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Conditions - Gallstones

Gallstones are solid material that forms in the gallbladder and very occasionally in the bile duct. They form inside the gall bladder because cholesterol and bile salts precipitate out of solution due to changes in their relevant concentrations and as a result of biliary stasis. Most stones have predominantly cholesterol within them. The exact composition of the stones is not particularly important as they can all cause symptoms.

Risk factors for gallstones include female gender as women between 20 and 60 are twice as likely to develop gallstones as men. Obesity is also a major risk factor especially in women. Estrogen excess from pregnancy, HRT or the OCP is also implicated. Cholesterol lowering drugs, diabetes and rapid weight loss increase the amount of cholesterol in bile and this can contribute to formation of gallstones.

Symptoms

Most people with gallstones do not have symptoms. They may have the diagnosis made incidentally and in this situation is not essential to have the gallbladder removed. Most people, when they develop symptoms have pain which is usually in the upper abdomen centrally or to the right side. It is common for the pain to be referred through to the back. The pain is usually colicky in nature but can be constant. There are a number of nonspecific symptoms that are often associated with gallstones including upper abdominal bloating, nausea, belching and intolerance to fatty foods.

Occasionally patients will present with complications of the stones. These include cholecystitis which is infection within the gallbladder secondary to stones obstructing the outflow from the gallbladder. Gallstones can escape from the gallbladder and then cause problems within the bile duct. Cholangitis is infection within the bile duct that can ascend into the liver. Pancreatitis is inflammation of the pancreas gland. This occurs when gallstones travel down the bile duct and temporarily occlude the duct that drains the pancreas.

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