More on Gallstones

Pigment stones:
These are dark green in color, small in size, usually multiple and irregular in shape. They are usually seen inside the gall bladder and rarely in the common bile duct. They are formed due to blood disorders like haemolytic jaundice, chronic myeloid leukemia (blood cancer) and other chronic infections that maintain the erythrocyte sedimentation rate (ESR) at a high level. These conditions, due to blood destruction, cause increased serum bilirubin level. These bilirubins are trapped in the liver and excreted in the bile. If the bile doesn’t flow properly, these pigments accumulate as sediment and form stones.

Cholesterol stones are yellow in color and usually seen in singles. It is oval in shape, soft in consistency and smooth. This type of stone is usually seen in the hartmann’s pouch in the neck of the gall bladder since these types of stones usually float.

Septic stones are more than aseptic stones.
Mixed stones are brown in color, large in size, usually multiple and irregular in shape. These types constitute 70-80 per cent of stones. These stones are composed of cholesterol, pigments, salts and other chemicals. Since it is somewhat larger in size, it is usually seen in the body of the gall bladder as it cannot escape into the intestine and outweigh the risk of blockage in the common bile duct.

Causes of gallstones:
Mainly, stagnation of bile in the gall bladder or duct for a prolonged time evokes stone formation as the outcome of precipitation or sediment. It may also be due to variation in concentration ratio of cholesterol with bile salts (normal it is 1:20-1:30) in the bile. In general, routine causes are:

Functionless gall bladder i.e. thick walled gall bladder with no contraction at all
Untimely, unconditioned diet and starvation often. Also reduced food intake can reduce the secretion of bile acids from the liver. This causes difference in composition ratio of bile salts and cholesterol, which finally results in cholesterol stones.

* Prolonged use of drips, by avoiding oral foods in case of hospital stay
* Fatty, flabby belly and pregnancy can relax the gall bladder and thus cause stones
* Malfunctioning of liver which secretes less bile with less bile salts
* Infection of gall bladder (acute or chronic cholecystitis)
* Injury in the gall bladder area which causes inflammation of gall bladder
* Taking non-veg foods, fast foods, pastry, oily and spicy foods often.
* Increased blood cholesterol level
Diseases of the intestines - for example, ulcerative colitis, crohn’s disease, irritable bowel syndrome, etc. Here, absorption of bile salts from the intestine or recycling of bile salts is interrupted, so the liver secretes bile containing very low bile salts. These lowered bile salts can’t maintain the cholesterol in solution, thus forming cholesterol gallstones.

Symptom of gallstones
Even though many gallstones are silent or symptom-less, its presence can be gauged from:

* Intermittent or constant uneasy feeling or fullness in the right upper quadrant of the abdomen
* Pain occurring just below the centre of the right lower rib pointing to the gall bladder area
* Vague pain after eating in the right upper quadrant of abdomen. The pain is more while bending or moving (since the rib presses the gall bladder) or due to infection
* Pain may radiate to the right back or just below the right shoulder blade or right shoulder
* Fever in case of infection or obstruction Bilious symptom complex - headache, nausea, constipation and abdomen discomfort. These complaints are usually better after vomiting.
* Indigestion, gas trouble, eructation or heartburn and vomiting

There are many times that stone pain arises at night, similar to tooth ache. This is because small stones block the neck of the gall bladder while the person is in a horizontal position.