatment: • only if medical condition preventing surgery • only for cholesterol stones • reappear within 5 years if treated this way • Oral dissolution therapy: - dissolve stones with a drug created from bile acid. -months to years before stones disappear -effects: diarrhea, raised blood cholesterol and liver enzyme transaminase • Contact dissolution therapy: -injection of methyl tert-butyl ether into gallbladder -cholesterol stones -1 to 3 days dissolves stones -effects: irritation, complications reported

18. Future outlook/research • Seven genes have been discovered in humans that are more prone to gallstones through animal research. • We are looking for genes that may identify susceptibility for humans for gallstones. • The growing of obesity in out world has researchers to believe that this increases the rates of gallbladder disease.

19. References Anil, M. Christine, A.(2004). Gallstones. In The Digestive System and Digestive Disorders(125-127). New York, NY: Facts On File, Inc. Bunch, Bryan.(2003). Gallstones. In Diseases (Vol.4, pp.22-25) Danbury CT: Scientific Publishing, INC. Gallstones. Retrieved April 13, 2008, from AGA Patient Center Medical Information from the American Gastroenterological Association Website: http://www.gastro.org/wmspage.cfm?parm1=688 (2007). Gallstones. Retrieved April 13th, 2008, from National Digestive Diseases Information Clearinghouse (NDDIC) Website: http://www.liu.edu/cwis/cwp/library/workshop/citapa.htm Harvey, S.(2008). Gallstones and gallbladder disease. Retrieved April 13, 2008, from University of Maryland Medical Center. Website: http://www.umm.edu/patiented/atricles Lehrer, J. (2007). Gallstones. Retrieved April 13, 2008, from Medline Plus Website: http://www.nlm.nih.gov/medlineplus/ency/article/000273.htm William, Kane. (2002). Gallstones. In Health Matters (vol.8,pp.85-86). Danbury, CT: Grolier Educational. Rhodes, Monica.(2007). Gallstones. Retrieved April 13, 2008, from BCHealth Guide Website: http://www.bchealthguide.org/kbase/topic/major/hw107151/descrio.htm