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Gallbladder Stones:

Article Context:

Gallstone Disease:

The gallbladder is located under the surface of the liver, bound by vessels, connective tissue, and lymphatics. It has four regions: the fundus, body, infundibulum, and the neck. The gallbladder terminates in the cystic duct and then enters the extrahepatic biliary tree. The fundus is the round, blind edge of the organ. It is composed of fibrotic tissue and projects just beyond the right lobe of the liver. The fundus leads to the body of the gallbladder, the largest part.

The superior surface of the body is attached to the visceral surface of the liver, unless a mesentery is present. This close relationship allows for the direct spread of inflammation, infection, or neoplasia into the liver parenchyma.

The infundibulum is the tapering area of the gallbladder between the body and neck. This portion and the free surface of the body of the gallbladder lies close to the first and second portions of the duodenum, and in close proximity to the hepatic flexure and right third of the transverse colon. The infundibulum is attached to the right transverse colon surface of the second part of the duodenum by the cholecystoduodenal ligament.

The neck of the gallbladder is 5 to 7 mm in diameter and often forms an S-shaped curve. It is superior and to the left, narrowing into a constriction at the junction with the cystic duct.

gallstones
Fig1. – Gallstones

Symptoms of Gallstones:

The following are the most common symptoms of gallstones:

  • Pain or tenderness under the rib cage on the right side
  • Pain between shoulder blades
  • Stools light or chalky colored
  • Fatty stools
  • Indigestion after eating, especially the fatty foods
  • Burping or belching
  • Feeling of fullness or food not digesting
  • Nausea
  • Dizziness
  • Diarrhea
  • Bloating
  • Gas
  • Vomiting
  • Constipation or frequent use of laxatives
  • Headache over eyes, especially right
  • Bitter fluid comes up after eating
Gallbladder
Fig2. – Gallbladder

Causes of Gallstone Disease:

The following are the most common causes of gallstone disease:

Age:

The incidence of gallstone disease increases with age. Symptomatic calculous disease of the biliary tract is rare before the age of 20, and when found in this group, is commonly among patients with chronic predisposing conditions such as cystic fibrosis or hemolytic anemia.

Drugs:

Many drugs have been implicated in gallstone disease. The most common offenders include ceftriaxone, clofibrate, oral contraceptives, estrogen replacement, progestogens, and octreotide. Some drugs are secreted into bile and may complex, precipitate, and form stones. Other compounds can produce gallbladder stasis with concomitant increases in cholesterol secretion into bile.

Gender:

The prevalence of gallstones is higher in women than men. Studies have shown that gallstone disease is common in young women but rare in young men. However, the difference narrows with increasing age. It is presumed that the reason for this gender difference is hormonal. Serum estrogen increases (especially during pregnancy) promotes biliary cholesterol saturation and increased progesterone may lead to inhibition of the contraction of the gallbladder.

Geography and Ethnicity:

The Pima Indians of Arizona have the highest prevalence of gallstones worldwide. Ninety percent of Pima women over the age of 65 have gallstone disease. The Micmac Indians of Canada, Hispanics, and Mexican American women also have a higher prevalence of gallstone disease, as do both men and women in Norway and Chile. The risk appears to be lower in blacks. No genes have been identified in humans that are conclusively linked to gallstone development.

Obesity:

Obesity is a significant risk factor for gallstone disease, especially in women. Studies have demonstrated that overweight women with a body mass index (BMI) greater than or equal to 30 kg/m2 have double the risk of gallstone disease when compared with normal weight women with less than 25 kg/m2. Cholesterol hypersecretion(associated with obesity) is a major pathogenic factor. Gallstone disease has also been associated with the regional distribution of fat. High central or truncal adiposity has been positively correlated with risk of gallstone disease. Physical activity and diet have been studied independently as risk factors for gallstone disease. Increased vigorous physical activity and recreational activity appear to reduce gallstone disease risk.

Weight Loss:

An increased risk of gallstone disease may be found among individuals who undergo rapid weight loss on very low calorie diets. Gallstone formation is one of the most significant complications of voluntary weight loss plans. In these instances, cholesterol is activated from adipose tissue and secreted into the bile. This leads to cholesterol supersaturation and diminishes gallbladder contraction, producing stasis. Studies have shown that individuals on weight loss plans, either dramatically reduced calorie diets or surgical weight-loss procedures, have a higher incidence of development of gallstone disease when compared to those who are not dieting. Weight fluctuation may also be a risk factor.

