Gallbladder Disease and HCV
Some people with hepatitis C will develop problems with their gall bladder.
This takes the form of inflammation and pain causing nausea and possibly vomiting and difficulty eating certain foods, especially fatty foods. Gall stones can develop but not in all cases. It is not uncommon for people with hepatitis C to have their gall bladder removed as a result.
Also See :
EASL 2012-Gallbladder shown as potential stem cell source for regenerative liver and metabolic disease
Gut Liver. 2012 Apr;6(2):172-87. Epub 2012 Apr 17.
Epidemiology of gallbladder disease: cholelithiasis and cancer.
View Full Study Here
Abstract
Diseases of the gallbladder are common and costly. The best epidemiological
screening method to accurately determine point prevalence of gallstone
disease is ultrasonography. Many risk factors for cholesterol gallstone formation
are not modifiable such as ethnic background, increasing age, female gender
and family history or genetics. Conversely, the modifiable risks for cholesterol
gallstones are obesity, rapid weight loss and a sedentary lifestyle.
The rising epidemic of obesity and the metabolic syndrome
predicts an escalation of cholesterol gallstone frequency. Risk factors for
biliary sludge include pregnancy, drugs like ceftiaxone, octreotide and thiazide
diuretics, and total parenteral nutrition or fasting. Diseases like cirrhosis,
chronic hemolysis and ileal Crohn's disease are risk factors for black pigment
stones. Gallstone disease in childhood, once considered rare, has become
increasingly recognized with similar risk factors as those in adults,
particularly obesity. Gallbladder cancer is uncommon in developed countries. In the U.S.,
it accounts for only ~ 5,000 cases per year. Elsewhere, high incidence rates occur in North and
South American Indians. Other than ethnicity and female gender, additional risk factors for
gallbladder cancer include cholelithiasis, advancing age, chronic inflammatory conditions
affecting the gallbladder, congenital biliary abnormalities, and diagnostic confusion over gallbladder
polyps.
Advanced cirrhosis is a well-established risk factor for gallstones, with an overall prevalence at 25% to 30%.
Usually the stones consist of the black pigment type in patients with cirrhosis.
This is likely related to altered pigment secretion, abnormal gallbladder motility and/or increased estrogen
levels. Gallstone disease is also associated with chronic hepatitis C viral infection and nonalcoholic fatty liver disease;
other factors for this are the metabolic syndrome and obesity.
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2011- Comparative study of gallbladder motility in patients with chronic HCV hepatitis and with HCV
cirrhosis
2011 Gallstones and Liver Disease: an Overview
The results of the study by Coelho and colleagues deserve some considerations that could be
summarized by answering three main questions:
a) How did we get here? b) What is the reason for the increased frequency of gallstones in cirrhosis? c)
Do gallstones worsen the course of liver cirrhosis?
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2010 - Hepatitis C infection and gallstone disease
However, whether from the liver or gallbladder, bile primarily consists of the
following substances: water, bile salts, bilirubin, cholesterol, fatty acids,
lecithin, sodium and proteins. If the chemical balance of bile contains too much
of any of these components, particularly cholesterol, crystals form and harden
into gallstones. Cirrhosis causes the abnormal metabolism of bile pigment.
Because of this, gallstones develop twice as often in cirrhosis patients as in
those without the disorder. Cirrhosis prevents bile from flowing freely to
and from the gallbladder, the bile hardens as gallstones.
Hepatitis C Virus Infection is a Risk Factor for Gallstone Disease:
A Prospective Hospital-based Study of Patients with Chronic Viral C Hepatitis M. Acalovschi; C. Buzas; C. Radu; M. Grigorescu
12/04/2009
Authors and Disclosures
Indeed, it has been confirmed that insulin resistance is increased in both cholesterol gallstone disease[35–37] and chronic HCV infection, particularly in patients with visceral obesity, regardless of genotype and of the severity of liver damage.[38–40] Increased insulin resistance might be a candidate link between chronic HCV infection and GD, by increasing the bile saturation in cholesterol. Presumably, gallstones are predominantly of the cholesterol type in patients with chronic HCV infection, but to date, no study has evaluated this aspect
continue reading......
Signs and Symptoms In Gallbladder Disease
About 90% of gallstones cause no symptoms. There is a very small (2%) chance of developing pain during the first 10 years after gallstones form. After 10 years, the chance for developing symptoms declines. On average, symptoms take about 8 years to develop. The reason for the decline in symptoms after 10 years is not known, although some doctors suggest that "younger," smaller stones may be more likely to cause symptoms than larger, older ones. The mildest and most common symptom of gallbladder disease is intermittent pain called biliary *colic, which occurs either in the mid- or upper-right portion of the upper abdomen.
Large or fatty meals can precipitate the pain, but it usually occurs several hours after eating, often at night. Biliary colic produces a steady pain, which can be quite severe and may be accompanied by nausea. Changes in position, over-the-counter pain relievers, and passage of gas do not relieve the symptoms. Biliary colic usually disappears after several hours. Attacks of pain tend to be intermittent and infrequent; the chance of pain recurring within a year is less than 50%. In one study, 30% of people who had had one or two attacks experienced no further biliary pain over the next ten years.
