GallStone

By Ran Zhang, Sept 2014 Acupuncture

Definition• What is GallstoneCalculi formed by precipitation of cholesterol and/or bilirubin from bile solution• What are the signs and symptomsUpper right abdominal pain, vomiting, nausea, clay-colored stool, etc• How is it diagnosedUltrasound,• Who gets itWomen during reproductive year, on estrogen, during pregnancy, aged population, people with hemolytic anemia, • How widespread is itAt least 10% of general population, an estimated 20% of adults over 40 years of age and 30% of those over age 70 have biliary calculi. 500,000 gallbladder removal surgery due to Gallstone is performed each year in the US

Pathogenesis • Normal functioning of the biliary treeBile is produced in the liver. It moves from the hepatic ducts to the gallbladder for storage. When signaled, the gallbladder pumps the bile out into cystic duct to common bile duct to the duodenum.• Solutes and components of BileCholesterol, pigments like bilirubin• Causes of stone formationElevated levels of cholersterol and/or bilirubin in the bile solution.• Type of stonesCholesterol stones and Bilirubin stones• Risk factors for cholesterol gallstonesElevated levels of steroid hormones like estrogen, progesterone, Obese people with elevated level of cholesterol in the blood,• Risk factors for bilirubin gallstonesPeople with hemolytic anemia, elevated levels of bilirubin in the blood

Pathophysiology• CholelithiasisGallstone in the gallbladder. When the gallbladder contracts, stones might get stuck and increased pressure in the gallbladder might cause tissue damage in the gallbladder wall. Inflammation resulted from tissue damage might cause fever and leukocytosis. There is a risk of gallbladder rupture.• CholecystitisInflammation in the gallbladder and cystic duct. If the gallstone is stuck somewhere along the cystic duct or in the common duct, the high pressure from the gallbladder contraction will affect both the wall of gallbladder and the cystic duct, causing tissue damage and inflammation.• CholangitisInflammation in the ducts of the biliary tree, which are results of tissue damaged caused by elevated pressure on the duct wall tissues.

Pathophysiology• Choledecholithiasis, CholestasisObstruction of the biliary Track obstructs the flow of bile. There many problems can arise from the obstruction of bile flow.1. Acute Pancreatitis – the bile reflux into the pancreatic duct, activating the

proenzymes in the pancreas causing autodigestion of pancreas tissue, resulting in massive inflammation, bleeding, a medical emergency

2. Bile acid not getting into the small intestine, impairing the functions of bile in the small intestines, including digestions and absorptions of lipid, regulating metabolism and bile-acid-gut-microbiome axis

3. Bile acid accumulating in the liver and backing into the blood circulation causing toxic effect in the liver and other body systems, like the brain.

4. Bile solution along with elevated bilirubin backed up in blood circulation affecting the functioning of the kidney causing kidney tissue damage

• Obstructive jaundiceInduces nephropathy that ranges from limited proximal tubulopathy to renal failure.

Interaction with Other conditions• Liver tissue damage• Gut microbiome, bile acid pool size• Metabolism regulation, bile acid receptor• Brain• Nephropathy, • Pancreatitis• Lipid digestion and absorption• Obesity

General Course of Gallstone• Gallstones start small. When they are small, they can pass through all the

ducts easily. Gallstones are usually not treated unless a stone gets stuck in a duct and blocks the bile flow completely. It takes some time for the gallstones in the gallbladder to get bigger and bigger in size and having more and more gallstones forming in the gallbladder. The speed at which the Gallstones get bigger and get more in number is the speed of the worsening of the condition. For people who can manage their cholesterol level and bilirubin level in blood and bile, they can keep the existing stones from getting bigger and not getting any new stones.

• Otherwise, the stones get bigger• When the bile is blocked completely, the end treatment is the removal of

the gallbladder

Sleep, diet, other Lifestyle factors• Keep an healthy weight1. Quality sleep – reduced the risk of obesity2. Property diet – reduce cholesterol intake, fruit and veggie 3. Regular exercise• Consider the risk of gallstone before taking any steroid hormone

medication