Thursday, January 20, 2011

Cholelithiasis or Gall Stones

Gall bladder is a small pouch that stores bile. 
It is a pear shaped pouch that is located on the underside of the right portion of the liver. 
It can hold 45 milliliters of bile at a time. 
Gallbladder is situated at the right side of abdomen below the liver. 

Liver, responsible for digestion of food, produces bile to digest fatty food. Bile goes into the gallbladder and collects there till there arises the need to digest any fatty food. 
The bile goes to small intestine via bile ducts and from there is excreted out of the body. 

Abnormal concentration of bile acids, cholesterol imbalance and phospholipids in the bile can cause the formation of gallbladder stones.

Gallstone composed of calcium salt, phospholipids, lecithin, bilirubin (a pigment), bacteria and crystallized cholesterol.

On the basis of their composition, gallstones can be divided into the following types:
1. Cholesterol stones :
Cholesterol stones vary in color from light yellow to dark green or brown and are oval 2 to 3 cm in length often having a tiny dark central spot.
The cholesterol stones are formed when bile contains too much cholesterol, bilirubin, or not enough bile salts, or when the gallbladder does not empty completely or often enough due to constipation or other reasons.

2. Pigment stones :
Pigment stones are small, dark stones made of bilirubin and calcium salts that are found in bile.The cause of pigment stones is not exactly known. These stones tend to develop in people having liver cirrhosis, biliary tract infections, or hereditary blood disorders where the liver makes too much bilirubin.  

3. Mixed stones :  
Mixed gallstones typically contain 20–80%  cholesterol.Other common constituents are calcium carbonate, palmitate phosphate, bilirubin, and other bile pigments. 
Because of their calcium content, they are often radiographically visible.

Gallstones are a hard object that forms in the gall bladder, cyctic duct, hepatic duct or bile duct (common bile duct). 
It is irregular in shape and varies in size. 
It varies in color from yellow, black or red.
These calculi are formed in the gallbladder, but may pass distally into other parts of the biliary tract such as the cystic duct, common bile duct, pancreatic duct, or the ampulla of Vater.

Presence of gallstones in the gallbladder may lead to acute cholecystitis, an inflammatory condition characterized by retention of bile in the gallbladder and often secondary infection by intestinal microorganisms, predominantly Escherichia coli and Bacteroides species. 
Presence of gallstones in other parts of the biliary tract can cause obstruction of the bile ducts, which can lead to serious conditions such as ascending cholangitis or pancreatitis. 
Either of these two conditions can be life-threatening, and are therefore considered to be medical emergencies.

Causes :
01. Excess of the hormone estrogen - That is why women suffer more from gallbladder stones than men.

02. Heredity - Gallbladder stones often run in families due to some genetic cause.

03. Obesity - Being even moderately overweight increases the risk for developing gallbladder stones, especially in women.

04. Low fiber, high fat Diet - Increased cholesterol in the bile and reduced gallbladder emptying leads to gallbladder stones.

05. Constipation - Accumulation of bile in gallbladder can lead to formation of gallbladder stones.

06. Cholesterol lowering drugs - These drugs increase the amount of cholesterol secreted into bile leading to formation of gallbladder stones.

07. Diabetes - Diabetics usually have high levels of fatty acids called triglycerides that increase the risk of gallbladder stones.

If you experience the following symptoms, you might be at risk of gallbladder stones :
01. Acute or intermittent pain in the upper abdomen that can last for a few minutes or hours together.

02. Constant pain below the breastbone that can go up into the right or left shoulder and even to the back.

03. Indigestion that may show signs of gastric trouble and abdominal pain.

04. Nausea and vomiting accompanied with gallbladder pain.

05. Yellowish discoloration of the skin and eyes.

06. Dark colored urine along with clay-colored stools.

 07. A patient may also experience referred pain between the shoulder blades or below the right shoulder.

 08. Other symptoms include abdominal bloating, intolerance of fatty foods, belching, gas and indigestion. 

However, some people with gall bladder stones may not show any of the symptoms and these gallstones are termed as "silent stones". These stones do not interfere with gallbladder, liver, or pancreas function and do not need treatment, as well.  

Gallstones can be Diagnosed mainly by:
01. Ultrasonography - a use of high frequency sound waves that detect abnormalities inside the body.

02. Cholecystography - a use of X-ray after the patient swallowed a dye to outline the ducts and gall bladder.

Complications :
Choledocholithiasis (stones in common bile duct) is one of the complications of cholelithiasis (gallstones), so the initial step is to confirm the diagnosis of cholelithiasis.

Treatment :
01. Cholesterol gallstones can sometimes be dissolved by oral ursodeoxycholic acid, but it may be required that the patient takes this medication for up to two years. Gallstones may recur however, once the drug is stopped. 

02. Obstruction of the common bile duct with gallstones can sometimes be relieved by endoscopic retrograde sphincterotomy (ERS) following endoscopic retrograde cholangiopancreatography (ERCP). 