Diagnosis of Gallstone Disease:

The physical exam in patients with gallstone-related symptoms can often be completely normal. However, sometimes a gallbladder can be palpated and there may be right subcostal tenderness with inspiratory arrest (Murphy’s sign), which is suggestive of acute cholecystitis.

There are several diagnostic tests available to detect stones.

Ultrasound:

An ultrasound test which is also known as ultrasonography, uses the sound waves to detect the gallstones in the gallbladder. Generally to detect the gallstones, pulses of sound waves are sent into the abdomen to create an image of the gallbladder.

If gallstones are present, the sound waves will bounce off the stones, revealing their location in the gallbladder.

Ultrasonography is a noninvasive technique, which means nothing is injected into the body or penetrates the body. In addition, ultrasound is painless and eliminates the exposure to the radiation from X-rays.

X-rays:

There are three different tests that use X-rays to examine the gallbladder, which are as follows:

Oral Cholecystography:

Oral Cholecystography is commonly used to detect the gallstones in the gallbladder. The procedure requires a patient to swallow pills containing a dye the night before X-rays are taken.

This dye is absorbed into the bile and outlines on Z-ray film the gallbladder and any stones that may be present. Oral Cholecystography is now rarely performed because it has been largely replaced by ultrasound of the gallbladder.

Risks of Oral Cholecystography include the cellular damage from radiation exposure from X-rays. Also, this procedure should not be used for patients who have severe kidney or liver damage.

PTC (Percutaneous Transhepatic Cholangiography)

In PTC the dye is injected through a very thin tube which is called as catheter. The injected dye outlines the network of bile ducts when an X-ray picture of the abdomen is taken and thus can detect stones lodged in the bile ducts.

Complications of the dye include leaking from the liver into the abdomen and also increased risk of bleeding or puncture of the vessels with catheter.

ERCP (Endoscopic Retrograde Cholangiopancreatography)

ERCP is an invasive procedure which will involve the use of an endoscope. Endoscope is actually a long, flexible tube through which a doctor can directly view the digestive tract.

Treatments for Gallstones:

Patients who are suffering with gallstones should get that treated to avoid any emergency conditions.

Natural treatment for gallstones:

  • Maintain a Healthy Body Weight
  • Avoid Rapid Weight Loss and Fad Diets
  • Follow an Anti-Inflammatory Diet that Supports Liver and Gallbladder Health
  • Be More Active
  • Reconsider Taking Birth Control Pills or Unnecessary Medications

Surgical treatment for gallstones:

Gallstones will not go away on their own. Doctor may suggest to remove gallbladder if the gallstones start to cause other symptoms. This type of surgery is called a cholecystectomy. It’s one of the most common surgeries doctors perform. About 80% of people who have gallstones will need surgery.

Types of Gallbladder Surgery:

Doctors can remove your gallbladder in one of two ways:

surgical procedure for gallstones
Fig3. – Surgical Procedure for Gallstones
Open surgery:

During open surgery, the surgeon will make a 5 to 7 inch incision on belly to take out the gallbladder. Patient need’s the open surgery if patient has a bleeding disorder. Patient may also need this surgery if they have severe gallbladder disease. Patient is overweight, or are in your last trimester of pregnancy.

Laparoscopic cholecystectomy:

Generally this surgical procedure is also called as keyhole surgery. This means the surgeon will make few very tiny hole to perform the surgery (size of a keyhole). He makes four small cuts. He inserts a very thin, flexible tube that contains a light and a tiny video camera into the belly. These help the surgeon see the gallbladder better. Next, he will insert special tools to remove the diseased organ.

Risk Factors for Developing Gallstones:

There are several factors that make people more susceptible to developing gallstones, including their diet, age, gender, body composition and genetics.

Gallstones are most common in:

  • Women
  • Over 40 year people
  • Overweight or obese people
common gallstones
Fig4. – Common Gallstones

Other risk factors for gallstones include:

  • Eating a poor diet
  • Losing weight too quickly (for example, fasting and going long periods without eating)
  • Pregnancy
  • High triglycerides
  • Diabetes
  • Lack of physical activity
  • Family history of gallstones
  • Low HDL (good) cholesterol
risk factors of gallstones
Fig5. – Risk Factors of Gallstones

Diet for Gallbladder:

S. No

Foods to be taken

Foods to be avoided

1

Low fat food

Foods that are fried, like french fries and potato chips

2

High fibre foods like brown rice and wholemeal bread can help to make stools more firm

High-fat meats, such as bacon, bologna, sausage, ground beef, and ribs

3

Fruits, vegetables and whole grains

High-fat dairy products, such as cheese, ice cream, cream, whole milk, and sour cream

4

Caffeine free drinks

Pizza

5

Low sugar foods and drinks

Foods made with lard or butter

6

Foods which are less spicy

Creamy soups or sauces

7

Avocados – a good way to get needed fats directly from food

Meat gravies

8

Garlic helps with liver cleansing but not processed types like flakes or powder. Some people have difficulty with it but is usually ok and even helpful. Just pay attention to your own body with this one.

