Gallbladder Calculations - Gallbladder Calculations

Generality

Gallbladder stones (gallbladder) are one of the most common biliary tract diseases. Fortunately these pebbles often do not give problems to the patient and only in rare cases are responsible for a specific symptomatology. When this happens, however, violent pains arise, comparable, according to some, to those of childbirth.

To avoid complications or relapses, surgery is often suggested. Recently, thanks to the advent of modern technologies, "minimally invasive" techniques have been developed, thanks to which the patient is discharged 1 to 3 days after the operation.

A little Anatomy

The gallbladder or gall bladder is a small bag, located under the lower face of the liver (right side of the abdomen). This small bladder serves as a bile deposit produced by hepatocytes (liver cells).

The cystic duct connects the lumen of the gallbladder with the main bile ducts, small "ducts" that originate from the liver and transport the bile DIRECTLY to the small intestine (duodenum). The gall bladder is therefore not a vital organ, given that the passage of bile is however permitted by other routes.

The last tract of the biliary tract is the common bile duct that ends in the duodenal ampulla of the Vater with a natural sphincteral narrowing (sphincter of Oddi) in which also the pancreatic duct of Wirsung (except anatomical anomalies) flows.

In addition to collecting and concentrating the bile (5-20 times), at the appropriate time, the gallbladder also provides to pour it inside the duodenum always through the common bile duct.

Causes

When foods pass from the stomach to the intestine, a series of stimuli mediated by chemical substances (CCK) cause the gall bladder to contract which pours its contents into the small intestine.

Thanks to its chemical composition (water, bile salts, bilirubin, cholesterol and other fats) bile promotes digestion and absorption of lipids.

In particular conditions the cholesterol and bile pigments it contains can precipitate aggregating into small crystals that tend to pile up over time.

In these cases we speak of biliary lithiasis or more commonly of gallbladder stones. More or less appropriate synonyms for this condition are: gall bladder stones, gallstones, or, improperly, "liver stones".

The dimensions of the calculations are variable, sometimes they resemble grains of sand, other times they reach the size of a marble.

Unfortunately, there is also the possibility that these calculations move from their position of origin going to enclose the bile flows and causing a colic. In general the smaller calculations, having a greater mobility, are more dangerous than the big ones since moving can go more easily to occlude the bile and pancreatic ducts. This creates an obstacle to the escape of bile and the substances secreted by the pancreas. This condition can cause one of the most serious complications of stones, called acute pancreatitis.

Fortunately, the consequences of gall bladder calculations are not always so serious. In most cases gall bladder stones are discovered by chance and, in all probability, the patient they are diagnosed with will not develop symptoms or complications in the following years. Other subjects less fortunate complain of digestive disorders, nausea, vomiting and visceral pain.

Classification

PURE CALCULATIONS

PIGMENTED CALCULATIONS

MIXED CALCULATIONS

about 10% frequency, solitary, large, round

(calculation usually single, spherical, light in color) most interesting is the Caucasian race. The incidence increases with the progression of social and economic conditions and with age (more frequent middle age).

about 10% frequency, consisting of unconjugated bilirubin, calcium and other organic material which precipitate to form calcium bilirubinates; they do not contain cholesterol;

brown pigmented stones are more widespread in low-social environments with a high risk of infections; black pigmented stones are not associated with bile infections but are common in cirrhotic patients or with blood disorders. This type of calculations is rarely found in Italy (present above all in the southern and insular regions).

about 80% frequency, mainly consisting of cholesterol (70%), calcium salts, bilirubin, proteins, bile acids, debris; usually multiple, they can be round or faceted, smooth or wrinkled.

This type of gall bladder stones is common in Western countries, probably due to the high rate of obesity, dietary fiber deficiency, and overeating, especially in the consumption of fat and simple sugars.

COMPONENTS OF BILE: water (80%), conjugated bile salts (10%), phospholipids (4%), cholesterol (1%), bilirubin diglucuroid and electrolytes.