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Gallstones
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Gallstones are stones that form in the gall (bile). Bile is a watery liquid made by the cells of the liver that is important for digesting food in the intestine, particularly fat. Liver cells secrete the bile they make into small canals within the liver. The bile flows through the canals and into larger collecting ducts within the liver (the intrahepatic bile ducts). The bile then flows within the intrahepatic bile ducts out of the liver and into the extrahepatic bile ducts-first into the hepatic bile ducts, then into the common hepatic duct, and finally into the common bile duct. From the common bile duct, there are two different directions that bile can flow.
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Gallstones are rocklike nuisances that can form inside the gallbladder. The gallbladder is a pouch that collects bile as it flows from the liver to the intestine through the bile ducts. Bile is a fluid that is made, in part, to help with digestion. The salts in bile make it easier for you to digest fat. However, bile ... contains some waste products including cholesterol and bilirubin (created when old red blood cells are destroyed). Gallstones form in the gallbladder when cholesterol or bilirubin particles begin to cluster together into a solid lump.
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Gallstones have several different causes, some better understood than others. An overload of cholesterol or bilirubin in the bile can definitely contribute to stone formation. In addition, certain proteins seem to act like seeds to help stones form. You may ... develop stones if your gallbladder doesn't contract properly to empty itself, leaving more time for bile to just sit around.
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Gallstones can cause several different disorders. Cholelithiasis is defined as the presence of gallstones within the gallbladder itself. Choledocholithiasis is the presence of gallstones within the common bile duct that leads into the first portion of the small intestine (the duodenum). The stones in the duct may have been formed inside it or carried there from the gallbladder. These gallstones prevent bile from flowing into the duodenum. Ten percent of patients with gallstones have choledocholithiasis, which is sometimes called common-duct stones.
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Gallstones affect about 10% of all adults over 40. They occur in nearly 25% of women in the U.S. by age 60 and in up to 50% by age 75. About 20% of men have gallstones by the time they reach 75 years of age. About 80% of men and women over age 90 show evidence of gallstones. Gallstone disease is relatively rare in children, although those with a spinal injury or a history of abdominal surgery are at risk. Children who have damaged immune systems or who receive nutrition intravenously ... have a higher incidence of cholelithiasis. Girls do not seem to be more at risk than boys.
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Gallstones arise when there is an imbalance among the bile components. Bile is composed of: bile salts; bilirubin; cholesterol, phospholipids, and fatty acids; water; electrolytes; and other substances. The most common stones are mixed, containing cholesterol and its derivatives along with varying amounts of bile salts, bile pigments, and inorganic salts of calcium. The required step in mixed stone formation is elevations of cholesterol within the gallbladder. The solubility of bile is based on the relative concentrations of cholesterol, bile acids, phosphatidylcholine (lecithin) and water. Since free cholesterol is water-insoluble, it must be incorporated into a lecithin-bile salt mixture.
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Gallstones