Gall bladder is a small pear-like structure located below the liver which produces bile that is responsible for metabolizing fats in the body. Gall stones are concretions formed due to abnormal or abnormal constituents of bile. They can form in the gall bladder or anywhere in the biliary tree (bile carrying system).

Gall stones are the most common cause for damage to the gall bladder worldwide. They   can occur at any age from 18 to 65 years but are more common in middle age and three times more common in women. 

In fact, Cholelithiasis is said to have a high association with 4 Fs, that is, female, fat, forty, fertile. 

Stones forming in the gall bladder are composed of cholesterol or pigment and also contain some amount of calcium salts. 

 Common underlying causes for formation of gall stones is increased cholesterol production in the body. This is more in elderly, in women and obese people. If obese people loose weight rapidly there is a risk of gall stones. Impaired emptying of the gall bladder as in pregnancy, fasting states, also leads to stasis of bile in the gall bladder and increased risk of cholesterol gall stone. 

Where there is break down of red blood cells inside the body, there is risk of predominant pigment stones, as in certain type of anemias. Infections of the biliary tree also lead to formation of pigment stones. Hepatic cirrhosis makes one more prone to gall stones. Genetic susceptibility also exists for having gall stones. 

 Most of the times gall stones cause no problem and may be  detected accidentally. Ten per cent stones cause problems and need treatment. 

Presence of gall stones causes pain, commonly in the right upper half of the body. Pain can be radiated to the right shoulder, even upper back. 

But it can be felt in the central upper part or even the right flank, thus mimicking other diseases. 

 This pain commonly appears after meals, more so after a fatty meal. In acute cases it is severe, excruciating and associated with nausea and vomiting.

If infected, high fever occurs with chills. Stones in the common bile duct cause obstruction to flow of bile. Thus, along with pain, one develops jaundice, loss of appetite, vomiting, itching all over body and white-coloured stools. 

Untreated cholecystitis can lead to perforation of the gall bladder, which can be fatal. 

On suspicion of gall stones, diagnosis is established by X-rays and ultra sound of the abdomen. 

Medical treatment consists of drugs which tend to dissolve the gall stones like ursodeoxycholic acid. Along with it antibiotics are given for the infection, painkillers for pain and fluid therapy is needed if there is dehydration due to vomiting and poor intake due to anorexia. 

Drug therapy is useful if stones are less than 15mm, problem is mild to moderate and intermittent and person is lean. But obese individuals or those having recurrent persistent or severe symptoms need surgical interventions.

A  fat free diet, good physical exercise, less alcohol and addicting substances are useful to prevent gall stones. Those who already have symptomatic gall stones are advised to take fat-free diet and frequent small meals to take off the load from the gall bladder. 

Dr Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital