Gallstone disease is a worldwide medical problem, but the incidence rates show geographical variation, with the lowest rates reported in African populations.
Publications in English language on gallstones which were obtained from reprint requests and PubMed database formed the basis for this paper. Data extracted from these sources included authors, country, year of publication, age and sex of patients, pathogenesis, risk factors for development of gallstones, racial distribution, presenting symptoms, complications and treatment.
Gallstones occur worldwide, however it is commonest among North American Indians and Hispanics but low in Asian and African populations. High biliary protein and lipid concentrations Dating age gap problems after gallbladder risk factors for the formation of gallstones, while gallbladder sludge is thought to be the usual precursor of gallstones.
Biliary calcium concentration plays a part in bilirubin precipitation and gallstone calcification.
Treatment of gallstones should be reserved for those with symptomatic disease, while prophylactic cholecystectomy is recommended for specific groups like those with sickle cell disease and those undergoing weight-loss surgical treatments.
Treatment should be undertaken Dating age gap problems after gallbladder a little percentage of patients with gallstones, as majority of those who harbor them never develop symptoms.
The group that should undergo cholecystectomy include those with symptomatic gallstones, sickle cell disease patients with gall stones, and patients with morbid obesity who are undergoing laparotomy for other reasons.
Gallstones are hardened deposits of the digestive fluid bile, that can form within the gallbladder. They vary in size and shape from as small as a grain of sand to as large as a golf ball.
Gallstone disease is often thought to be a major affliction in modern society. This article gives a clinically useful Dating age gap problems after gallbladder of the literature on gallstones disease and focuses on current information about the pathogenesis, risk factors, investigations, and treatment of gallstones.
The paper is intended to make readers aware of current thinking Dating age gap problems after gallbladder this field. Publications in English language on gallstones up to were obtained from both reprint requests and by searching PubMed database.
Data extracted from these papers included authors, country, year of publication, age and sex of patients, pathogenesis, risk factors Dating age gap problems after gallbladder development of gallstones, racial distribution, presenting symptoms, complications and treatment.
Gallstones are composed mainly of cholesterol,
Dating age gap problems after gallbladder, and calcium salts, with smaller of protein and other materials.
In the simplest sense, cholesterol gallstones form when the cholesterol concentration in bile exceeds Dating age gap problems after gallbladder ability of bile to hold it in solution, so that crystals form and grow as stones. Three types of abnormalities have been considered to be responsible for cholesterol gallstone formation. Cholesterol supersaturation, the essential requirement for cholesterol gallstone formation, might occur via excessive cholesterol biosynthesis, which Dating age gap problems after gallbladder the main lithogenic mechanism in obese persons.
Finally, interruption of the enterohepatic circulation of bile acids could increase bile saturation. Estrogen treatment also reduces the synthesis of bile acid in women. Pigment stones occur when red blood cells are being destroyed, leading to excessive bilirubin in the bile. Black pigment stones are more common in patients with cirrhosis or chronic hemolytic conditions such the thalassemias, hereditary spherocytosis, and sickle cell disease, in Dating age gap problems after gallbladder bilirubin excretion is increased.
The resulting unconjugated bilirubin precipitates as its salts. Primary brown pigment stones of the bile ducts often occur in Asians, associated with decreased biliary secretory Immunogloblin A IgA.
High biliary protein and lipid concentrations are risk factors for the formation of gallstones. The sources of sludge are pregnancy,[ 34 ] prolonged total parenteral nutrition,[ 35 ] starvation, or rapid weight loss. The Dating age gap problems after gallbladder calcium concentration plays a part in bilirubin precipitation and gallstone calcification.
Impaired motility of the gallbladder as seen in patient with high spinal cord injury[ 43 ] or with the use of the somatostatin analogue octreotide, has been cited as another contributing factor in the development of gallstones. Intestinal hypomotility has been recently recognised as a primary factor in cholesterol lithogenesis. Epidemiological studies have suggested a marked variation in overall prevalence between different populations. Gallstone is one of the diseases prevalent in developed nations, but it is less prevalent in the developing populations that still consume traditional diets.
All epidemiological studies showed that increasing age was associated with an increased prevalence of gallstones. Gallstones are times more frequent in older than younger subjects. In all populations of the world, regardless of overall gallstone prevalence, women during their fertile years are almost twice as likely as men to experience cholelithiasis.
This preponderance persists to a lesser extent into the postmenopausal period, but the sex difference narrows with increasing age. Both necropsy and population studies have clearly shown the existence of racial differences that cannot completely be explained by environmental factors. The Pima tribe of Arizona has the highest gallstone prevalence in the world: High rates of gallstone prevalence have Dating age gap problems after gallbladder also reported in other North Dating age gap problems after gallbladder Indian tribes, including the Chippewas, Navajo, Micmacs, and Cree-Ojibwas.
Some studies strongly support the existence of Amerindian lithogenic genes in Mexican-Americans. Obesity is an important risk factor for gallstone disease, more so for women than for men. It raises the risk of cholesterol gallstones by increasing biliary secretion of cholesterol, as a result of an increase in 3-hydroxymthylglutaryl coenzyme A HMGCoA reductase activity. Epidemiological studies have found that the lithogenic Dating age gap problems after gallbladder of obesity is strongest in young women, and that slimness protects against cholelithiasis.
In fasting associated severely fat restricted diets, gallbladder contraction is reduced, and the accompanying Dating age gap problems after gallbladder stasis favors gallstone formation.
Enhancing gallbladder emptying by inclusion of a small amount of dietary fat inhibits gallstone formation in patients undergoing rapid weight loss. Younger women with gallstones were shown to be more prone to skip breakfast than controls. Nutritional exposure to western diet, i. Coffee components stimulate cholecystokinin release,[ 69 ] enhance gallbladder motility, inhibit gallbladder fluid absorption, decrease cholesterol crystallization in bile[ 70 ] and perhaps increase intestinal motility.