Chocolate

9

Omega 3 oils like flax or hemp. Use these with fresh lemon juice or vinegar on your salads. DO NOT COOK flax oil.

Oils such as palm and coconut oil

10

Grapes, apples, berries, papaya, pears, pomegranates, watermelon and fresh organic grape juice

Skin of chicken or turkey

Symptoms After Gallbladder Removal:

  • Attacks
  • Mild pain
  • Gas and bloating, distension
  • Burping, belching
  • Feelings of fullness
  • Heartburn, often worse
  • Acid and bile reflux
  • Constipation
  • Diarrhea
  • Dumping syndrome
  • Weight gain

Frequently Asked Questions:

  1. Can I function without a gallbladder?
  2. Can I have any fats since my gallbladder was removed?
  3. Is gallbladder health hereditary?
  4. Why is it common in women?
  5. What age is it most likely affected?
  6. What is the recovery time?
  7. If a doctor suspects a gallstone how is it diagnosed?
  8. Is it ever life threatening having a gallstone?

Can I function without a gallbladder?

Yes you can. The bile will still be produced in the liver and find its way to the small intestine. It will continue to break down the dietary fats and to remove toxins from the liver. What is different is that the bile will no longer be as concentrated (the gallbladder removes 90% of the water from the bile) and its function as a regulator will be gone. Some people have no problem with this at all; others have problems with getting the right amount of bile at the right time, either too much or too little.

Can I have any fats since my gallbladder was removed?

You cannot live without fats. Every cell membrane in your body is made with fat. Fats feed the brain, and many hormones are made with fat. What is important is what kind of fats you are eating. Avoid fried foods, hydrogenated and partially hydrogenated fats, and refined oils.

Instead of these, try to use unrefined virgin olive oil, or flax oil in your food. Avoid cheese and dairy in general. Unless your gallbladder was defective in some way, the reason you had it removed is more related to your eating habits, or the state of your liver. Your diet should be the same whether you have had your gallbladder removed or not. It is very important to maintain a diet that helps your liver to digest fats properly and that helps the liver to do its job of filtering toxins. It is also important to give it the tools it needs in order to do its job, i.e. real nutrients, and to avoid piling up its workload by eating highly processed food, preservatives, bad fats and other toxic foods.

Avoid eating at fast food restaurants, and ask about oils used even at good restaurants.

Is gallbladder health hereditary?

Current thought believes gallbladder health to be hereditary, yet it is equally important to acknowledge the role of inherited dietary habits in the functioning of the gallbladder.

Why is it common in women?

Women are twice as likely as men to develop gallstones, especially in ladies who have had children.  The main reason is the female hormone, oestrogen. Excess oestrogen from pregnancy, hormone replacement therapy, and birth control pills can potentially increase cholesterol levels in bile and decrease gallbladder movement, which then lead to gallstones.

What age is it most likely affected?

Besides people who are obese and females, especially those who have had children, those who are forty (40) or older also have an increased risk of gallstones.

What is the recovery time?

Post laparoscopic removal of the gallbladder, most patients usually stay for one night. Most of them can return to work within a week. They can also resume most of their social activities in a week’s time.

If a doctor suspects a gallstone how is it diagnosed?

The best test to diagnose gallstones is the ultrasound. It is non-invasive and has no radiation risk. We have other methods also to diagnose gallstones, please refer to “Diagnosis of Gallstone Disease

Is it ever life threatening having a gallstone?

Yes, but it a very rare to have emergency complications. The gallstone may block up the duct of the gallbladder and cause the gallbladder infection, also known as acute cholecystitis. A severe form of infection may lead to gangrene of the gallbladder. Sometimes the gallstone may slip into the common bile duct and cause obstruction of the bile duct which causes jaundice. If the obstructed ducts get infected, also called cholangitis, this may lead to death.

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