Acute gallbladder inflammation
Between 1 and 3% of people with symptomatic gallstones develop inflammation in the gallbladder (acute cholecystitis) which occurs when stones or sludge block the duct,
Nausea, vomiting, and severe pain and tenderness in the upper right abdomen are the most common complaints; fever is usual but may be absent. The discomfort is intense and steady and lasts until the condition is treated with medicine or surgery. Patients with acute cholecystitis frequently complain of pain when drawing a breath. The pain can radiate from the abdomen to the back. Acute cholecystitis is usually caused by gallstones, but, in some cases, can occur without stones
Anyone who experiences such symptoms should seek medical attention. Acute cholecystitis can progress to gangrene or perforation of the gallbladder if left untreated. Infection develops in about 20% of patients with acute cholecystitis, and increases the danger from this condition.
Symptoms of Chronic Cholecystitis or Dysfunctional Gallbladders
Chronic gallbladder disease (chronic cholecystitis) involves gallstones and mild inflammation. In such cases the gallbladder may become scarred and stiff. Symptoms of chronic gallbladder disease include the following:
Complaints of gas, nausea, and abdominal discomfort after meals; these are the most common symptoms, but they may be vague and difficult to distinguish from similar complaints in people who do not have gallbladderdisease.Chronic diarrhea (4 - 10 bowel movements every day for at least 3 months).
Symptoms of Stones in the Common Bile Duct (Choledocholithiasis)
Stones lodged in the common bile duct can cause symptoms that are similar to those produced by stones that lodge in the gallbladder, but they may also cause the following symptoms
Acute gallbladder inflammation
Between 1 and 3% of people with symptomatic gallstones develop inflammation in the gallbladder (acute cholecystitis) which occurs when stones or sludge block the duct,
Nausea, vomiting, and severe pain and tenderness in the upper right abdomen are the most common complaints; fever is usual but may be absent. The discomfort is intense and steady and lasts until the condition is treated with medicine or surgery. Patients with acute cholecystitis frequently complain of pain when drawing a breath. The pain can radiate from the abdomen to the back. Acute cholecystitis is usually caused by gallstones, but, in some cases, can occur without stones
Anyone who experiences such symptoms should seek medical attention. Acute cholecystitis can progress to gangrene or perforation of the gallbladder if left untreated. Infection develops in about 20% of patients with acute cholecystitis, and increases the danger from this condition.
Symptoms of Chronic Cholecystitis or Dysfunctional Gallbladders
Chronic gallbladder disease (chronic cholecystitis) involves gallstones and mild inflammation. In such cases the gallbladder may become scarred and stiff. Symptoms of chronic gallbladder disease include the following:
Complaints of gas, nausea, and abdominal discomfort after meals; these are the most common symptoms, but they may be vague and difficult to distinguish from similar complaints in people who do not have gallbladderdisease.Chronic diarrhea (4 - 10 bowel movements every day for at least 3 months).
Symptoms of Stones in the Common Bile Duct (Choledocholithiasis)
Stones lodged in the common bile duct can cause symptoms that are similar to those produced by stones that lodge in the gallbladder, but they may also cause the following symptoms
Jaundice (yellowish skin)
Dark urine, lighter stools, or both
Rapid heartbeat and abrupt blood pressure drop
Fever, chills, nausea and vomiting, and severe pain in the upper right abdomen. These symptoms suggest an infection in the bile duct (called cholangitis).
As in acute cholecystitis, patients who have these symptoms should seek medical help immediately. They may require emergency treatment ,
Symptoms - Bowel Movements /
Pale stools are often due to some form of bile dysfunction. Bile salts, which are made by the liver and excreted via the bile ducts, make feces the normal brown color. An inflamed liver (hepatitis) or some kind of blockage in the bile ducts (like a gall stone) can turn stools pale.
Moderate/mild unexplained fevers or unexplained fevers that hit hard or unexplained high fevers
Urinary
Most people get foamy urine now and again, typically because of muco-proteins in the fish, meat or chicken that they eat. During digestion, the body doesn't break down these proteins completely, so they are expelled in the urine. As muco-proteins shoot out of the body, they momentarily come in contact with air and then with water in the toilet bowl. Foam appears because protein does not mix with air or water. These bubbles occur most frequently in concentrated (dark) urine, like the urine that is passed right after waking up in the morning. If the urine is extremely foamy and continues all the time, there may be a problem with bile salts or the gallbladder.
Lab Values
Gallstone formation does not correlate with blood cholesterol levels, but persons with low HDL cholesterol (the so-called good cholesterol) levels or high triglyceride levels are at increased risk.
Metabolic
Obesity in both men and women increases the risk for gallstones. This may be a result of lower levels of bile salts relative to cholesterol in the bile causing a higher risk for cholesterol supersaturation and the formation of stones.
May Not Be Symptoms Of Gallbladder disease
Digestive complaints such as belching, feeling unusually full after meals, bloating, heartburn (burning feeling behind the breast bone), or regurgitation (acid back-up in the food pipe) are not likely to be caused by gallbladder disease. Conditions that may cause these symptoms include peptic ulcer, gastroesophageal reflux disease, or indigestion of unknown cause
Risks
If cirrhosis prevents bile from reaching the gallbladder, a person may develop gallstones as a result
People with diabetes are at particular risk for serious complications.