Gall-stones Health Dictionary

See LIVER.... gall-bladder

See GOUT.... chalk-stones

Another name for BILE.... gall

The gall-bladder rests on the underside of the LIVER and joins the common hepatic duct via the cystic duct to form the common BILE DUCT. The gall-bladder acts as a reservoir and concentrator of BILE, alterations in the composition of which may result in the formation of gallstones, the most common disease of the gallbladder.

Gall-stones affect 22 per cent of women and 11 per cent of men. The incidence increases with age, but only about 30 per cent of those with gall-stones undergo treatment as the majority of cases are asymptomatic. There are three types of stone: cholesterol, pigment and mixed, depending upon their composition; stones are usually mixed and may contain calcium deposits. The cause of most cases is not clear but sometimes gall-stones will form around a ‘foreign body’ within the bile ducts or gall-bladder, such as suture material. BILIARY COLIC Muscle ?bres in the biliary system contract around a stone in the cystic duct or common bile duct in an attempt to expel it. This causes pain in the right upper quarter of the abdomen, with nausea and occasionally vomiting. JAUNDICE Gall-stones small enough to enter the common bile duct may block the ?ow of bile and cause jaundice. ACUTE CHOLECYSTITIS Blockage of the cystic duct may lead to this. The gall-bladder wall becomes in?amed, resulting in pain in the right upper quarter of the abdomen, fever, and an increase in the white-blood-cell count. There is characteristically tenderness over the tip of the right ninth rib on deep inhalation (Murphy’s sign). Infection of the gall-bladder may accompany the acute in?ammation and occasionally an EMPYEMA of the gall-bladder may result. CHRONIC CHOLECYSTITIS A more insidious form of gall-bladder in?ammation, producing non-speci?c symptoms of abdominal pain, nausea and ?atulence which may be worse after a fatty meal.

Diagnosis Stones are usually diagnosed on the basis of the patient’s reported symptoms, although asymptomatic gall-stones are often an incidental ?nding when investigating another complaint. Con?rmatory investigations include abdominal RADIOGRAPHY – although many gall-stones are not calci?ed and thus do not show up on these images; ULTRASOUND scanning; oral CHOLECYSTOGRAPHY – which entails a patient’s swallowing a substance opaque to X-rays which is concentrated in the gall-bladder; and endoscopic retrograde cholangiopancreatography (ERCP) – a technique in which an ENDOSCOPE is passed into the duodenum and a contrast medium injected into the biliary duct.

Treatment Biliary colic is treated with bed rest and injection of morphine-like analgesics. Once the pain has subsided, the patient may then be referred for further treatment as outlined below. Acute cholecystitis is treated by surgical removal of the gall-bladder. There are two techniques available for this procedure: ?rstly, conventional cholecystectomy, in which the abdomen is opened and the gall-bladder cut out; and, secondly, laparoscopic cholecystectomy, in which ?breoptic instruments called endoscopes (see FIBREOPTIC ENDOSCOPY) are introduced into the abdominal cavity via several small incisions (see MINIMALLY INVASIVE SURGERY (MIS)). Laparoscopic surgery has the advantage of reducing the patient’s recovery time. Gall-stones may be removed during ERCP; they can sometimes be dissolved using ultrasound waves (lithotripsy) or tablet therapy (dissolution chemotherapy). Pigment stones, calci?ed stones or stones larger than 15 mm in diameter are not suitable for this treatment, which is also less likely to succeed in the overweight patient. Drug treatment is prolonged but stones can disappear completely after two years. Stones may re-form on stopping therapy. The drugs used are derivatives of bile salts, particularly chenodeoxycholic acid; side-effects include diarrhoea and liver damage.... gall-bladder, diseases of

These are rare. POLYPS may form and, if symptomatic, should be removed. Malignant change is rare. CARCINOMA of the gall-bladder is a disease of the elderly and is almost exclusively associated with gall-stones. By the time such a cancer has produced symptoms, the prognosis is bleak: 80 per cent of these patients die within one year of diagnosis. If the tumour is discovered early, 60 per cent of patients will survive ?ve years.... other disorders of the gall-bladder

Small, hard collections of solid material within the body. (See also calculus, urinary tract; gallstones.)... stones

Cholecystitis

Acute or chronic. One of the commonest acute abdominal emergencies. An impressive rise in incidence in the young female population has been linked with the use of oral contraceptives. Other causes: heavy consumption of animal fats, sugars.

Symptoms. Severe upper abdominal pain, often radiating to the shoulder and right midback. Constancy of the pain contrasts with the repeated brief attacks of gall-stone (biliary) colic. Sweating, shallow erratic breathing, tenderness upper right abdomen, distension, flatulence, nausea, intolerance of fatty foods.

In cases of suspected cholecystitis, bitter herbs help liquefy bile and prevent consolidation. Prevention: Blue Flag, or Wild Yam, 2 tablets at night.

For infection: Echinacea.

Alternatives. BHP (1983) selection: Barberry, Mountain Grape, Balmony, Fringe Tree, Wild Yam, Wahoo, Chiretta, Dandelion, Black root; according to individual case. Milk Thistle.

Teas. Agrimony, Milk Thistle, Fumitory, Black Horehound, Wormwood. 1 heaped teaspoon to each cup boiling water, infuse 15 minutes. Half-1 cup freely.

Cold tea. One teaspoon Barberry bark to each cup cold water. Steep overnight. Half-1 cup freely. Tablets/capsules. Blue Flag. Echinacea, Wild Yam, Milk Thistle.

Powders. Equal parts: Echinacea, Wild Yam, Milk Thistle. Dose: 500mg (two 00 capsules, or one-third teaspoon) thrice daily.

Tinctures. Equal parts: Wild Yam, Blue Flag, Milk Thistle. 1 teaspoon thrice daily in water.

Topical. Castor oil pack over painful area.

Diet. Low fat. Avoid dairy products.

Supplementation. Vitamins A, B-complex, C. Bromelain, Zinc. Note. See entry: COURVOISER’S LAW. ... gall bladder, inflammation