conditions gallstones

RECND4764

Gallstones

Condition:Cholelithiasis
Other:Gallstones
ICD-10 Codes:K80

Naturopathic Treatments

Lifestyle
• remove the cause (e.g. infection, stress, diet, medication, etc)
• stress management - stress suppresses PNS
• exercise - decreases cholesterol
• avoid fasting - causes cholestasis
• eat regular meals - decreases cholestasis

Diet
• consume bitter vegetables - increases bile flow
• avoid saturated fats & trans fats
• increase polyunsaturated fat, monounsaturated fat
• increase fiber

Specific Foods
coffee - decreases risk of gallstones
• nuts - decreases risk of gallstones

Botanicals (internal)
bitter herbs in general
boldo (Peumus boldo)
barberry or oregon grape (Berberis spp.)
• greater chelidine (Chelidonium majus)
wild yam (Dioscorea villosa) - lowers cholesterol

Supplements
• lecithin (phosphatidylcholine) - increases solubility of the bile
peppermint oil (capsules) - decreases biliary colic
• bile salts supplementation - can dissolve stones
vitamin C - may decrease stone formation
melatonin

Caution: gallstone flush with olive oil and lemon water may be suitable for sludge in the gall bladder but increases the risk of impacted gallstones in patient with stones.

Conventional Treatments

• no treatment required if asymptomatic
• surgery

Signs & Symptoms

• often asymptomatic
• severe RUQ or epigastric pain that may accompanied with
- radiating pain to back, right scapula, or to substernal area
- fever
- nausea & vomiting, and/or diarrhea

DDx

• functional dyspepsia
pancreatitis
• GERD
gastric ulcer
• appendicitis
hepatitis
• malignancy
• gallbladder polyp

Pathogenesis

Types of gallstones
• cholesterol stones (80%)
• pigmented stones (bilirubin and calcium with some cholesterol)
• mixed stones (cholesterol stones with a little billirubin and calcium)

Choleterol stones
• bile becomes supersaturated with cholesterol due to:
- cholestasis
- infection
- increased cholesterol synthesis
- decrease in bile salt formation

Pigmented stones
• increase in the bilirubin in the bile due to
- hemolytic anemias (sickle-cell disease, hereditary spherocytosis)
- cirrhosis
- infectious cholecystitis

Mixed stones
• bile becomes supersaturated with both cholesterol and bilirubin

Diagnostics

• ultrasound
• +ve Murphy's sign

References

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