CLINACASE

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Category: General
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createdon: 07 Feb 2023
updatedon: 05 Apr 2023

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Author: Khoa Tran
Published Feb 07, 2023
Updated Apr 05, 2023

Table of contents

Gallstones

History of Gallstones

Gallstones are hard deposits that form in the gallbladder, a small organ located under the liver that plays a role in digesting fats.

The first recorded reference to gallstones comes from ancient Greece, where the physician Hippocrates described symptoms that were likely caused by gallstones. He described symptoms such as severe pain in the upper abdomen, vomiting, and fever that were likely caused by gallstones. He referred to the condition as "hepatic colic" and noted that it was often accompanied by yellowing of the skin and eyes, a condition known as jaundice. These symptoms are still commonly associated with gallstones today.

During the 2nd century AD, the Roman physician Galen also wrote about gallstones, describing their hard and smooth texture.

In the 17th century, anatomists began to study the gallbladder and its contents more closely. The Dutch anatomist Frederik Ruysch was one of the first to examine gallstones under a microscope, and he described their smooth surface and yellow color.

In the 18th century, the English physician William Heberden described the symptoms of gallstones and distinguished them from other digestive disorders. He also suggested that the consumption of certain foods, such as eggs and fatty meats, could contribute to the formation of gallstones.

In the 19th century, advancements in surgical techniques allowed physicians to remove gallstones from patients. The French surgeon Claude Bernard performed the first successful operation to remove gallstones in 1848, and the German surgeon Carl Langenbuch performed the first successful laparoscopic gallbladder removal in 1882.

In the 20th century, imaging technologies such as X-rays and ultrasound allowed for non-invasive diagnosis of gallstones. Researchers also discovered that certain factors, such as obesity and a family history of gallstones, could increase the risk of developing the condition.

Modern Understanding of Gallstones

Gallstones are small, hard deposits of bile that form in the gallbladder. The gallbladder is a small organ located near the liver that stores bile, which is a substance produced by the liver that helps break down fat in the digestive process.

When bile becomes concentrated, it can form stones. These stones can vary in size from as small as a grain of sand to as large as a golf ball. In some cases, people with gallstones may experience no symptoms, but in others, the stones can cause abdominal pain and discomfort.

The most common symptoms of gallstones include pain in the upper right abdomen that may radiate to the right shoulder or back, bloating, and indigestion. If a gallstone becomes stuck in a duct that connects the gallbladder to the small intestine, it can cause a blockage and result in a more severe and sudden pain called biliary colic.

Causes of Gallstones

The exact causes of gallstones are not fully understood, but there are several factors that can contribute to their formation.

- Cholesterol imbalance: Gallstones can form when there is an imbalance in the substances that make up bile, a fluid produced by the liver and stored in the gallbladder. Bile contains cholesterol, bile salts, and other substances, and when the balance between these substances is disrupted, cholesterol can accumulate and form stones.
- Gallbladder motility: If the gallbladder does not empty its contents properly or frequently enough, bile can become concentrated, making it more likely to form stones. This can occur due to certain medical conditions or medications that affect the function of the gallbladder.
- Genetics: There may be a genetic component to gallstone formation, as the condition tends to run in families.
- Obesity: Being overweight or obese is a known risk factor for gallstone formation. This may be due to changes in the way the body processes cholesterol and other substances.
- Age and gender: Women and older adults are more likely to develop gallstones than men and younger individuals.
- Medical conditions: Certain medical conditions, such as diabetes and liver disease, can increase the risk of gallstone formation.
- Rapid weight loss: Rapid weight loss, such as that which occurs after bariatric surgery or crash dieting, can increase the risk of gallstone formation.

Treatments for Gallstones

The treatment for gallstones depends on several factors, such as the size and number of stones, the severity of symptoms, and the overall health of the patient. Here are some of the common treatments for gallstones:

- Watchful waiting: If the gallstones are small and not causing any symptoms, the doctor may recommend a wait-and-see approach. In such cases, the patient may be advised to make certain dietary changes and to monitor symptoms for any changes.
- Medications: Medications such as ursodeoxycholic acid can be used to dissolve small cholesterol stones. These medications may be prescribed for a period of several months.
- Surgery: Surgery is often recommended for patients with larger stones, multiple stones, or symptoms that are severe or recurrent. The most common surgical option is laparoscopic cholecystectomy, in which the gallbladder is removed through several small incisions in the abdomen.
- Endoscopic procedures: In some cases, gallstones can be removed using an endoscope, a flexible tube with a camera and a small tool at the end. This is typically done for patients who cannot undergo surgery or for those with stones in the bile ducts.
- Shock wave lithotripsy: This procedure uses high-energy sound waves to break up the gallstones into smaller pieces, which can then be passed out of the body through the stool. This method is usually reserved for patients with small, non-calcified stones.

Symptoms

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Yellowing of skin and eyes (jaundice)
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Weight loss
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Abdominal pain
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Chest pain
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763
Bloating
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Fever
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765
Chills
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766
Dark colored urine/pee
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767
Loss of appetite

Confirmation Tests

- Ultrasound
- CT scan
- Blood test

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