The Gallstone Elimination Report
Under abnormal conditions, the cholesterol may precipitate in the gallbladder, resulting in the formation of cholesterol gallstones, as shown in Figure 64-12. The amount of cholesterol in the bile is determined partly by the quantity of fat that the person eats, because liver cells synthesize cholesterol as one of the products of fat metabolism in the body. For this reason, people on a high-fat diet over a period of years are prone to the development of gallstones. Causes of gallstones Causes of gallstones Formation of gallstones. Formation of gallstones. in the bladder in progressively greater concentrations. Then the cholesterol begins to precipitate, first forming many small crystals of cholesterol on the surface of the inflamed mucosa, but then progressing to large gallstones.
The clinical presentation of cholangitis can be typical, as outlined earlier, but many patients may present with subtle findings. Hence, radiographic tests can be useful in making or confirming the diagnosis. Plain radiographs of the abdomen are usually not helpful unless the patient has radiopaque gallstones, which are present in only 20 of cases. Nonspecific findings, such as ileus, may be noted. Ultrasound is the first screening test that should be obtained, and the finding of gallstones and common bile duct dilatation in a patient with jaundice suggests bile duct obstruction resulting from a gallstone. However, a normal, nondilated biliary ductal system is found in some patients with acute cholangitis early in the disease. Intrahepatic biliary dilatation and air within the biliary tree, in the absence of biliary-enteric anastomosis, are indicators of biliary infection and obstruction. The sonographer can also provide information regarding the cause of obstruction, because...
Carcinoma of the gallbladder is associated with gallstones (90 ), older age (median age of 71 years), and female gender (2.7 1). Large ( 3 cm) gallstones, a calcified gallbladder wall, and anomalous junction of the common bile duct and pancreatic duct (with the latter proximal to the sphincter) are also associated with gallbladder cancer. Pathology
Biliary fistulas are uncommon, but only by familiarity with the components of such fistulas can they be appropriately approached and managed. Biliary fistulas are grouped as spontaneously occurring or as iatrogenic, postoperative, or post-traumatic. They are specified also as internal or external by the site of exit of the fistula. Most spontaneous biliary fistulas result from complications of gallstone disease, frequently when there have been delays in or insufficient treatment of symptomatic disease. The most frequent site of fistulization in spontaneous cases is to the gastrointestinal (GI) tract, particularly the duodenum, and passage of a large stone through such a fistula may result in gallstone ileus. Rarely, fistulas occur externally to the skin or internally to another part of the biliary tree, to the pleural cavity or bronchial tree, or to the hepatic artery or portal vein or other vascular structures. Fistulas have been reported that tracked to the pericardial space, the...
In most of the common forms of hereditary spherocytosis, splenectomy brings about a return of hematocrit to normal or near-normal values. However, because the anemia is usually mild, deferral of operation until adolescence is preferable, to lessen the risk of overwhelming postsplenectomy sepsis. An exception to this guideline is the young child who develops frequent hemolytic crises, usually in conjunction with an acute infection, manifested by a profound decrease in hematocrit necessitating transfusion. Because hemolysis is chronic, an examination of the gallbladder with ultrasound to assess for bilirubin gallstones is important the gallbladder may be removed at the time of splenectomy.
Another antiobesity drug, sibutramine, was approved for use in 2001. Sibutramine is meant for people whose body mass index (BMI) registers at 27 or higher. But if you're on thyroid hormone, as well as medications for depression, seizures, glaucoma, osteoporosis, gallbladder disease, liver disease, heart disease or stroke prevention, kidney disease, migraines, or Parkinson's disease, you should discuss whether sibutramine is appropriate.
The elements of clinical decision making. Chapter 1. In Weinstein MC, Fineberg HV, Eds. Clinical Decision Analysis. Philadelphia WB Saunders Company 1980. Kassirer JP, Pauker SG. The toss-up. NEJM 1981 305 1467. Abraham AN, Barkun JS, Barkun GM, Fried LJ, and the McGill Gallstone Treatment Group. What is the optimal management of patients with suspected chole-docholithiasis in the era of laparoscopic cholecystectomy A decision analysis. Gastroenterology 1999 116 G0012.
In patients with symptomatic gallstones, cholecystectomy at the completion of the rectal reconstruction is appropriate. If the splenic flexure has been mobilized, this can be done without extending the incision and with very little incremental complication. Resection of hepatic metastasis is appropriate only in selected patients and in general only if this involves a minimal operation. A wedge or segmental resection may be appropriate. Major anatomic resections of the liver are best done as a staged procedure through a more appropriate incision.
Patients with gallbladder cancer present with signs and symptoms that are indistinguishable from those of cholelithiasis (Table 11.10). Small tumors are often found when patients have concomitant symptoms from their gallstones. More-advanced cancers often present with obstructive jaundice and are often associated with other, nonspecific signs such as weight loss, anorexia and malaise. Occasionally, patients can present with fever and severe pain. Tumors that obstruct the cystic duct can cause a clinical picture indistinguishable from acute cholecystitis. Tumors invading the common bile duct will often present as jaundice and sometimes, patients have associated ascending cholangitis.
