Gall Bladder Stones

Overview of Gallstones (Cholelithiasis)

Generally, Gallstone formation is the most common disorder of the biliary tree and it is unusual for the gallbladder to be diseased in the absence of gallstones. Moreover, In developed countries, gallstones occur in 7% of males and 15% of females aged 18–65 years, with an overall prevalence of 11%. Individuals under 40 years there is a 3:1 female preponderance, whereas in the elderly the sex ratio is about equal.

In developed countries, the incidence of symptomatic gallstones appears to be increasing and they occur at an earlier age. Gallstones are less frequent in India, the Far East also Africa. There has been much debate over the role of diet in cholesterol gallstone disease; an increase in dietary cholesterol, fat, total calories and refined carbohydrate or lack of dietary fiber has been implicated. At present, the best data support an association between simple refined sugar in the diet and gallstones. [1]

Indian epidemiology then other

This refers to the initiating factors that trigger a disease process.

• Examples of causes include:
  
  • Pathogens: Viruses, bacteria, fungi, parasites (infectious diseases)
  • Genetic mutations: Inherited or spontaneous changes in genes (genetic diseases)
  • Environmental factors: Toxins, radiation, nutritional deficiencies
  • Lifestyle choices: Smoking, unhealthy diet, lack of exercise (contributing factors)

Causes of Gallstones (Cholelithiasis)

It’s not clear what causes gallstones to form. Doctors think gallstones may result when:

• Your bile contains too much cholesterol. Normally, your bile contains enough chemicals to dissolve the cholesterol excreted by your liver. But if your liver excretes more cholesterol than your bile can dissolve, the excess cholesterol may form into crystals and eventually into stones.
• Your bile contains too much bilirubin. Bilirubin is a chemical that’s produced when your body breaks down red blood cells. Certain conditions cause your liver to make too much bilirubin, including liver cirrhosis, biliary tract infections and certain blood disorders. The excess bilirubin contributes to gallstone formation.

Your gallbladder doesn’t empty correctly. If your gallbladder doesn’t empty completely or often enough, bile may become very concentrated, contributing to the formation of gallstones [2]

Types of Gallstones (Cholelithiasis)

Types of gallstones that can form in the gallbladder include:

• Cholesterol gallstones. The most common type of gallstone, called a cholesterol gallstone, often appears yellow in colour. Additionally, these gallstones are composed mainly of undissolved cholesterol, but may contain other components.
• Pigment gallstones. These either dark brown or black stones form when your bile contains too much bilirubin.[2]

Risk factors are things that make you more likely to develop a disease in the first place.

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology, on the other hand, focuses on the functional changes that occur in the body due to the disease. It explains how the disease disrupts normal physiological processes and how this disruption leads to the signs and symptoms we see.

Imagine a car accident. Pathogenesis would be like understanding how the accident happened – what caused it, the sequence of events (e.g., one car ran a red light, then hit another car). Pathophysiology would be like understanding the damage caused by the accident – the bent fenders, deployed airbags, and any injuries to the passengers.

In simpler terms, pathogenesis is about the "why" of a disease, while pathophysiology is about the "how" of the disease’s effects.

Pathophysiology of Gallstones (Cholelithiasis)

Gallstones are conveniently classified into cholesterol or pigment stones, although the majority is of mixed composition. Cholesterol stones are most common in developed countries, whereas pigment stones are more frequent in developing countries. Gallstones contain varying quantities of calcium salts, including calcium bilirubinate, carbonate, phosphate also palmitate, which simper radio-opaque. All in all, Gallstone formation is multifactorial, toms are not now recognized as being caused by and the factors involved are related to the type of gallstone [2]

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Sign & Symptoms of Gallstones (Cholelithiasis)

(I) General—Include fever with often chills at Onset, also tachycardia.

(II)Local—

(a) Tenderness and muscle guarding in right upper quadrant.

(b) Palpable mass of globular shape below right costal margin also moving on inspiration may be felt.

(c) Murphy’s sign – Patient complains of pain on taking a deep breath while the examiner’s hand is pressed below the right costal margin.

(d) Abdominal distension – may occur and if marked simulates intestinal obstruction.

(e)Boa’s sign – Area of hyperesthesia over right subscapular region.[2]

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Diagnosis of Gallstones (Cholelithiasis)

Tests and procedures used to diagnose gallstones also complications of gallstones include:

• Abdominal ultrasound. This test is the one most commonly used to look for signs of gallstones. Abdominal ultrasound involves moving a device (in other words; transducer) back and forth across your stomach area. Additionally, the transducer sends signals to a computer, which creates images that show the structures in your abdomen.
• Endoscopic ultrasound (EUS). This procedure can help identify smaller stones that may be missed on an abdominal ultrasound. During EUS your doctor passes a thin, flexible tube (i.e. endoscope) through your mouth and through your digestive tract. A small ultrasound device (i.e. transducer) in the tube produces sound waves that create a precise image of surrounding tissue.
• Other imaging tests. Additional tests may include oral cholecystography, a hepatobiliary iminodiacetic acid (i.e. HIDA) scan, computerized tomography (i.e. CT), magnetic resonance cholangiopancreatography (i.e. MRCP) or endoscopic retrograde cholangiopancreatography (in other words; ERCP). Gallstones discovered using ERCP can be removed during the procedure.
• Blood tests. In detail; Blood tests may reveal infection, jaundice, pancreatitis or other complications caused by gallstones.[3]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

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Treatment of Gallstones (Cholelithiasis)

Surgical treatment—Laparoscopic or open cholecystectomy is the only radical procedure for symptomatic gallstones.

