Gallstones

It's amazing how something so small can cause so much pain. Almost twenty percent of adult Canadians have stones in their gallbladder, and here is what they look like. They don't look like stones or rocks that you might find on a beach but rather they are softer, often irregular and to understand why they form you need to know something about bile.

Bile is a fluid produced by the cells of the liver. It is a complex mixture of various components including pigment from old red blood cells and cholesterol. The liver produces about a litre a day of bile (or call as it used to be called). It's secreted into tubing that collects the bile and empties into the intestine just past the stomach. The gallbladder is a small collecting bag that sits on a little side channel of this tubing. The gallbladder is small (it only hold about 35 cc of bile on average) and that's where the bile is stored and concentrated. Bile is used by the body to digest fat and, when you eat a meal rich in fat the gallbladder contracts to pump concentrated bile into the intestine. Though bile is 90% water, it contains many other chemicals, and it is the balance of these chemicals that are important tin understanding the formation of gallstones, which form when these chemicals come out of solution? It is like putting more and more sugar into your coffee ' eventually the coffee can only hold so much and the sugar crystals will no longer dissolve. In bile, when the cholesterol and the pigment come out of solution? They form very fine crystals that accumulate to form a gallstone. When the gallbladder contracts with the next fatty meal, the stone gets stuck in the tubing, producing the characteristic recurring sharp pain the upper abdomen or in the area just under the liver.

Many of us have inherited a tendency for thickened bile so we are more at risk for gallstones. But there are other conditions that increase cholesterol like obesity, or pregnancy that also cause gall gallstones. So why not just change the concentration of chemicals in the bile. Well, that is pretty hard to do and would mean life long chemical treatment. So, unfortunately, the best way to deal with the pesky stones is with surgery. The gallbladder must be removed as well as the stones or more stones will form. Fortunately removal of the gallbladder is now a much easier procedure. Often done as an outpatient because of the new laparoscopic surgical techniques.

MEDICINE 101

Gallstones