Gall stones are hardened deposits of digestive fluid that can form in the gall bladder. Gall stone disease is one of the most common problem affecting the digestive tract. The prevalence of gall stones is related to many factors, including age, Gender and ethnic background. Before adolescence, men and women seems to be equally affected, thereafter the disease is more prevalence in women. Women are three times more likely to develop Gallastone than men, and first degree relatives of patients with gallstones have a two fold greater prevalence. According to Ayurveda, gall stones are given the name Pitta- ashmari, are a kapha disorder associated with underactive thyroid and slow metabolism.
Mechanism of formation of Gall Stones?
The formation of gallstones is a complex process that starts with bile, a fluid composed mostly of water, bile salts, lecithin .Gall stones are usually caused by disturbances in the composition of the bile, a change in the ratio of cholesterol and bile salt may result in the formation of deposits. At the start, they may be in the form of fine gravel. But these fine particles constitute the nucleus for further deposits, ultimately leading to formation of large stones .An irritation of the lining of the gall bladder due to inflammation may also lead to formation of particles.
Types of Gall Bladder Stones?
Gall stones are classified by their cholesterol content as either cholesterol stone or pigment stone. Pigmented stone can further classified as either Black Or Brown. Thre may be another classification as mixed gall stones.
1.Cholesterol GB stones
About 70 to 80% of all gall stones are cholesterol stone. Cholesterol stones caused by a change in the ratio of cholesterol to bile acids.
2. Pigmented GB stones (Composed of bile pigment)
Pigmented stones caused by destruction of red blood cells due to certain blood diseases. There stones are smaller, darker and are made up of bilirubin.
3. Mixed GB stones
They are consisting of layers of cholesterol, calcium and bile pigment ( billirubin) resulting from stagnation of the bile flow.
What causes the gall bladder stones?
- Hereditary factors
- Decreased motility of gall bladder
- Dietary factors- diet rich in excess carbohydrates and fats.
Predisposing factors in development of gall stones?
- Dietary factors
- Crohn’s disease
- Gastric surgery
- Sickle cell disease
What are the symptoms of stone in gall bladder?
1.Pain in the upper rite side or upper middle of the abdomen-
In general gall stones are not painful. They remain in gallbladder for a long time without causing any pain, indeed, you will not know they are there. Pain occurs when the gall bladder tries to push the stones out the gall blader through the bile duct. The pain may be sharp, cramping or dull, spread to back or below the right shoulder.
2. Nausea and Vomiting
3. Clay colored stool
6. Feeling of fullness after meals
7. Intolerance to fat
Which complications can be due to gall bladder stones?
- Blockage of the common bile duct
- Blockage of the pancreatic duct
- Cholecystitis –inflammation of gallbladder
- Empyema of gallbladder
- Gallbladder perforation
- Carcinoma gall bladder
1. Murphy’s sign:
During deep palpitation of the right upper abdomen, patient is asked to take deep breath. Patient complaints of severe pain during deep inspiration with inspiratory arrest, because the tender enlarged gall blader comes down.
2. Boas’s sign-
If patient is diagnostic of acute cholecystitis, this is an area of hyperaesthesia between the 9th and 11th rib posteriorly on the right side.
Which investigation should be done for gall bladder stones?
- CBC- WBCs count is often elevated to 12000-15000/up
- Lipid profile– Mild elevation in serum bilirubin
- USG- Scan shows gallstone, sludge(mud) and thicking of gall bladder wall
- Isotope scanning ( HIDA, PIPIDA scanning)
Treatment modalities for Gall stones?
- If patient do not have jaundice give him a Sneha Pan with Patoladi ghrita
- Virechana with Avipattikar powder with katuki kashaya and honey
2. Ayurvedic Medicines and home remedies
- Have juice of bitter gourd two times a day with honey
- Have decoction of horse gram two times a day with honey
- Hajral yahood rasa
- Kutki powder
- Soorashekhara rasa
- To reduce pain- put a warm castor oil pack on your abdomen. Castor oil produces is slow sustained heat that is soothing and healing.
3. Natural healing
Smaller gall stones can be cleaned through the nature cure methods. Diet is the basic factor in the treatment of gallbladder stones. The patient should eat small meals at frequent interval, rather than three large meals. The following is the suggested menu for those suffering from gallblader disorder-
- On rising- a glass of warm water mixed with lemon juice and honey for fresh fruit juice
- Breakfast- fresh fruit, one or two slices of hall meal toast and a cup of skimmed powder milk
- Mid morning- Fresh fruit juice
- Lunch- vegetable soup, a large salad consisting of vegetables in season with dressing of lemon or vegetable oil fresh fruit for dessert if desired
- Dinner- vegetable juice, 1 or 2 lightly cooked vegetables, baked potatoes, brown rice or whole wheat chappati and a glass of buttermilk
- Regular application of hot and cold fomentation to the abdomen improve the circulation of the liver and gallbladder
- The pain of gall stone colic can be relieved by the application of hot pack for fermentation to the upper abdominal area
- A warm water enema at body temperature will help eliminate the the fecal accumulation if the patient is constipated
Several yoga asanas are beneficial for prevention of gall stones. These posture(asanas) will improve circulation in the gall bladder, helping to prevent the the crystallization process.
- The Bow pose
- Peacock pose
- Spinal twist
- Narayan pose ( lying on left side)
Surgery becomes necessary if the gall stones are very large in size or in case they have been present for long.
- Open cholecystectomy
- Laparoscopic cholecystectomy
In order to prevent gall stone formation, one has to improve both thyroid function and metabolism.
- Light food
Stay away from-
- Deep fried food
- Dairy products ( such as yogurt and cheese)
- All fatty foods
- Animal fat and saturated fat
Written by: Dr Ranjeet Singh
Revised by: Dr. Manoj kureel, MS (surgeon Ay.)