Most disorders of the extrahepatic biliary tract are related to gallstone problems.

The gallbladder is a pear shaped sac in which bile is stored. Bile, which is formed in the liver, is necessary to emulsify fats in the duodenum so that they can be more easily digested by pancreatic enzymes. Bile is released from the gallbladder under the control of the hormone cholecystokinin, in response to the presence of fats in the duodenum.

Factors that influence the formation of gallstones:

  • Gender: gallstones are more common in women.
  • Age: risk increases with age.
  • Ethnic group: some groups are more predisposed than others.
  • Obesity.
  • Western type diet: high in saturated fats and refined foods.
  • Genetics: a family history of gallstones.

The only two risk factors that can be controlled and therefore reduce gallstone formation are the management of obesity and following a balanced healthy eating plan.

Management of symptoms

 

No symptoms – asymptomatic gallstones

When gallstones are discovered during evaluation of other problems the question arises about whether to recommend surgery for removal of the stones that are not causing any obvious problems. Most individuals with asymptomatic gallstones will probably decide that the discomfort, expense and risk of surgery are not worth the gain of removing an organ that may never cause illness. However, if symptoms appear active therapy including diet, drugs and possibly surgery is advisable.

Symptomatic gallstones:

  • Biliary pain recurs with irregular, pain-free intervals of days or months.
  • Diets and drugs are not helpful.
  • Surgical removal of the gallbladder (cholecystectomy) is necessary.

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