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Gallstones and other gallbladder disorders: a national health problem.

This year, over one million people will discover that they have gallstones. They will join an estimated 25 million Americans, over 10% of the population, who already have gallstones or other gallbladder disorders.

Anyone is a potential candidate for gallstone disease, but women are particularly vulnerable. In fact, women between the ages of 20 and 60 are three times more likely to develop gallstones than are men.

Although anyone in the general population can develop gallstones, there are several groups who are at higher risk, including the following:

* Women who are overweight

* Women who have been pregnant

* Women who have used oral menopausal estrogen therapy or oral contraceptives

* Those who have recently lost weight

* Those who are American Indian ancestry

Even though gallstones are more common in females at a younger age, by the age of 60, almost 10% of all men, as well as 20% of women, have gallstones.

We are just beginning to learn some of the answers to fundamental questions, such as what causes gallstones to form and the relative roles of the liver and gallbladder in stone formation. We still do not know why some people develop gallstones and others do not. But researchers are working to answer these questions.

What is the gallbladder

and what does it do?

The gallbladder is a small pear-shaped organ that averages three to six inches in length. It is tucked under the liver and is connected to the liver and intestine by small tubes called bile ducts. Bile -- a greenish-brown fluid that is essential to the digestion of fatty foods -- is produced by the liver and secreted into the gallbladder. The gallbladder serves as a receptacle for the concentration and storage of bile.

What are gallstones?

Gallstones are lumps of solid material that form in the gallbladder. They may be as small as tiny specks, or in extreme cases, as large as the gallbladder. The vast majority, however, are small, less than 20 mm., or about 1 inch.

There are two major types of gallstones:

* Cholesterol gallstones, composed mainly of cholesterol, account for approximately 80% of all cases diagnosed in the United States.

* Pigment gallstones, composed mainly of calcium salts of bile pigments and other compounds, account for the remaining 20%.

Since most patients have cholesterol gallstones, they may be candidates for non-surgical treatment. Gallstone type is important since only patients with cholesterol gallstones are candidates for non-surgical treatments.

Do gallstones always cause problems?

In many patients, gallstones remain "silent" or asymptomatic and cause few serious problems. However, the longer gallstones are present, the more likely they are to cause complications. The chance that a silent gallstone will cause discomfort is about 3% per year in any patient. Thus, in 20 years, the majority of patients who have asymptomatic gallstones will develop symptoms. Once symptoms arise, they persist. And, when problems occur in older people, they can be much more difficult to treat, especially if the person has other medical problems.

As gallstones grow larger, they may block the outlet of the gallbladder and begin to cause serious disorder. Blockage can progress from gradual or occasional obstruction of the outlet, causing inflammation of the gallbladder (chronic cholecystitis), to total obstruction, causing acute inflammation of the gallbladder (cholecystitis), a condition which requires surgical treatment.

Other complications may result when gallstones block the common bile duct which leads to the intestine. There can be infection of the bile ducts (acute cholangitis) which causes chills and fever. Bile pigments may accumulate in the blood, causing jaundice, a yellow discoloration of the skin and eyes. Acute inflammation of the pancreas (pancreatitis) may occur. If the bile duct remains blocked for a long period of time, liver damage occurs, leading to liver failure and death. Rarely, large gallstones move into the small intestine and cause obstruction near the junction of the small and large intestine.

What are signs and symptoms

of gallstones?

Many people have gallstones, but do not have symptoms. When symptoms are evident, a person with gallstones may experience:

* severe and steady pain in the upper abdomen, which can spread to the chest, shoulders or back, and is sometimes mistaken for the symptoms of a heart attack

* indigestion, nausea or vomiting

* severe abdominal pain and tenderness in the right side of the abdomen when the gallbladder is inflamed

* jaundice, chills, and fever when gallstones block the passage of bile

How are gallstones diagnosed?

Most gallstones can be discovered by simple, painless techniques. Patients who complain of abdominal pain or gastrointestinal distress are often given specific tests designed to diagnose gallstones.

Often, an ordinary x-ray of the abdomen will detect gallstones. However, such gallstones are rich in calcium.

A more sensitive technique, called ultrasound, produces an image or photograph of the gallbladder and bile ducts, and allows the physician to determine if any type of gallstone is present. This is the most common screening technique since no radiation is used.

Another test, called cholecystography, requires the patient to swallow pills containing dyes. The dye passes from the bloodstream into the bile, and outlines the gallbladder so gallstones can be detected by x-rays.

More complicated procedures are required when gallstones in the bile ducts are suspected.

With ERCP (Endoscopic Retrograde Cholangiopancreatography), a flexible tube is passed through the small intestine into the bile duct; dye is injected into the bile ducts and an x-ray is taken.

With a technique called PTC (Percutaneous Transhepatic Cholangiography), a thin needle is passed through the abdomen into the duct network of the liver. Then, dye is injected and an x-ray is taken.

How can gallstones be treated?

The gallbladder is an important organ, but is not essential for life. Many patients with gallstones -- or complications resulting from gallstones -- have had their gallbladders surgically removed safely. The operation is called a cholecystectomy and is among the most common surgical procedures in the world. More than 500,000 are performed in the U.S. each year. Surgical risk increases as patients age and when the patient has other illnesses. If the gallbladder is removed, the bile then flows directly from the liver to the small intestine. There may be little or no effect on digestion. For some patients, however, gallbladder removal may not relieve the symptoms of gas, pain, bloating, or nausea.

An oral medication, ursodiol, dissolves cholesterol gallstones and represent a safe and effective alternative to gallbladder surgery for many patients. Ursodiol is a naturally-occurring bile acid which lowers the amount of cholesterol in the bile and slowly dissolves gallstones within six to 24 months in many patients, depending on the size of the stones.

Many people who have cholesterol gallstones and in whom there is no obstruction of the flow of bile into and out of the gallbladder may be candidates for treatment with ursodiol. It may be of particular interest for people who are high risk surgery patients, and for those who wish to avoid surgery. Small stones composed entirely of cholesterol respond especially well to treatment with ursodiol. The drug is extremely well tolerated with only rare instances of mild, transient diarrhea reported, and has been widely used and tested in Europe, Asia, and the U.S.

Another alternative to surgery is being explored on a research basis. Shock wave lithotripsy is a new technique which uses external sound waves to fragment gallstones into small pieces. The pieces are then dissolved by ursodiol taken orally, although some stones will pass spontaneously.

Following these new, non-surgical techniques, which leave the gallbladder in place, fully half the patients who were followed up for five years did not have a recurrence of gallstones. Of the patients whose stones recur, a recent study states that only a small percentage will experience symptoms. And, for those who experience symptoms, re-treatment should provide relief.

The American Liver Foundation is the only national voluntary health organization dedicated to fighting all liver diseases through research, education and support groups.

Each year more than 25 million Americans are afflicted with liver and gall bladder diseases and more than 27,000 die of cirrhosis. There are few effective treatments for most life-threatening liver diseases, except for liver transplants. Research has recently opened up exciting new paths for investigation, but much more remains to be done to find cures for more than 100 different liver diseases.
COPYRIGHT 1989 American Liver Foundation
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Copyright 1989 Gale, Cengage Learning. All rights reserved.

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Publication:Pamphlet by: American Liver Foundation
Article Type:pamphlet
Date:Jan 1, 1989
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