Gall Stones, Causes and Prevention

Gall stone formation is the most common disorder of the biliary tree and it is unusual for the gall bladder.
PATHOLOGY:
They are classified into cholesterol or pigment stones, although the majority are mixed type. Cholesterol stones are most common type in industrialised countries.
Gall stones contain varying degree of calcium salts including calcium bilirubinate, carbonate, phosphate and palmitate which are radio opaque .
Epidemiology:
Gall stones occur commonly in females aged 18-65 yrs .
In those under 40 yrs there is 3:1 female preponderance. Gallstones are common in north america , Europe, Australia and less frequent in India and Africa .
Risk factors:
1.Increased cholesterol secretions :
• Elderly
• Female
• Pregnancy
• Obesity
• Rapid weight loss
2.Impaired gall bladder emptying :
• Pregnancy
• gallbladder stasis
• fasting
• spinalcord injuries
3. decreased bile salts secretion:
• Pregnancy
CLINICAL FEATURES:
The majority of the gall stones are asymptomatic and remain so ,only about 10% of those with gall stones develop clinical symptoms.
Symptomatic gall stones develop biliary pain or as a consequence of the cholecystitis.if the gall stone gets impacted in the cystic duct ,the patient will experience pain. the pain is of sudden onset and it lasts for 2-6hours,if it lasts for more than 6hours it suggests that the complication such as cholecystitis or pancreatitis has developed.
Pain is felt in the epigastrium or right upper quadrant and radiates to the inter sacapular region or to the tip of the right scapula
COMPLICATIONS:
• Empyema of the galladder
• Choledecholithiasis
• Pancreatitis
• Fistula between gall bladder and duodenum or colon
• Gall stone ileus
• Carcinoma of the gall bladder

MANAGEMENT:
• Cholesystectomy open or laproscopic
• Oral bile acids
• Lithotripsy
• Endoscopic sphincterotomy