Non-surgical treatment

Oral litholytic treatment i.e. 

• Bile acids Chenodeoxycholic acid 10–12 mg/kg/day, and Ursodeoxycholic acid 10–12 mg/kg/day, either alone or in combination (using one half of the dose of each) is suitable for radiolucent small stones (<10 mm in diameter). Pigment stones are not responsive to medical therapy. Lastly, the whole dose should preferably be taken at bed time.

Side effects –

Chenodeoxycholic acid: diarrhoea also hypertransaminasemia.

Ursodeoxycholic acid: in brief; gallstone calcification resulting in treatment failure.

Contact dissolution treatment—

• Percutaneous transhepatic gallbladder puncture followed by application of methyl-butyl ether (powerful cholesterol solvent) directly to the stones. Any number also size of stones can be treated. In detail, Complete dissolution is usually achieved within a few hours.

Side effects – Post-puncture severe abdominal pain also nausea, erosive duodenitis and biliary peritonitis.

Extracorporeal shockwave lithotripsy (ESWL)

• Fragments the stones using focused sound waves; the fragments are subsequently dissolved by bile acid therapy. The procedure is suitable for patients with up to three stones of diameter 10–30 mm.

Side effects –

Biliary colic, haemobilia and pancreatitis.

Recurrent stones—

are radiolucent and smaller, and can be redissolved with bile acids if detected early.[1]

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Homoeopathic Treatment:

Homeopathic Treatment of Cholelithiasis

 Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

•  The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

 A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

 What Homoeopathic doctors do?

 A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

 Homeopathic Medicines for Cholelithiasis:

 The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicine Gallstones (Cholelithiasis):

1. Kali mur: Air-Chilly in the open air. Additionally; Back and neck–Shivering over the back and neck with warm feet.
2. Apis: General oedema. Inflammation of knee joint.
3. Sulphur: Rawness in the larynx, with hoarseness. Dry cough especially in the evening, waking at night, with dyspnoea, (<) night when lying on the back, with pressure and anxiety in the chest; suffocation. Cough dry at night, but loose in the day time from crawling in the larynx. Burning in the chest, extending upward to the face. Besides this, Sharp sticking pains in the sides, often extending to back, (<) night and lying on the back. Anxiety and oppression in the chest. Weakness when talking.
4. Belladona: Persistent, dry, also burning hot (with thirst), followed by sweat only on the head. Chill alternates with heat, internal heat, with anxiety; internal chill with external burning heat. In detail, Heat of the head, with coldness of the extremities.
5. Merc-sol: Raised considerable mucus from larynx and trachea (second day). Larynx and trachea free from mucus; generally collected there in the morning (second day). Sensation of heat in the larynx (first day). Sensation of roughness in the larynx, after breakfast (second day). Occasional hoarseness (second day). Unusual expectoration of mucus (second day). Mercurial fetor of the breath (second day); (third day).
6. MAGN PHOS: For the pain
7. CALC PHOS: To prevent formation.
8. LYCOPODIUM: Symptoms characteristically on right side of body, < 4-8 pm. Poor circulation, cold extremities, craves everything warm. Pains come and go suddenly. Great weakness of digestion. Better – by motion, after midnight also from warm food and drink.

CHINCHONA OFFICINALIS: Much flatulent colic. > Bending double. Pain in right hypochondrium. Gallstone colic. Jaundice. Stool undigested. Worse – slightest touch, after eating. On the other hand Better – bending double, warmth.[5]

Diet & Regiment of Gallstones (Cholelithiasis)

• Eat more foods that are high in fiber, such as. …
• Eat fewer refined carbohydrates and less sugar.
• Eat healthy fats, like fish oil and olive oil, to help your gallbladder contract and empty on a regular basis.
• Avoid unhealthy fats, like those often found in desserts and fried foods. [4]

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References of Gallstones (Cholelithiasis)

[1] Davidsons Principles and Practice of Medicine (PDFDrive.com)

[2] Medicine Golwala

[3]https://www.healthgrades.com/right-care/gallbladder-removal-surgery/cholelithiasis

[4]https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones/eating-diet-nutrition

[5]T.F.Allen

Frequently Asked Questions

What is Gallstones?

A small, hard crystalline mass formed abnormally in the gall bladder or bile ducts from bile pigments, cholesterol, and calcium salts. Gallstones can cause severe pain and blockage of the bile duct.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Gallstones?

• Kali mur
• Apis
• Sulphur
• Belladona
• Merc-sol
• Mag Phos
• Calcarea Phos

What causes Gallstones?

• Bile contains too much cholesterol
• Bile contains too much bilirubin
• Gallbladder doesn’t empty correctly

What are the symptoms of Gallstones?

• Fever with often chills at Onset, and tachycardia.
• Tenderness and muscle guarding in right upper quadrant.
• Murphy’s sign
• Abdominal distension
• Boa’s sign

Give the types of Gallstones?

• Cholesterol gallstones
• Pigment gallstones