Gallstones, Choledocholithiasis – Common Bile Duct Stones Part 2

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Gallbladder Diseases without Stones (Acalculous Gallbladder Disease)

Gallbladder disease can occur without stones, a condition called acalculous gallbladder disease. This refers to a condition in which a person has symptoms of gallbladder stones, yet there is no evidence of stones in the gallbladder or biliary tract. It can be acute (arising suddenly) or chronic (persistent).

• Acute acalculous gallbladder disease usually occurs in patients who are very ill from other disorders. In these cases, inflammation occurs in the gallbladder. Such inflammation usually results from reduced blood supply or an inability of the gallbladder to properly contract and empty its bile.

• Chronic acalculous gallbladder disease (also called biliary dyskinesia) appears to be caused by muscle defects or other problems in the gallbladder, which interfere with the natural movements required to empty the sac.

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Gallstones Symptoms and Treatment Part 1

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Symptoms:

About 90% of gallstones cause no symptoms. There is a very small (2%) chance of developing pain during the first 10 years after gallstones form. After 10 years, the chance for developing symptoms declines. On average, symptoms take about 8 years to develop. The reason for the decline in symptoms after 10 years is not known, although some doctors suggest that “younger,” smaller stones may be more likely to cause symptoms than larger, older ones. Acalculous gallbladder disease will often cause symptoms similar to those of gallbladder stones.
Biliary Pain or Colic

The mildest and most common symptom of gallbladder disease is intermittent pain called biliary colic, which occurs either in the mid- or the right portion of the upper abdomen. Symptoms may be fairly nonspecific.

A typical attack has several features:

• The primary symptom is typically a steady gripping or gnawing pain in the upper right abdomen near the rib cage, which can be severe and can radiate to the upper back. Some patients with biliary colic experience the pain behind the breast bone.

• Nausea or vomiting may occur.

• Changing position, taking over-the-counter pain relievers, and passing gas do not relieve the symptoms.

• Biliary colic typically disappears after 1 to several hours. If it persists beyond this point, acute cholecystitis or more serious conditions may be present.

• The episodes typically occur at the same time of day, but less frequently than once a week. Large or fatty meals can trigger the pain, but it usually occurs several hours after eating and often awakens the patient during the night.

• The condition commonly returns, but attacks can be years apart.

Digestive complaints such as belching, feeling unusually full after meals, bloating, heartburn (burning feeling behind the breast bone), or regurgitation (acid back-up in the food pipe) are not likely to be caused by gallbladder disease. Conditions that may cause these symptoms include peptic ulcer, gastroesophageal reflux disease, or indigestion of unknown cause.

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Gallstones, The Gallbladder, Bile, Formation Of Stones Part 1

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Introduction:

Gallstones are small, hard deposits that can form in the gallbladder, a sac-like organ that lies under the liver on the right side of the abdomen. Most people with gallstones don’t even know they have them. But in some cases a stone may cause the gallbladder to become inflamed, resulting in pain, infection, or other serious complications.

Bile and the Gallbladder

The formation of gallstones is a complex process that starts with bile, a fluid composed mostly of water, bile salts, lecithin (a fat known as a phospholipid), and cholesterol. Most gallstones are formed from cholesterol.
* Bile is important for the digestion of fat. It is first produced by the liver and then secreted through tiny channels that eventually lead into a larger tube called the common bile duct, which leads to the small intestine.

* Only a small amount of bile drains directly into the small intestine, however. Most flows into the gallbladder through the cystic duct, which is a side extension off the common bile duct. This system of ducts through which bile flows is called the biliary tree.

* The gallbladder is a 4-inch sac with a muscular wall that is located under the liver. Here, most of the bile fluid (about 2 – 5 cups a day) is removed, leaving a few tablespoons of concentrated bile.

* The gallbladder serves as a reservoir until bile is needed in the small intestine to digest fats. This need is signaled by a hormone called cholecystokinin, which is released when food enters the small intestine.

* Cholecystokinin causes the gallbladder to contract and deliver bile into the intestine. The force of the contraction propels the bile down the common bile duct and into the small intestine, where it emulsifies (breaks down) fatty molecules.

* This part of the digestive process enables the emulsified fat, along with important fat-absorbable nutrients (such as vitamins A, D, E, and K), to pass through the intestinal lining and enter the bloodstream.

Supersaturation and cholelithiasis can occur as a result of various abnormalities, although the cause is not entirely clear.

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Gallstones, Choledocholithiasis – Common Bile Duct Stones Part 1

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Secondary Common Bile Duct Stones. In most cases, common bile duct stones originally form in the gallbladder and pass into the common duct. They are then called secondary stones. Secondary choledocholithiasis occurs in about 10% of patients with gallstones.

Primary Common Bile Duct Stones. Less often, the stones form in the common duct itself (called primary stones). Primary common duct stones are usually of the brown pigment type and are more likely to cause infection than secondary common duct stones.

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