Regular exercise, in addition to facilitating weight control, alone or in combination with dieting, improves several metabolic abnormalities related to both obesity and cholesterol gallstones. In contrast, sedentary behaviour, is positively associated with the risk of cholecystectomy. All fibric acid derivatives increase Dating age gap problems after gallbladder cholesterol saturation while lowering serum cholesterol.
ACAT inhibition leads to an increased availability of free or unesterified cholesterol for
Dating age gap problems after gallbladder into bile, favouring gallstone formation.
People with diabetes generally have high levels of fatty acids called triglycerides. These fatty acids may increase the risk of gallstones. Gallbladder function is impaired in the presence of diabetic neuropathy, and regulation of hyperglycaemia with insulin seems to raise the lithogenic index.
For practical purpose gallbladder disease can be equated with gallstones as these are present in the large majority of patients. Patients with symptomatic stones most often present with recurrent episodes of right-upper-quadrant or epigastric pain, probably related to the impaction of a stone in the cystic duct. Often, attacks occur after a particularly fatty meal and almost always happen at night. Some patients with gallstones present with acute cholecystitis, and often secondary infection by intestinal microorganisms, predominantly Escherichia coli and Bacteroides species.
Dating age gap problems after gallbladder of the gallbladder wall causes severe abdominal pain, especially in the right upper quadrant, with nausea, vomiting, fever, and leucocytosis. Less commonly, gallstones can become lodged in the common bile duct choledocholithiasis
Dating age gap problems after gallbladder, sometimes with obstruction of the common bile duct and symptoms
Dating age gap problems after gallbladder cholestasis.
Stones in the common bile duct usually cause pain in the epigastrium or right upper quadrant, but may be painless. The passage of common-bile-duct stones can provoke acute pancreatitis, probably by transiently obstructing the main pancreatic duct where it passes near the common bile duct at the ampulla of Vater. There may be fever, tender right upper quadrant with or without Murphy's sign, tenderness when the hand taps the right costal arch Ortner's sign. The three primary methods used to diagnose gallbladder disease are ultrasonography, nuclear scanning cholescintigraphyand oral cholecystography.
Today, ultrasonography is the method most often used to detect cholelithiasis and cholecystitis. Occasionally gallstones are diagnosed during plain X-rays. In cholescintigraphy, a patient Dating age gap problems after gallbladder injected with a small amount of non-harmful radioactive material that is absorbed by the gallbladder, which is stimulated to contract if intravenous injection of cholecystokinin is given in addition.
It can detect total obstruction of the bile duct, but cannot provide anatomical information, and cannot identify gallstones. It permits the rapid assessment of gallbladder function in a patient with suspected acute cholecystitis. Gamma rays emitted by the tracer are used to make an image of the bile ducts and gallbladder. Failure of the tracer to enter the gallbladder suggests obstruction Dating age gap problems after gallbladder the neck of the gallbladder, as occurs in acute cholecystitis.
In oral cholecystography, an iodinated contrast agent such as iopanoic acid Telepaque is given orally the day before the examination. It is still useful in patients who have suspected gallbladder symptoms but a negative or equivocal
Dating age gap problems after gallbladder examination.
On oral cholecystography the gallbladder may be seen to contain stones, polyps, or sludge, or it may simply not be visualized because contrast material is reabsorbed through an inflamed gallbladder wall or because the cystic duct is obstructed.
Treatment of gallstones depends partly on whether they are causing symptoms or not. Recurrent episodes of upper abdominal pain related to gallstones are the most common indication
Dating age gap problems after gallbladder the treatment of gallstones. Prophylactic cholecystectomy for gallstones has been recommended in specific groups, such as children, because symptoms develop in almost all patients. Prophylactic cholecystectomy is also recommended in certain high-risk groups to prevent gallbladder Dating age gap problems after gallbladder. Prophylactic cholecystectomy was recommended for diabetic patients with gallstones because Dating age gap problems after gallbladder an increased risk of acute cholecystitis and increased mortality with emergency cholecystectomy.
Recent studies show that diabetic patients have increased operative risk with elective as well as emergency gallbladder surgery[ 91 ] related to risk of cardiovascular disease and other coexisting conditions rather than to diabetes mellitus itself. Open cholecystectomy was formerly the gold standard of treatment for gallstones, until the advent of laparoscopic cholecystectomy. The evaluation and treatment of suspected stones in the common bile duct can be carried out by endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy.
The laparoscopic procedure requires more operating time than the open procedure, but usually only one night in the hospital postoperatively; postoperative pain is greatly reduced, and the patients can usually return to work early, i.
Attempts to use oral bile salts to dissolve gallstones began more than 30 years
Dating age gap problems after gallbladder because of those who refuse or are poor risks for surgery. Therapy with bile salts is suitable for only a minority of patients with symptomatic cholesterol gallstones. Candidates for treatment with bile salts should have a patent cystic duct and noncalcified cholesterol gallstones.
Gallstones frequently recur after oral bile salts are stopped. Contact dissolution therapy of cholesterol gallstones rapidly is possible by instilling solvents like the organic solvent methyl tert-butyl ether into the gallbladder through a percutaneous catheter placed through the liver. Serious side effects include severe burning pain. Finally a mixture of plant terpenes may also be useful for dissolving radiolucent gallstones, particularly when used in combination with a bile acid.
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Abstract Gallstone disease is a worldwide medical problem, but the incidence rates show substantial geographical variation, with the lowest rates reported in African populations. Cholecystectomy, dissolution therapy, gallstones, risk factors.