In this video we will get to know the gallstones, also called cholelithiasis. It is a fairly common disease, which depends on the presence of stones inside the gallbladder and more generally of biliary tract.
Gallstones are collections of solid material, similar to small "pebbles"; these aggregates are formed inside the gallbladder or bile ducts when the bile is too rich in certain substances, such as cholesterol, calcium salts, bilirubin and other bile pigments. To understand better, let's start as always with a brief anatomical review. gallbladder, also called gallbladder, is a pear-shaped organ located just below the liver. The primary function of the gallbladder is to "storing and concentrating bile produced by the liver. Bile is a thick, greenish-brown liquid consisting mostly of water, cholesterol, bile salts and bilirubin. As we have seen, bile is therefore produced by the liver, accumulated and concentrated in the gallbladder between meals, and finally poured into the intestine where it fulfills a digestive function; in particular, the bile has the purpose of facilitating the digestion and absorption of dietary fats. All this is allowed by a dense network of channels responsible for transporting bile from the liver cells that produced it, to the gall bladder and intestine; on the whole, these bile transport channels are called biliary ducts or bile ducts.
Calculations develop for effect of sedimentation of some substances normally present in the bile. This event can occur when the normal biliary composition is altered, or when the gallbladder does not empty completely and the bile thus stagnates inside it. In such situations gods begin to form small insoluble crystals, derived from the precipitation and aggregation of some biliary components. Gradually, other salts and lipids are deposited on these nuclei, thus giving rise first to the bile sand, then to the actual calculations. Gallstones can vary in size from a few millimeters to a few centimeters, and are distinguished by their chemical composition. In most cases, these pebbles are composed of aggregates of only cholesterol. The so-called are rarer pigment stones, consisting of calcium salts and bilirubin crystals; the latter is a substance produced by the breakdown of blood hemoglobin and metabolized by the liver. The main problem with stones is that they can occlude the bile ducts, thus hindering the normal outflow of bile from the liver to the gallbladder and intestine. The bile, as a result, accumulates, producing a double insult, of a chemical and pressure nature. In fact, the bile pushes against the walls of the bile ducts and damages them, also due to some of its chemical components. The final effect is ainflammation of the gallbladder, of the bile ducts and, sometimes, of the liver, with painful symptoms and even serious consequences.
Gallstones is quite common in the adult population and the incidence increases with the passing of the years. It affects about 15% of the over 40s and prefers to affect women over men. On balance, gallstones are 4 times more frequent in women, particularly during pregnancy or when taking birth control pills or hormone replacement therapy. In addition to these elements, there are other factors that can increase the risk of gallstones, both in men and women. These factors are for example obesity, fasting and even losing weight too quickly. , the gallbladder remains inactive and does not contract for many hours; consequently, the bile stagnates inside it and some of its components can precipitate and aggregate. Finally, other predisposing factors seem to be familiarity with the disease, a diet with too much fat and low in fiber, and the use of certain medications.
As long as the gallstones remain small enough in size to pass through the bile ducts and be excreted, the stones are not a big deal. In these cases, patients experience no major symptoms; at most they can complain of slight disturbances, such as abdominal swelling, difficulty in digestion, flatulence, heartburn and a feeling of weight in the stomach. The problems, the real ones, arise when one or more of these pebbles reach occlude the bile ducts or ad prevent the outflow of bile from the gallbladder. Under such circumstances, the gallbladder begins to contract repeatedly to try to expel the stone. This is how the so-called and feared "biliary colic", Characterized by a very strong pain localized in the upper abdomen, and radiated to the right side and back. This pain arises suddenly, in the form of pangs that last from a few tens of minutes to a few hours. Biliary colic can also be associated with nausea, vomiting and fever. The obstruction of the bile ducts and the consequent stagnation of the bile can also cause a obstructive jaundice, which dyes the skin and whites of the eyes a yellowish color. At the same time, the stools turn pale, while the urine takes on a dark, tea-like color. Among the major risks that may arise in the case of gallstones there is also the cholecystitis, that is, inflammation of the gallbladder; if this condition is not treated promptly, the inflammatory process can extend to the pancreas resulting in severe pancreatitis. Other possible complications include infections of the bile ducts and the biliary cirrhosis.
The presence of gallstones is commonly detected by an "ultrasound or abdominal CT scan. In cases of stones that are difficult to diagnose, it is possible to use more sophisticated methods, such as a particular type of magnetic resonance imaging or endoscopic retrograde cholangio-pancreatography (ERCP). This last procedure, within certain limits, also allows for the removal of stones during the same diagnostic examination.
In many cases, gallstones do not cause ailments, so no treatment is needed. However, when a person is prone to continuous gallstone formation or has possible complications, doctors often find it more appropriate to remove the gallbladder, through an operation called cholecystectomy. This is a fairly simple surgery, generally minimally invasive, because it is performed laparoscopically by making small cuts on the patient's abdomen; in this way the surgery to remove the gallbladder is resolved with a very short hospital stay. Subsequently, the patient will be able to lead an almost normal life, since the liver will continue to produce bile normally, but pouring it directly into the small intestine. digestive problems will therefore be minimal and "at most there may be" an initial intolerance to very fatty foods. Also for this reason, a low-fat, high-fiber diet is recommended after cholecystectomy, which helps the liver to regain its normal functionality , without tiring it. As an alternative to surgery, in some cases it is possible to resort to extracorporeal lithotripsy; this surgery, widely used in the treatment of kidney stones, uses acoustic shock waves to try to break the stones into fragments small enough to pass through the bile ducts. Finally, treatment with drugs, such asursodeoxycholic acid, has the purpose of dissolving some types of gallstones, such as those composed mainly of cholesterol; however it can take many months and often does not produce satisfactory results. In addition, the main drawback of drug treatment options is that gallstones can re-form when treatment is stopped.
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