Gallstones are small, hard pellets that form in the gallbladder, the pouch like organ situated just under the liver, in the upper-right portion of the abdomen. Most gallstones are composed of cholesterol crystals, although some are made of bile salts, which are digestive substances manufactured in the liver and stored in the gallbladder. The stones can be as tiny as the head of a pin or as large as a walnut. It is not clear why they form, but it may be because of an imbalance in the substances that make up bile; excess cholesterol in the bile juices seems to be an important contributing factor. If a gallstone blocks one of the ducts that carry bile from the gallbladder to the intestine, the result can be an attack of biliary colic, producing such symptoms as severe abdominal pain, nausea, vomiting, bloating, belching, sweating, and jaundice. The presence of gallstones can also cause gallbladder inflammation and infection, a condition known as acute cholecystitis. More often, however, the gallbladder harbors stones without causing any symptoms; an estimated 16 to 20 million Americans over the age of 40 have gallstones, but only a million experience attacks in the course of a year. Gallstones most often afflict middle aged, overweight females. Women taking birth control pills or replacement estrogen also have an increased risk of the condition. For unexplained reasons, about 70 percent of Navajo Indians of both sexes have gallstones.
Diagnostic Studies And Procedures
A doctor usually makes the initial diagnosis of an acute attack on the basis of symptoms. During an attack, abdominal pain occurs suddenly, soon after eating, and continues in waves as the duct contracts to get rid of the stone. An episode may last for several hours, stopping abruptly when the gallstone passes into the intestine. Diagnostic studies include blood tests and imaging the gallbladder with X-rays, ultrasound, and CT scanning.
“Silent,” or asymptomatic, gallstones do not require treatment. Those that cause recurrent painful attacks are most often treated by removing the gallbladder, an operation called a cholecystectomy. During this procedure, the bile is redirected so that it flows directly from the liver to the intestines. A relatively new type of surgery, called laparoscopic cholecystectomy, reduces the length of a patient’s hospital stay and speeds convalescence, though it is not recommended for persons who have had prior abdominal surgery. This operation involves making four small punctures in the abdomen and inserting a laparoscope, a catheter with a miniature television camera. The surgical team passes its special operating instruments through the laparoscope, and performs the surgery while viewing the gallbladder and the surrounding organs on a video monitor. The team then removes the gallbladder through the laparoscope. Instead of taking out the gallbladder, a physician may advise pulverizing the gallstones with shock-wave treatment, known as lithotripsy. Medications, such as ursodiol or chenodiol, can dissolve gallstones, but these drugs take months to work and must then be taken for life to prevent more of the stones from forming.
Alternative therapies are unlikely to cure gallstones, but they may alleviate the colicky pain of an attack.
Acupuncture and Acupressure
Pain may be relieved by stimulating points on the meridians that serve the gall bladder, stomach, and liver.
Herbalists recommend alfalfa tablets or dandelion, either in capsule form or as an extract mixed with water, to enhance gall bladder function. Turmeric capsules are also thought to have a protective effect. European herbalists advocate peppermint oil capsules.
Homeopaths often prescribe celedonium, podophyllum, and berberis. 1aken in highly diluted form, these are said to be similar to the substances that cause gallstones.
Practitioners of this Japanese form of pressure point massage apply rhythmic pressure in circles around the abdominal area of the gallbladder to alleviate pain.