Gallstones are hard, solid masses formed in the biliary tract, usually in the gallbladder.
They usually develop insidiously and may remain asymptomatic for decades.
Occurrence of gallstone disease is higher in western countries such as America and Europe.
Women are more likely to develop gallstones, especially during their reproductive age.
Two major substances involved in gallstone formation are cholesterol, and calcium bilirubinate.
Gallstones form when the bile is supersaturated with these substances.
Three major types of gallstones include cholesterol stones, Black pigment gallstones, and brown pigment gallstones.
Causes for cholesterol gallstone formation include the following.
Obesity.
Obesity is associated with metabolic syndrome, insulin resistance, hyperlipidemia, and type 2 diabetes.
In all these conditions, liver secretes high amounts of cholesterol in bile, increasing the risk of gallstones.
Multiple pregnancies.
When a woman becomes pregnant, progesterone levels in blood increases.
It reduces the gallbladder contractility, leading to prolonged retention and greater concentration of bile.
Other causes of gallbladder stasis include, spinal cord injuries, which also reduces the gallbladder contractility.
Prolonged fasting and total parenteral nutrition, which reduces the intestinal stimulation of gallbladder contraction.
Gastric bypass surgery.
Medications causing gallbladder stones include the following.
Estrogen, used for contraception.
Fibrate drugs, which are used to reduce blood cholesterol, and Somatostatin analogues.
Genetics also plays a role in gallstone formation.
Other causes of gallstone disease include, disorders of increased heme turnover, such as sickle cell disease, thalassemia, and cirrhosis.
Post operative biliary strictures.
Liver fluke infestation.
Crohn’s disease and ileal resection, which decreases the absorption of bile salts.
Burns.
Paralysis.
Prolonged ICU care.
And major trauma.
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