Why do gallbladder Stones develop?
Why do gallstones develop?
To understand the formation of gallstones, one must first know the mechanisms of action that lead to their formation in the gallbladder and their chemical composition. The formation of the gallbladder stones results from the concentration and crystallization of the compounds in bile (cholelithiasis). The liver makes bile, a thick, brown-green fluid secreted by the liver into the gallbladder to aid with food and fat digestion in the small intestines. While in storage, the bile becomes concentrated 10-fold as water is extracted from the gallbladder. Formation of gallstones is favored by factors that increase bile’s cholesterol concentrations, promote crystal formation, or reduce the gallbladder motility (Rolfes). The chemical composition of bile is formed by mostly water, bile salts (natural detergents that are the principal emulsifying agents of fat), cholesterol, proteins, phospholipid (lecithin) helps dissolve fat and a small amount of free cholesterol, inorganic salts, bile pigment (bilirubin); Bilirubin is a waste product of hemoglobin metabolized from red blood cells and plays no significant role in digestion. Bile is alkaline in its reactions (Ronzio), (Collins Dictionary of Biology).
There are two types of gallstones cholesterol and pigment gallstones. Cholesterol stones are the most prominent stones forming about 90% of the cases. The cholesterol in the bile can precipitate out of solution and form small crystal, which eventually come together to form stones (Rolfes). Pigment stones are primarily made up of the calcium salts of bilirubin (calcium bilirubinate). Black pigment stones result from excessive red blood cell breakdown, which leads to excessive bilirubin breakdown. Brown pigment stones develop because of bacterial infections, which alters the structure of bilirubin and causes it to precipitate out of bile and form stones (known as bacterial cholangitis), (Rolfes). Conditions associated with pigment stones are biliary tract infections, cirrhosis, cystic fibrosis, and sickle cell anemia.
Risk factors that contribute to stone formation are based on lifestyle and genetic factors. Women are twice more likely to develop gallbladder stones than men, especially if overweight, menopausal, or pregnant. Genetic factors related to ethnicity play a role in certain populations like Native Americans are 75% more likely to develop gallbladder stones. The prevalence of gallstones increases with age due to an increase in cholesterol concentration and a reduction in bile salt production leading to greater likelihood of crystallization (Rolfes). Other factors that may lead to gallstone formation are smoking, rapid weight loss, high triglyceride levels, hypertension, medications, insulin resistance, diabetes mellitus, and certain parasite infections (Clonorchis sinensis and Opisthorchis viverrini, also known as Chinese liver fluke) are associated with a higher risk of bile duct diseases. If you travel to Southeast Asia, eat fish only if it is well cooked. If you do eat undercooked fish while traveling in this area, ask your doctor for a stool parasite test, especially if you have symptoms of weight loss or diarrhea (Harvard Medical School).
Consequences of gallstones vary, and many individuals are asymptomatic (exhibiting no symptoms) and make up 75 to 80 percent of the cases (Rolfes). Symptoms may develop acutely with severe pain or gradually overtime. Bile duct diseases often cause symptoms related to liver products backing up and leaking into the blood stream. Other symptoms result from the bile ducts' failure to deliver certain digestive juices (bile salts) to the intestines, preventing the absorption of some fats and vitamins. Symptoms of a blocked bile duct include yellowing of the skin (jaundice), itching, light brown urine, fatigue, weight loss, fever or night sweats, abdominal pain, especially common on the right side under the rib cage, greasy stools (steatorrhea), or clay-colored stools, liver damage, and diminished appetite (anorexia). Another organ that can be damage due to backup secretions of the common bile duct is the pancreas. The pancreas and the common bile duct both secrete substances through the pancreatic duct into the small intestines to start digestion. Normally, the powerful digestive enzymes of the pancreas are inactive until they reach the small intestine. When the pancreas becomes inflamed, however, its enzymes leak out, become activated, and begin to digest the tissues they contact, so they begin to eat away at the pancreas and surrounding tissues. The resulting damage can cause swelling of tissues and blood vessels (Gale, 3rd edition). This can lead to chronic pancreatitis, loss of pancreas tissue, or diabetes mellitus due to damage to the beta pancreatic cells.
Treatments available for recurrent gallbladder stones include removal of the gallbladder (cholecystectomy) laparoscopic method, non-surgical procedures Ursodiol prescription (Ursodeoxycholic), shockwaves lithotripsy, diet therapy and nutrition counseling. There are other treatments, but the ones listed above are the most common ones. A bit more about Ursodiol (UDCA) prescription of secondary bile acid, it’s used for 6-18 months and is best for smaller stones. The recurrence rate is 30-50% within 3-5 years. Research on gut microbial dysbiosis was observed in gallbladder stone patients and partially reversed by UDCA/CDCA treatment, which also effectively dissolved gallbladder stones (Jungnam).
This research paper is intended to provide free education, and not to diagnose. Always work with your MD or healthcare provider team. Thank you.
Works Cited
"Bile Duct Diseases." Harvard Medical School Health Topics A-Z, edited by Harvard Medical School, Harvard Health Publications, 2017. Credo Reference, http://sinclair.ohionet.org/login?url=https://search.credoreference.com/content/entry/hhphealth/bile_duct_diseases/0?institutionId=6043. Accessed 05 May 2023.
"bile." Collins Dictionary of Biology, W. G. Hale, et al., Collins, 2nd edition, 2005. Credo Reference,http://sinclair.ohionet.org/login?url=https://search.credoreference.com/content/entry/collinsbiology/bile/0?institutionId=6043. Accessed 06 May 2023.
"Pancreatitis." Human Diseases and Conditions, edited by Gale, 3rd edition, 2017. Credo Reference, http://sinclair.ohionet.org/login?url=https://search.credoreference.com/content/entry/galehuman/pancreatitis/0?institutionId=6043. Accessed 08 May 2023.
Jungnam Lee, et al. “Gut Microbial Profile Changes in Patients with Gallbladder Stones after UDCA/CDCA Treatment.” Biomedicines, vol. 11, no. 777, Mar. 2023, p. 777. EBSCOhost, https://doi.org/10.3390/biomedicines11030777. Accessed 05 May 2023.
Ronzio, Robert. "bile." Library of Health and Living: The Encyclopedia of Nutrition and Good Health, Robert Ronzio, Facts On File, 3rd edition, 2017. Credo Reference, http://sinclair.ohionet.org/login?url=https://search.credoreference.com/content/entry/fofnagh/bile/0?institutionId=6043. Accessed 07 May 2023.