Hepatobiliary calcifications are common. Small, round hepatic parenchymal calcifications can be the result of chronic granulomatous disease such as histoplasmosis or tuberculosis. Irregular, large calcifications in the liver can indicate the location of a benign tumor, such as hemangioma. Metastatic lesions from cancers of the ovary, breast, colon, and stomach can calcify, as can those of melanoma, mesothelioma, carcinoid, and leiomyosarcoma. Primary hepatobiliary tumors typically do not calcify. About 10 to 15 of gallstones develop laminar calcification. Calcification of the gallbladder itself ( Fig. 12-1 ) ( porcelain gallbladder ) is an indication of chronic cholecystitis and is a risk factor for development of gallbladder cancer. Figure 12-8 Cholecystostomy tube placement and percutaneous gallstone removal. A, Scout view of the abdomen demonstrates a cholecystostomy tube with a retention pigtail in the gallbladder fundus. The tube was placed in preparation for gallstone removal in...
Fragmentation of human gallstones using ultrasound and electrohydraulic lithotripsy Experimental and clinical experience. Surgery, 107 121, 1990. 13. Pitt, H.A., McFadden, D.W., and Gadacz, T.R. Agents for gallstone dissolution. Am. J. Surg., 153 233, 1987.
The most common side-effects of somatostatin analog are generally mild and include nausea, transient abdominal cramps, flatulence, diarrhea and local reaction at the injection site. Most of these minor side-effects resolve with time. In 2-50 of patients gall stones are formed de novo, but these remain virtually always asymptomatic. Rare, more severe adverse events of octreotide therapy include hypocalcemia, bradycardia, acute pancreatitis, hepatitis, jaundice, transitory ischemic attacks, and a negative inotropic effect of the analogs.18,4
Asymptomatic stones in a patient with sickle cell disease Asymptomatic gallstones larger than 2 cm After the subserous areolar tissue plane is opened on each side of the gallbladder, the fundus is grasped with a clamp and is drawn downward and medially away from the liver. The gallbladder is freed downward out of its fossa by sharp and blunt dissection (see Fig. 13-65 ). Often a sizable blood vessel is encountered running from the posterior surface of the gallbladder to the liver this vessel must be ligated. In severe gallbladder disease in which the shrunken organ is densely adherent to the liver, it may be difficult to free the gallbladder from the liver bed. This dissection may be accomplished more easily if the contents of the gallbladder are not aspirated because a full viscus better outlines its limits. In some instances, however, the gallbladder may be so distended that it obstructs the view of the operative field, so the surgeon may need to evacuate it in order to see...
No known treatment exists for fatty liver. The widely accepted treatment goal is to eliminate the potential causes and risk factors, since fatty liver due to obesity or alcoholism is reversible. Such actions as the discontinuation of drugs or toxins, body weight control and the prescription of hyperlipidemia and hyperglycemia help to reach this goal. Many other treatments have also been tested, including ursodeoxycholic acid (UDCA),94 metformin,95 rosiglitazone,96 betaine,97 and vitamins E and C.98 Although more investigations are required before recommendations can be made for NAFLD patients, UDCA and metformin seem promising. UDCA is a non-toxic natural bile acid that is initially used to dissolve gallstone and is now used to reduce liver fat deposition. Metformin, an antidiabetic drug and an insulin-sensitizing agent, is potentially useful for the fatty liver caused by insulin resistance and hyperisulinemia.95
Ultrasonography has led to the increased detection of polypoid lesions of the gallbladder. Most polyps are small projections from the gallbladder wall and represent cholesterol deposits. I ' They are usually associated with gallstones. Unlike gallstones, polyps do not change with position during ultrasound examination. I ' Of course, cholesterol polyps are not true neoplasms. Adenomas (Adenomatous Polyps)
PCI can also be classified as primary (idiopathic) or secondary, the latter being associated with a wide variety of both gastrointestinal and nongastrointestinal lesions ( Table 32-1 ). PCI of the left side of the colon is usually idiopathic, whereas PCI of the small bowel or ascending colon is usually secondary. 1 I 1 Secondary PCI accounts for about 85 of reported cases and has been described in association with chronic obstructive pulmonary disease, high positive-pressure ventilation, necrotizing enterocolitis, pseudomembranous enterocolitis, diverticulitis, intestinal strangulation, appendicitis, gallstones, volvulus, pyloric stenosis, peptic ulcers, Crohn's disease, ulcerative colitis, esophageal stricture, tuberculous enteritis, scleroderma, blunt abdominal trauma, diaphragmatic hernia, jejunoileal bypass, steroid use, chemotherapy,
Less commonly reported hepatobiliary complications include cholelithiasis, focal nodular hyperpla-sia, nodular regenerative hyperplasia and hepatic mi-crovesicular fatty change and siderosis. In a singleinstitution study including 6,050 childhood cancer patients, Mahmoud et al. reported a higher risk of biliary calculi in childhood cancer patients (median age 12.4 years) who did not have underlying chronic hemolytic anemia or a history of gallstones before treatment, compared with rates observed in the general population 119 . The cumulative risk for cholelithiasis was 0.42 at 10 years, and 1.03 at 18 years, after diagnosis. Treatment factors significantly associated with an increased risk of cholelithiasis included a history of ileal conduit (RR 61.6 27.9-135.9), parenteral nutrition (RR 23.0 9.8-54.1), abdominal surgery (RR 15.1 7.1-32.2) and abdominal radiation (RR 7.4 3.2-17.0). The frequency of conventional predisposing factors like family history, obesity, oral contraceptive use...
