Jan 29, 2008

Gall Bladder Stones (Cholelithiasis)


 Formation of gallstones in the biliary tract is common disorder and is associated with diseased gallbladder. It is unusual for the gall bladder to be diseased in the absence of gallstones.

Types of gallstones

Cholesterol stones- these stones have more than 70% of their dry weight as cholesterol and are commonest type (80%) in industrialized countries. Effective medical therapy is available presently for the cholesterol stones.


Pigment stones- these stones have less than 20% of their dry weight as cholesterol. They are uncommon and seen more frequently in developing countries.


Mixed stones

Pathogenesis

Cholesterol stones formation is the result of secretion of abnormal bile (lithogenic bile) by the liver. Cholesterol in the bile is kept in soluble form by bile salts in two physical forms. Either an excess of cholesterol or a relative decrease in the bile salt could lead the super saturation of the bile with cholesterol, which may get precipitated, in the form of gall stone. The lithogenic bile may have any of three reasons either defective bile acid synthesis or loss of bile salts (steatorrhoea) or excessive cholesterol secretion and impaired gallbladder functions.

Pigment stones are almost always the result of bacterial and parasitic infection in the biliary tree. These are of two types: black pigmentation stones found in gallbladder and earthy brown pigment stones found in common bile duct. The pigment stones are result of excess of unconjugated bilirubin in the bile, which get precipitated as insoluble bilirubin polymer (calcium bilirubinate). Haemolysis is the important cause of these pigment stones.

Risk factors for Gallstones

1.Cholesterol Stones

A.Increase cholesterol secretion


a. Elderly Persons
b. Obesity
c. Female
d. Pregnancy


B.Impaired Gall bladder emptying


a. Fasting
b. Total parenteral nutrition
c. Bile stasis in gallbladder
d. Spinal injury
e. Pregnancy


C.Bile salt secretion



a. Pregnancy

2.Pigment stones

a.Haemolysis
b.Hepatic cirrhosis
c.Age related
d.Ileac resection / disease
e.Stasis of infected bile

Clinical Features

Mostly the gallstones are asymptomatic and remain so for a long period. The occurrence is denoted by 4F (Fatty, Female, Forty and Fair) which mean that Gall stones are common in fatty, fair complexioned females above the age of 40 years. Only about 10% patients has symptoms either as biliary colic or acute inflammation of gall bladder. If the gall stone impacted in cystic duct the patient experience acute pain that remains for about 1-2 hours.
Prolonged pain more than 6 hours suggests either inflammation of gall bladder or pancreatitis (inflammation of Pancreas), as a complication of gall stone.
The stone in common bile duct due to migration of a gall stone produces biliary colic and obstructive jaundice due to cholestasis. Painless progressive obstructive jaundice, fever with rigor and itching over skin.

Diagnosis

Plain X-Ray of abdomen
Ultrasonography
CT Scan and MRI
Oral Cholecystography

Complications

Empyema of gall bladder
Pancreatitis
Cancer of gall bladder
Fistula formation with gallstone

Treatment

Asymptomatic gallstones are not usually treated. The best curative treatment for symptomatic gall stone is surgery. And in non surgical treatment gall stones can be dissolved and removed by ERCP.

Homeopathic Treatment

Acute pain, swelling ,vomiting, sign and symptoms related to gall stones can easily be treated by Homeopathic medicines. Gall stone colic cases may become asymptomatic again by homeopathic treatment. But in recurrent cases, after symptoms subside, surgery is recommended. 



More then 70 medicines are available in homeopathy for gall stone cases. Few common medicines are following:- 


Belladona, Berberis Vulg, China, Cardus Mar, Calcarea Carb, Chelidonium, Chionanthus, Dioscorea, Lachesis, Nux Vomica, Podophyllum, Lithium Carb, Cholesterinum etc.

4 comments:

fritz said...

Very informative Keep it up Dr. Ravin thanks for your best effort on this blog.

Fritz

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Anonymous said...

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Anonymous said...

Every participating doctor, patient and visitor should share their knowledge or achievement regarding the subject.I would further like to request every one to please share their knowledge regarding successful treatment of gall stone with our miracle homeopathic medicines,warm regards,malaker