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Is there really any solid evidence that Gallstones can exit gallbladder?

If there was any solid evidence that Gallstones can exit gallbladder, why would any doctor claim that gallstones CAN NOT exit gallbladder?

Fact: Some gallstones (smaller gallstones) can exit gallbladder.

Fiction: All gallstones can exit gallbladder. Anyone believing that every stone can exit gallbladder is ignorant/uninformed or irrational. Rare stones can be even larger then 2 inch ( 5cm ) in smallest diameter.

Fiction: Gallstones can not exit gallbladder. Anyone believing that no stone can exit gallbladder is ignorant/uninformed or irrational. Stones can be smaller then 2 mm in diameter, and could easily travel through the bile ducts without any chance of causing obstruction.

Majority of gallstones starts their "life" as a microscopic crystal of cholesterol. Very few gallstones ever get a chance to grow larger then 2mm. Most are expelled while small as sand.

cholesterol = chole + sterol
The name originates from the Greek chole- (bile) and stereos (solid)

cholesterol = Greek for solid bile

How do we know that some gallstones can exit gallbladder?

It is a well documented medical phenomenon.

Obstruction of the common bile duct is often caused by gallstones that were expelled from the gallbladder:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2407039&dopt=Abstract
In patients with chronic Pancreatitis, common bile duct obstruction is reported in 3.2-45.6% of patients; however, only 5-10% of all patients with chronic Pancreatitis require operative decompression of the bile duct.

http://www.virtualgastrocentre.com/diseases.asp?did=191
Passage of gallstones into the common bile duct occurs in approximately 10-15% of patients with Gallstones. The incidence is thus related to the presence of gallstones, which are very common (10-20% of population).

Common bile duct stone References

[1] Braunwald, Fauci, Kasper, Hauser, Longo, Jameson. Harrison's Principles of Internal Medicine. 15th Edition. McGraw-Hill. 2001.
[2] Cotran, Kumar, Collins 6th edition. Robbins Pathologic Basis of Disease. WB Saunders Company. 1999.
[3] Fletcher, D. Gallstones, In: Tjandra, JJ, Clunie GJ, Thomas, RJS (eds); Textbook of Surgery, 2nd Ed, Blackwell Science, Asia. 2001.
[4] Haslet C, Chiliers ER, Boon NA, Colledge NR. Principles and Practice of Medicine. Churchill Livingstone 2002.
[5] Hurst JW (Editor-in-chief). Medicine for the practicing physician. 4th edition Appleton and Lange 1996.
[6] Kumar P, Clark M. CLINICAL MEDICINE. WB Saunders 2002.
[7] Longmore M, Wilkinson I, Torok E. OXFORD HANDBOOK OF CLINICAL MEDICINE. Oxford Universtiy Press. 2001
[8] McLatchie G and LEaper DJ (editors). Oxford Handbook of Clinical Surgery 2nd Edition. Oxford University Press 2002.
[9] MEDLINE Plus
[10] Raftery AT Churchill's pocketbook of Surgery. Churchill Livingsone 2001.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1119388
Jaundice occurs in patients with gall stones when a stone migrates from the gall bladder into the common bile duct...

Acute pancreatitis

Acute pancreatitis develops in 5% of all patients with gall stones and is more common in patients with multiple small stones, a wide cystic duct, and a common channel between the common bile duct and pancreatic duct. Small stones passing down the common bile duct and through the papilla may temporarily obstruct the pancreatic duct or allow reflux of duodenal fluid or bile into the pancreatic duct resulting in acute pancreatitis.

Let us do some math here.

20% of people may develop gallstones during their life

15% of people with gallstones may experience obstruction of the common bile duct

How many people may experience obstruction of the common bile duct?

Answer: 3% of total population where 20% have gallstones.

What about USA?

Population of USA: 300 million.
How many people may experience obstruction of the common bile duct during their life?

3% = 9 million people in USA will experience obstruction of the common bile duct with gallstone(s), gallstone(s) that most likely was formed inside gallbladder, and then was expelled, only to be stuck into the common bile duct.

Question: Do all gallstones expelled from gallbladder end-up blocking common bile duct?

Answer: No, only gallstones that have specific size and/or shape.

By it's size and shape, the stone must be small enough or slim enough to pass through the cystic duct and exit gallbladder, but it should be large enough to stuck at the sphincter of oddi, and to block the flow of liquid bile and pancreatic juices into duodenum.

How many gallstones have that specific size and/or shape that would allow it to exit gallbladder, but would not allow it to pass through common bile duct or through the "sphincter of oddi"?

Nobody knows the answer to this question, of course.

But, we could estimate that less then 10% of all stones would qualify. That would be of course just an estimation.

We could estimate that 90% of gallstones (or gallbladder sand and sludge ) that exits gallbladder would not stuck in the common bile duct, and will never be registered. It would become feces.

What does that mean?

It could mean that majority of people with gallstones may have expelled some of their stones (or sand) at one time or another, without ever knowing it happened. Stones pass from bile ducts into intestines ... no pain ... no obstruction ... no symptoms ... no awareness .... nobody knows it happened. But it could be happening every day. That is what nature (evolution) intended for gallstones.

Remember that each stone starts as a microscopic crystal. Who could count the number of microscopic crystals that are existing gallbladder every day?

Why don't all stones pass?

Why don't gallbaldder get those crystals out before they become large enough?

There could be many reasons, like: the lack of phisical activity, poor diet, stress, dehydration, being owerweight, not drinking enough water, infection, illness,  .... hundreds of oissible reasons.

What about USA?

Population of USA: 300 million.

Number of people who will develop gallstones: 20% = 60 million.

If 90% of them expel some smaller gallstones at one time or another during their life, then we have 54 million people who are going to pass or have already passed gallstones, and are not aware of it!!!

Estimation:
54 million of people in USA may expel some smaller gallstones from their gallbladder. 9 million people in USA will experience obstruction of the common bile duct, obstruction caused by a gallstone small enough to exit cystic duct, but too large to exit sphinscter of oddi..

The sphincter of oddi is situated in the upper intestine, or duodenum, at the site where the common bile duct enters intestine. Normally, this sphincter functions as a one-way valve to allow bile and pancreatic secretions to enter the bowel, while preventing the contents of the bowel from backing up into these ducts.

White Shark

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