Gallstones (cont.)
Who is at risk for gallstones?
Risk for cholesterol
gallstones.
There is no relationship between cholesterol in the blood and
cholesterol gallstones. Individuals with elevated blood cholesterol do not have an increased prevalence
of cholesterol gallstones. A common misconception is that diet is responsible for the development of
cholesterol gallstones, however, it isn't. The risk factors for developing cholesterol gallstones include:
- Gender. Gallstones form
more commonly in women than men.
- Age. Gallstone prevalence
increases with age.
- Obesity. Obese
individuals are more likely to form gallstones than thin individuals.
- Pregnancy. Women who have
been pregnant are more likely to form gallstones than women who have not been
pregnant. Pregnancy increases the risk for cholesterol gallstones because
during pregnancy, bile contains more cholesterol, and the gallbladder does not
contract normally.
- Birth control pills and hormone therapy
The increased levels of hormones caused by either treatment mimics pregnancy.
- Rapid weight loss. Rapid weight loss by whatever means,
very low calorie diets
or obesity surgery, causes
cholesterol gallstones in up to 50% of individuals. Many of the gallstones
will disappear after the weight is lost, but many do not. Moreover, until they
are gone, they may cause problems.
- Crohn's disease. Individuals with Crohn's
disease of the
terminal ileum are more likely to develop gallstones. Gallstones form because patients
with Crohn's disease lack enough bile acids to solubilize the cholesterol in bile.
Normally, bile acids that enter the small intestine from the liver and gallbladder
are absorbed back into the body in the terminal ileum and are secreted again
by the liver into bile. In other words, the bile acids recycle. In
Crohn's disease, the terminal ileum is diseased. Bile acids are not absorbed
normally, the body becomes depleted of bile acids, and less bile acids are secreted
in bile. There are not enough bile acids to keep cholesterol dissolved in bile,
and gallstones form.
- Increased blood triglycerides. Gallstones occur more frequently in individuals with
elevated blood triglyceride levels.
Risk for pigment gallstones
Black pigment gallstones form whenever there is an increased load of
bilirubin that reaches the liver. This occurs whenever there is increased destruction of red blood cells,
as there is in sickle cell disease and
thalassemia.
Black pigment gallstones also are more common among patients with
cirrhosis of the liver. Brown pigment
gallstones form when there is stasis of bile (decreased flow), for example, when there are narrow,
obstructed bile ducts.
Next: What are the symptoms of gallstones? »
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