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Gallstones

Common condition in overweight, middle-aged women; it is often hereditary. The stones usually consist of a mixture of chloresterol, bile pigment and calcium, often in differing proportions; stones consisting purely of cholesterol and bile pigment are rare. Gallstones occur in the gall bladder or sometimes in the bile duct. They can remain in the gall bladder, but may block its exit or pass into the bile duct. Symptoms can vary considerably: it is possible for a stone to cause no difficul- ties for years, and simply to remain at rest in the gall bladder. Often however they move as described above, causing typical colic: violent pain in the area of stomach and gall bladder, radiating to the right and to the back, nausea and vomiting. The pain may disappear after several hours, but if the stone remains, it can cause cholecystitis. Blockage of the bile duct causes jaundice. Other, rarer complications are chronic cholecystitis, perforation of the gall bladder wall with peritonitis, and cholangitis. There are some signs that the possibility of cancer of the gall bladder is somewhat increased in the long run by gallstones. Diagnosis of gallstones is sometimes difficult; X-rays with contrast medium may provide an indication. If the bile duct is blocked, blood tests reveal abnormal quantities of liver enzymes and bilirubin. During an attack (colic) treatment is with painkillers, anti-convulsant drugs (to prevent contractions of the gall bladder which propel the stone into the exit), rest, and by ceasing to eat. Certain stones can now be dissolved with drugs, but the process is time-consuming.

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