SUNDAY HEALTH: Age, diet and history predispose to gallstones Dr ali mzige Daily News; Monday,June 16, 2008 @11:26 GALLSTONES (kokoto kwenye kifuko cha nyongo) are usually composed mainly of cholesterol that has crystallized from bile. Gallstones usually form in the gallbladder and may lodge in the cystic duct, the common bile duct or the pancreatic duct. When stones are in the gallbladder, the condition is called cholelithiasis, when stones are in the bile ducts, the condition is called choledocholithiasis. Gallstones are more common among women who are fertile (with children), fat (obese) and who are in the age of forties. We used to acronym them in the medical student days with those Fs-fat, fertile and forty. The risk factors for gallstone formation include increased age, obesity, a typical Western diet and a family history of gallstones. In the United States, about 20% of people older than age 65 have gallstones. In Tanzania from clinical practice, the Asians and Arabs descendants are the ones with more manifestations than Tanzanians of African origin, may be due to diet full of cholesterols and family history of gallstones. Generally, gallstones do not cause symptoms; about 80% of affected people never experience any problems. Bravo to KCMC Hospital in Moshi, Tanzania, now they can operate and remove gallstones by digging four holes in the abdominal wall. Each year, more than half a million people in the United States have their gallbladder surgically removed. Bile contains large amounts large amounts of cholesterol that usually remains dissolved in the bile. When bile becomes oversaturated with cholesterol, however, the cholesterol becomes insoluble and crystallizes. The microscopic crystals accumulate. Some gallstones are made up of calcium salts and bilirubin, the main pigment in bile. Most gallstones form in the gallbladder,which retains the small crystals and allows them to grow. Stones in the bile ducts have usually travelled there from the gall bladder. Stones that form in the bile duct are usually associated with infection or inflammation and consist of pigment material. Any stone in the bile duct system however can cause obstruction with inflammation and bacterial infection. A stricture (narrowing) can result, leading to further obstruction of bile flow even after the stone passes. Symptoms: Most gallstones do not cause any symptoms for many years, if ever, particularly if they remain in the gallbladder. Typically gallstones pass from the gallbladder into the bile ducts If tiny, they may pass through these ducts and into the small intestine without incident or they may remain in the ducts without obstructing the flow of bile or causing symptoms. Stones that obstruct a bile duct, however, may cause pain as well as nausea and vomiting. Obstruction can allow bacteria to flourish and quickly establish infection in the ducts and occasionally to cause abscess in the liver. If an infection develops, it may be accompanied by fever, chills and jaundice (a yellow discolouration of the skin and the whites of the eyes). Occasionally, a life-threatening infection called bacterial cholangitis develops. In bacterial cholangitis, the bacteria may spread to the bloodstream and cause infections elsewhere in the body, increasing the risk of death. Stones that obstruct the outlet of the gall bladder or the cystic duct (the duct that joins the gallbladder with the common bile duct) result in steady pain (biliary colic) in the upper abdomen, usually on the right side under the ribs. This pain comes on gradually, can last from 30 minutes to 12 hours and resolves. Continued obstruction causes the gallbladder to become inflamed (a condition called acute cholecystitis). The pain persists and may extend to the right shoulder blade. The person may have a fever as well. Stones also can obstruct the pancreatic duct (which joins the pancreas (kongosho) with the common bile duct), causing inflammation of the pancreas (pancreatitis) as well as pain. Rarely, large gallstones gradually erode the gallbladder wall and enter the small intestine. A gallstone in the small intestine can cause an intestinal obstruction, called a gallstone ileus. This condition occurs more commonly in older people. Diagnosis: With simple biliary colic, blood tests usually are normal. Liver function tests with obstruction may show abnormal results pertaining to the condition of the disease process. Ultrasound scanning is very important; this method is 95% accurate in detecting gallstones in the gallbladder. Less accurate in detecting stones in the bile ducts. Endoscopic retrograde cholangiogram and CT scan or MRI (Magnetic resonance imaging) of the biliary and pancreatic system is more appropriate to give final diagnosis. Treatment: Most people with gallstones that do not cause any symptoms (silent gallstones) do not require treatment. People with intermittent episodes of pain can try avoiding or reducing their intake of fatty foods, but dietary restriction rarely prevents pain or changes the progression of symptoms. If gallstones in the gallbladder cause disruptive recurring attacks, a doctor may recommend surgical removal of the gallbladder (cholecystectomy). Removal of the gallbladder causes no change in the digestion. No special dietary restrictions are required after surgery. During cholecystectomy, the doctor may investigate the possibility of stones in the bile ducts. About 90% of cholecystectomies are performed by laparoscopy. In this method, the gallbladder is removed through the tubes inserted through incisions in the abdominal wall. Laparoscopic cholecystectomy has lessened the discomfort after surgery, shortened the length of hospital stays and reduced sick leave. Treatment of dissolving stones by medication takes long-time and sometimes the gallstones may recur. Please consult your doctor for guidance and advise if you suspect you have gallstone symptoms.