Gallstones represent a polygenic disorder that affects more than 30,000,000 Americans. This very high number pushes many people to look for ways to dissolve gallstones and results in more than 750,000 surgeries in the United States annually.
Why Do People Get Gallstones:
Risk factors include age, gender, race, parity, obesity, and diabetes. A family history of gallstones also has been identified as a risk factor suggesting that genetics play a role in gallstone formation. However, the role of genetics in the pathogenesis of gallstone formation has not been determined.
Gallbladder disease or a diseased gallbladder represents a major healthcare problem in the United States. Approximately 12% of the U.S. population, or 30,000,000 Americans have gallstones or gallbladder sludge.
Approximately three-fourths of the patients with gallstones or gallbladder sludge in the United States have stones that are composed primarily of cholesterol. The pathogenesis of cholesterol gallstones is known to be multifactorial, with the key factors including: 1) cholesterol supersaturated bile; 2) nucleation and growth of cholesterol monohydrate crystals; and 3) altered biliary motility.
In size, gallstones can be as small as a grain of sand or as large as a golf ball. A person can form one large stone in his or her gallbladder, or hundreds. About 10 percent of the population have gallstones, but the vast majority can let their body dissolve gallstones naturally, experience no symptoms, and don't need help. However, in 1 percent to 2 percent of these people, gallstones can cause problems by lodging in bile ducts, stopping the flow of bile or digestive enzymes, poor digestion, and leading to severe abdominal pain, vomiting, inflammation, and even life-threatening infection.
Types of Gallstones:
There are two types of gallstones: cholesterol and pigment stones. About 80 percent of all gallstones are cholesterol stones, yellow-green stones made up of hardened cholesterol. Cholesterol stones are associated with bile that contains an overabundance of cholesterol, or is "supersaturated" with cholesterol. The other 20 percent of gallstones are pigment stones, composed of bilirubin and other elements. Pigment stones are often seen in Asian cultures but rarely in U.S. patients. They are black or brown in color, and why they occur is not fully understood. Black pigment stones tend to remain in the gallbladder, whereas brown pigment stones often lodge in bile ducts.
What Is Biliary Obstruction?
A biliary obstruction is a blockage of the bile ducts. The bile ducts carry bile from the liver and gallbladder through the pancreas to the small intestine. An obstruction may be caused by a number of factors involving the bile ducts, liver, gallbladder, pancreas, and the small intestine. The majority of the cases of biliary obstruction are a result of gallstones, which means women are more likely to get biliary obstruction than men. Bile is a dark-green or yellowish-brown fluid secreted by the liver to digest fats. Much of the bile is released directly into the small intestine, and what remains is stored in the gallbladder. After you eat, the gallbladder releases bile to help in digestion and fat absorption. Bile also helps rid the liver of waste products. Obstruction of any of these bile ducts is referred to as a biliary obstruction.
Many of the conditions related to biliary obstructions can be treated successfully. However, if the blockage remains untreated for a long time, it can lead to life-threatening diseases of the liver. You have several types of bile ducts. The two types of bile ducts in the liver are intrahepatic and extrahepatic ducts. Intrahepatic ducts are a system of smaller tubes within the liver that collect and transport bile to the extrahepatic ducts. The extrahepatic ducts begin as two parts, one on the right of the liver and the other on the left. As they descend from the liver, they unite to form the common hepatic duct. This runs directly toward the small intestine. The biliary duct, or the duct from the gallbladder, also opens into the common hepatic duct. The bile duct from this point onward is known as the common bile duct or choledochus. Before emptying into the small intestine, the common bile duct passes through the pancreas.
What Causes Biliary Obstruction?
A biliary obstruction may be caused by a number of factors involving the:
• bile ducts
• small intestine
The following are some of the most common causes of biliary obstruction:
• Gallstones, which is most common
• Gallbladder Sludge
• Diseased Gallbladder
• Inflammation of the bile ducts
• An abnormal narrowing of the duct
• enlarged lymph nodes
• an injury related to gallbladder or liver surgery
• tumors of the bile ducts
• tumors of the pancreas
• infections, including hepatitis
• cirrhosis, or scarring of the liver
• severe liver damage
What Are the Risk Factors?
The risk factors for biliary obstruction usually depend on the cause of the obstruction. The majority of the cases are a result of gallstones, making women more vulnerable to developing a biliary obstruction. Other risk factors include:
• a history of gallstones
• chronic pancreatitis
• a history of tumors in the right part of the abdomen
• an injury to the right part of the abdomen
• rapid weight loss
What Are the Symptoms of Biliary Obstruction?
The symptoms of biliary obstruction can depend on the cause of the obstruction. They can vary. People with biliary obstruction usually have:
• light-colored stools
• dark urine
• yellowish skin or eyes, which indicates jaundice
• pain in the upper right side of the abdomen (gallstone pain)
• weight loss
How Is a Biliary Obstruction Diagnosed?
Various tests are available for people who may have a biliary obstruction.
Blood Test - A blood test includes a complete blood count (CBC) and liver function test. Blood tests can usually rule out certain conditions, such as:
• cholecystitis, which is an inflammation of the gallbladder
• cholangitis, which is an inflammation of the common bile duct
• an increased level of conjugated bilirubin, which is a waste product of the liver
• an increased level of liver enzymes
• an increased level of alkaline phosphatase
Ultrasonography - Ultrasonography is usually the first test performed on anyone suspected of a biliary obstruction. It allows your doctor to see the gallstones easily.
Biliary Radionuclide Scan (HIDA scan) - A hepatobiliary iminodiacetic acid scan, or HIDA scan, is also referred to as a biliary radionuclide scan. It uses radioactive material to provide valuable information about the gallbladder and any possible obstructions.
Cholangiography - A cholangiography is an X-ray of the bile ducts.
MRI Scan - An MRI scan provides detailed pictures of the liver, gallbladder, pancreas, and bile ducts.
Magnetic Resonance Cholangiopancreatography (MRCP) - Magnetic resonance cholangiopancreatography (MRCP) is used for the diagnosis of biliary obstructions and pancreatic disease.
Endoscopic Retrograde Cholangiopancreatography (ERCP) - An endoscopic retrograde cholangiopancreatography (ERCP) involves the use of an endoscope and X-ray. It’s both a diagnostic and therapeutic tool. It allows your surgeon to see the bile ducts and it’s also used in treatment. This tool is particularly helpful because your doctor can use it to remove stones and take biopsy samples if necessary.
Can Biliary Obstruction Be Prevented?
Here are a few changes you can make to lower your chances of developing a biliary obstruction:
• Increase the amount of fiber in your diet.
• Decrease the amount of sugar and saturated fats in your diet. These can both cause gallstones.
• If you’re overweight, gradually get your weight into a healthy range for your sex, age, and height.