Operations on the small intestine can be performed with the patient supine and the table level. A midline incision, when possible, allows for easy access to the abdominal contents and can be extended superiorly and inferiorly as needed. When necessary, small intestinal procedures can be performed through alternate incisions, such as resection of a Meckel's diverticulum through an appendectomy incision. A thorough exploration should be undertaken upon entering the abdomen. The liver, pancreas, colon, small bowel, stomach, and spleen should be palpated for masses. The gallbladder should be evaluated for gallstones. The omentum and peritoneal surfaces should be inspected for mass lesions. The retroperitoneum should be evaluated for adenopathy.
Nicotinic acid in high doses may affect the cholescintigraphy because of poor extraction and elimination of the radiotracer (toxic effect on hepatocytes). Total parente-ral nutrition may cause delayed or no visualization of the gallbladder, even in patients with no gallbladder disease caused by bile stasis and the formation of thick viscous jelly-like bile. Nonvisualization of the gallbladder may also be caused by hepatic artery infusion during chemotherapy.
Gallstones Gallstone disease is still prevalent in the United States and results in over 600,000 cholecystectomies per year, but gallstones have decreased as a cause of cholangitis ( Fig. 15-1 ). Our belief is that the aggressive use of cholecystectomy for symptomatic cholelithiasis, especially since laparoscopic cholecystectomy was introduced, has decreased the incidence of the complications of stone disease. Gallstones Bile duct strictures Benign causes
Rosseland, A.R., and Solhaug, J.H. Early or delayed endoscopic papillotomy (EPT) in gallstone pancreatitis. Ann. Surg., 199 165, 1984. 65. Safrany, L., and Cotton, P.B. A preliminary report Urgent duodenoscopic sphincterotomy for acute gallstone pancreatitis. Surgery, 89 424, 1981. 67. Sauerbruch, T., Delius, M., Paumgartner, G., et al. Fragmentation of gallstones by extracorporeal shock waves. N. Engl. J. Med., 314 818, 1986.
CCs are believed to arise from biliary epithelium that is either within the liver (intrahepatic) or extrahepatic. The tumour is much less common than HCC, but its incidence and associated mortality has been increasing steadily over the past two to three decades, with most tumours arising in persons over 50 years, suggesting that carcinogenesis is a protracted and (possibly) multi-step process.2 Injury to the biliary epithelium with chronic inflammation, together with impedance of bile flow, are the common factors in high-risk conditions for CC such as primary scleros-ing cholangitis, hepatolithiasis (gall stones) and liver fluke infestation by Opistorchis viverrini and Clonorchis sinensis. Thus, chronic inflammation features prominently in the histogenesis of both HCC and CC, where the coordinated actions of the likes of iNOS and cytochrome c oxidase-2 (COX-2) will lead to oxidative DNA damage, cell proliferation and a suppression of apoptosis.3
Supine radiograph showing small bowel obstruction. Gas can be identified within the right and left hepatic ducts and the common bile duct. (From Field, S. The abdomen The plain abdominal radiograph the acute abdomen. In Grainger, R. G., and Allison, D. J. eds. Grainger and Allison's Diagnostic Radiology A Textbook of Medical Imaging, 3rd ed. Edinburgh, Churchill Livingstone, 1997, p. 891, with permission.)
The mobility and circumferential serosal coating of the duodenal bulb facilitate operations on the pylorus and duodenum. Pyloroplasties and gastroduodenal resections are performed with greater ease when the pylorus and adjoining duodenum are mobilized forward into the abdominal cavity by Kocher's maneuver. The proximity of the superior duodenum to the gallbladder explains the frequency of spontaneous passage of gallstones into the duodenum via a cholecystoduodenal fistula. The peritoneum covers the distal 2.5 cm of the first portion of the duodenum only ventrally. Its range of movement depends on the peritoneal coat. The posterior wall of the first portion of the duodenum is often intimately apposed to the structures of the hepatoduodenal ligament.
Often pain from a spastic viscus occurs in the form of cramps, with the pain increasing to a high degree of severity and then subsiding. This process continues intermittently, once every few minutes. The intermittent cycles result from periods of contraction of smooth muscle. For instance, each time a peristaltic wave travels along an overly excitable spastic gut, a cramp occurs. The cramping type of pain frequently occurs in appendicitis, gastroenteritis, constipation, menstruation, parturition, gallbladder disease, or ureteral obstruction.
Get Rid of Gallstones Naturally
One of the main home remedies that you need to follow to prevent gallstones is a healthy lifestyle. You need to maintain a healthy body weight to prevent gallstones. The following are the best home remedies that will help you to treat and prevent gallstones.