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Stones in the Body

Stones in the Body

Advisory by Marcus Heng, Guardian Pharmacist

Did you know that excruciating back pain, swollen tonsils and nausea could be the symptoms of stones present in the body?Like an oyster, our body has peculiar ways of growing 'pearls' right where they may hurt us most!

Tonsil stones
Tonsils are soft tissue sacs located at the back of the throat. Tonsils play a role in fighting infections by trapping bacteria and other debris. Sometimes, in people with chronic tonsillitis, these materials may calcify and form tonsil stones.

Tonsils are oval-shaped soft tissue sacs located at the back of the throat, with one on each side. Tonsils play a role in preventing and fighting infections by trapping bacteria and other debris passing through the throat (e.g. food, saliva, mucus). Sometimes, in people with chronic tonsillitis, these trapped debris may calcify and form tonsil stones.
Tonsil stones are usually small and harmless; the most annoying symptom is bad breath. Larger stones can be felt during swallowing causing pain, or seen as white debris at the back of the throat. If necessary, gargling, irrigation and hard swallowing can be attempted to dislodge and remove the stones. In more severe cases, surgery to remove the tonsils (tonsillectomy) may have to be performed to prevent recurrence and further infections.

Salivary stones
A salivary gland stone occurs when chemicals inside the saliva, normally calcium, clump together and harden. Most stones form in the submandibular glands at the base of the mouth. The condition rarely affects the parotid gland at the cheeks or the sublingual glands under the tongue. The exact cause is unknown but the use of anticholinergic medicine (e.g. antihistamines, blood pressure medicines) and or dehydration, which slows down saliva secretion, could be a possible risk factors.

Most salivary gland stones are asymptomatic although multiple stones may form. However, if the stones present are too big or a duct is blocked, it can cause painful swallowing or inflammation.

Treatments options for small salivary stones include stimulating saliva flow by sucking on sour candies or lemon, or actual pushing or massaging the stones out of the duct. However, if the stone is not dislodged or the size is too large, surgery (sialendoscopy) may be required to remove the stone.

Gallbladder stones
The gallbladder, located just under the liver, is a small sac that stores bile. Bile aids in fat digestion and is made up of cholesterol, bilirubin pigments and bile salts. Gallstones can be formed if there is an imbalance in these substances or if the bile flow is obstructed. The risk of developing gallstones is higher if you are obese, losing weight rapidly or on a high-calorie diet.

Most people with gallstones do not have symptoms, but if the stones are causing obstruction to the bile ducts , symptoms such as sudden, intense abdominal pain or nausea and vomiting may present. Fever, diarrhoea, greyish stools and jaundice may also occur as a result of prolonged bile duct obstruction. In such cases, medications or surgery may be required to remove the gallstones.


Kidney stones
The Kidneys filter out unwanted waste and minerals from our blood and form urine. Sometimes, this waste can agglomerate and form kidney stones. Kidney stones are rarely detected unless they cause blockages in the kidneys, narrowing the tubes leading to the bladder (ureters) or the bladder itself. Certain diseases can increase the risk of developing kidney stones, such as having a hyperactive parathyroid gland, gout or urinary tract infections. Low fluid intake, high-sodium intake and obesity are also common causes of kidney stone formation.

Kidney stones can cause severe back, abdominal or groin pain. The pain typically comes and goes and the painful area may shift as the stone moves around. Urination can also become frequent, incomplete and accompanied by the presence of blood or pain. Doctors usually use CT-scans to diagnose and locate the kidney stones .Although an ultrasound or X-ray can also be used as a substitute if CT-scans are unavailable or too costly.

Treatment for kidney stones depends on the size, location and the type of stones present. Most small stones (less than 10 mm) can be easily flushed out without surgery. In this case, doctors may ask you to increase the intake of fluids, give you medicines to help pass the stones quickly and with minimal pain or prescribe painkillers to alleviate the discomfort of passing the stones during urination.

As for the larger stones, especially those deep within the kidney, extracorporeal shockwave lithotripsy (ESWL) would be the treatment of choice. ESWL uses sound wave pulses to shatter stones into smaller pieces, which are then passed out via urination more easily.

Alternatively, a procedure called ureteroscopy uses the insertion of a scope via the urethra to loosen and remove stones that are lodged nearer to the bladder or along the ureters. Other surgical options such as nephrolithotomy, where the stones may be removed from the kidneys through an incision from the back, may be utilised if the other alternatives are unsuccessful.

After removal, the stones are often examined in order to determine their mineral composition. About 80% of kidney stones are calcium composites, although struvite, uric acid and cystine stones may occur in certain circumstances. Depending on the type of stone, your healthcare professional may recommend specialised therapies, like low purine diets or urinary alkalizers, to dissolve any remaining stones and prevent future formation of kidney stones.

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