03. Gallstones can be broken up using a procedure called lithotripsy (extracorporeal shock wave lithotripsy). which is a method of concentrating ultrasonic shock waves onto the stones to break them into tiny pieces. They are then passed safely in the feces. However, this form of treatment is only suitable when there are a small number of gallstones.

04. Cholecystectomy (gallbladder removal) has a 99% chance of eliminating the recurrence of cholelithiasis. Only symptomatic patients must be indicated to surgery. The lack of a gallbladder may have no negative consequences in many people
However, there is a significant portion of the population - between 5 and 40% - who develop a condition called postcholecystectomy syndrome which may cause gastrointestinal distress and persistent pain in the upper right abdomen. In addition, as many as 20% of patients develop chronic diarrhea.

There are two surgical options for cholecystectomy: 
01. Open cholecystectomy : 
This procedure is performed via an incision into the abdomen (laparotomy) below the right lower ribs. Recovery typically consists of 3–5 days of hospitalization, with a return to normal diet a week after release and normal activity several weeks after release. 

02. Laparoscopic cholecystectomy: 
This procedure is performed via three to four small puncture holes for a camera and instruments. Post-operative care typically includes a same-day release or a one night hospital stay, followed by a few days of home rest and pain medication. 

Ayurvedic view : 
Vitiation in the vata, pitta and kapha doshas of the body cause this disease. 
    The predominant factor is the aggravation in pitta dosha of the body.

    Remedies :
    01. Adopt the perfect gallbladder diet, that is high fiber-low fat diet. Low fat food will reduce the amount of cholesterol going into gallbladder and high fiber food will relieve you from constipation avoiding any formation of gallbladder stones.

    02. Diet for Gallstones Drink lots of water during the day. Drinking at least 8-10 glasses of water is beneficial for over all health too.

    03. Exercise regularly to help keep your bowel movement smooth. Reduce weight by natural ways to avoid gallbladder stones and many other health risks.

    04. Drink fresh juice of beets, carrot and cucumber twice a day. They help in gallbladder cleanse.

    05. Eat pear or drink its juice for cleansing gallbladder. Also take carrots, beets, grapefruit, lemons or grapes raw or in form of juice.

    06. Take about 125 ml each of the juices of dandelion and watercress twice a day.

    07. Take plain yoghurt, cottage cheese, and a tablespoon of olive oil twice a day. The best way is to include them into your diet.

    08. Avoid high fat foods like meat, eggs, animal fats, processed foods, fried and greasy foods, refined carbohydrates, alcohol, sugar as well as spices, condiments, and pickles.

    09. Eat frequent small meals rather than 2 or 3 large meals during the day.

    10. Drink apple juice for two days before going to bed. On the second night mix 3 ounces of fresh squeezed lemon and three ounces of dark olive oil and drink. If your gallbladder stones are very small, they will dissolve and pass out on the third day.

    11. To increases bile production, add dandelion and milk thistle in your morning tea. Other herbs such as chamomile, marshmallow, and slippery elm can also be added to decrease gallbladder inflammation.

    12. Chicory Plant: The flowers, roots and even the seeds of chicory are useful in the treatment of gall bladder. You can prepare decoction out of the flowers, seeds and roots of chicory and take it thrice in a day. 

    13. Aloe vera (കറ്റാര്‍ വാഴ) – Its juice can be taken in dosage of 20 ml on an empty stomach. 

    14. Coconut water – It should be taken 3 or 4 times a day.

    15. Papaya – It is a very effective treatment for stones. Extract juice of papaya and mix it with some water. Drink it in the morning on an empty stomach for a few days.

    16.  Kulthi  (മുതിര) – Soak 50 gms of Kulthi pulse in water overnight. Mash it in the morning and drink it. 30 ml decoction of Kulthi seeds can also be taken twice a day.

    Classical Preparations:
    01. Gokshuradhi kasahayam
    02. Punarnavadi kashaayam
    03. Hraswa Panchamoolam kashaayam

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    2. എനിക്ക് ദേ.. ഈ സാധനം ഇല്ല... ഗാള്‍ബ്ലാടെര്‍.... ...,... അത് ദാക്കിട്ടെര്സ് മുറിച്ചു കളഞ്ഞു... അതില്‍ നിറച്ചും കല്ലായിരുന്നത്രേ....

    3. എനിക്ക് ദേ.. ഈ സാധനം ഇല്ല... ഗാള്‍ബ്ലാടെര്‍.... ...,... അത് ദാക്കിട്ടെര്സ് മുറിച്ചു കളഞ്ഞു... അതില്‍ നിറച്ചും കല്ലായിരുന്നത്രേ....

    4. maggie.danhakl@healthline.comFriday, August 29, 2014

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    5. please give me full details to remove gallstone of my wife naturally as she has 3 to 10mm gallstone since april 2015
      your details chekced it is wonderful and i start for the same please give me sure ayurvedic treatment which is so easy and can disolve stone natually.

    6. The season of Summer is dominated by Fire Element (agni) which translates to Pitta Dosha in Ayurveda. The main characteristic of pitta is heat. Herbal remedies can help soothe inflammatory conditions & promote detoxification for Pittas.

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    8. Please advise treatment for 20 mm gall bladder stone..


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