Cholelithiasis:

Definition:

A gallstone is a crystalline concretion formed within the gallbladder by accretion of bile components.Presence of stones in the gallbladder is referred to as cholelithiasis (from the Greek: chol-, “bile” + lith-, “stone” + iasis-, “process”). 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.

Characteristics and composition:
On the basis of their composition, gallstones can be divided into the following types:

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. To be classified as such, they must be at least 80% cholesterol by weight.

Pigment stones:

Pigment stones are small, dark stones made of bilirubin and calcium salts that are found in bile. They contain less than 20% of cholesterol.

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.

Risk Factors:
Risk for cholesterol gallstones:

Gender:

Gallstones occur more commonly in women than men.

Age:

Gallstone prevalence increases with age.

Obesity:

Obese individuals are more likely to form gallstones than thin individuals.

Pregnancy:

Pregnancy increases the risk for cholesterol gallstones because during pregnancy, bile contains more cholesterol, and the gallbladder does not contract normally.

Birth control pills and hormone therapy:
The increased levels of hormones caused by either treatment mimics pregnancy.

Rapid weight loss:

Rapid weight loss by whatever means, very low calorie diets or obesity surgery, causes cholesterol gallstones in up to 50% of individuals. Many of the gallstones will disappear after the weight is lost, but many do not. Moreover, until they are gone, they may cause problems.

Crohn’s disease:

Individuals with Crohn’s disease of the terminal ileum are more likely to develop gallstones. In Crohn’s disease, the terminal ileum is diseased. Bile acids are not absorbed normally, the body becomes depleted of bile acids, and less bile acids are secreted in bile. As a result there is not enough bile acids to keep cholesterol dissolved in bile, resulting in gallstone formation.

Increased blood triglycerides:

Gallstones occur more frequently in individuals with elevated blood triglyceride levels.

Risk for pigment gallstones:

Black pigment gallstones form whenever an increased load of bilirubin reaches the liver.This occurs when there is increased destruction of red blood cells, as in diseases such sickle cell disease and thalassemia. Black pigment gallstones also are more common in patients with cirrhosis of the liver. Brown pigment gallstones form when there is stasis of bile (decreased flow), for example, when there are narrow or obstructed bile ducts.

Symptoms:

The majority of people with gallstones have no signs or symptoms and are unaware of their gallstones. (The gallstones are “silent.”) The gallstones often are found as a result of tests (for example, ultrasound or X-ray examination of the abdomen) performed while evaluating medical conditions other than gallstones. Symptoms can appear later in life, however, after many years without symptoms. Thus, over a period of five years, approximately 10% of people with silent gallstones will develop symptoms. Once symptoms develop, they are likely to continue and often will worsen.

Gallstones are blamed for many symptoms they do not cause. Among the symptoms gallstones do not cause are:

• dyspepsia (including abdominal bloating and discomfort after eating).
• intolerance to fatty foods.
• belching.
• flatulence (passing gas or farting).
• A positive Murphy’s sign is a common finding on physical examination.

• Characteristically, biliary colic comes on suddenly or builds rapidly to a peak over a few minutes.
• It is a constant pain, it does not come and go, though it may vary in intensity while it is present.
• It lasts for 15 minutes to 4-5 hours. If the pain lasts more than 4-5 hours, it means that a complication – usually cholecystitis – has developed.
• The pain usually is severe, but movement does not make the pain worse. In fact, patients experiencing biliary colic often walk about or writhe (twist the body in different positions) in bed trying to find a comfortable position.
• Biliary colic often is accompanied by nausea.
• Most commonly, biliary colic is felt in the middle of the upper abdomen just below the sternum.
• The second most common location for pain is the right upper abdomen just below the margin of the ribs.
• Occasionally, the pain also may be felt in the back at the lower tip of the scapula on the right side.
• On rare occasions, the pain may be felt beneath the sternum and is mistaken for angina or a heart attack.

An episode of biliary colic subsides gradually once the gallstone shifts within the duct so that it is no longer causing obstruction.

Biliary colic is a recurring symptom. Once the first episode occurs, there are likely to be other episodes. Also, there is a pattern of recurrence for each individual, that is, in some individuals the episodes tend to remain frequent while in others they are infrequent. The majority of people who develop biliary colic do not go on to develop cholecystitis or other complications.

Complications of gallstones:

• Cholecystitis.
• Cholangitis.
• Gangrene.
• Jaundice.
• Pancreatitis.
• Sepsis.
• Fistula.
• Ileus.
• Cancer.

Diagnosis:

• Ultrasonography.
• Transabdominal ultrasonography.
• Endoscopic ultrasonography (EUS).
• Magnetic resonance cholangio-pancreatography (MRCP).
• Cholescintigraphy (HIDA scan).
• Endoscopic retrograde cholangio-pancreatography (ERCP).
• Liver and pancreatic blood tests.
• Duodenal biliary drainage.
• Oral cholecystogram (OCG).
• Intravenous cholangiogram (IVC).

Suggestion about homeopathic treatment:

When the stones are of a smaller size, homeopathic medicines will help in possibly dissolving the stones. Homeopathy medicines are effective in alleviating pain as well as chronic inflammation of gallbladder (cholecystitis) associated with the condition. Homeopathy also helps to control further stone production activity. It the stones are bigger, multiple and impacted, it may require surgical intervention. In cases of Large and multiple stones, homeopathy has no curative role to play.