Gallbladder Disease

Gallbladder, Gallstones, Obesity, Weight Loss, Cholelithiasis, Cholecystitis---All of These Are Related

By Mark J. Holland MD. First Published April 22, 2013

GALLBLADDER (GREEN) AND ASSOCIATED ANATOMY

Gallbladder anatomy

The gallbladder is normally a roughly thumb-sized bag of bile that sits snugly 
against the liver in the upper right abdomen. Bile is actually chemically synthesized in the liver and the gallbladder simply acts as a storage resevoir in order to hold relatively large amounts of bile and to squirt that bile into the upper part of the small intestine when the bile is needed. The function of bile is to act as a kind of human soap that allows fat in a meal to become emulsified so that fat digesting enzymes like pancreatic lipase can chemically break it down. Without bile, a fatty meal would pass largely undigested as a large globule of grease. When a person consumes a fatty meal, that fat triggers the pancreas to produce a blood-hormone called cholecystokinin which in turn causes the muscles in the wall of the gallbladder to begin to contract, squeezing the gallbladder and ejecting bile into the partially digested food in the gut.

Gallstones:

The most common disease of the gallbladder involves the development of "stones" inside the "bag" of the organ. The most common kind of stones are made of cholesterol and they can become quite large, sometimes the size of a golfball. Some people develop gallbladder stones and never have any problems from them, but the majority of people with gallstones will eventually suffer from a gallbladder "attack" which occurs when a stone that is big enough to fit in the bulb of the gallbladder moves into the neck of the gallbladder (usually when the gallbladder is squeezing hard after a fatty meal) and gets stuck there, causing pressure to build behind it and blocking the free flow of bile. The symptoms of a gallbladder "attack" are described below.

Extreme abdominal pain: usually but not always in the right upper abdomen just under the ribs.

Pain Starts Gradually and Builds: Called "crescendo-decrescendo" pain, most gallbladder attacks start off with vague discomfort that slowly worsens, often until a person is doubled over in agony and then slowly fades away.

Pain often (but not always) radiates to the back. People often describe the pain from gallstones as feeling like a knife in the back.

Attacks usually occur after a fatty meal and almost always at night. Dietary fat triggers a hormone called cholecystokinin which causes the gallbladder to begin contracting in order to squirt bile into the gut to help digest fat. Unfortunately, if a person has an inflamed gallbladder filled with stones, this contraction is going to cause terrible pain-the "attack" itself. For some reason, perhaps because people eat more fat at night, many attacks of gallbladder tend to be in the evening. Attacks like this can last from a half-hour to several hours and normally resolves when the gallbladder stops squeezing or when the stone gets pushed all the way out into the gut. It is common that people will gallstones will have repeated attacks.

Risk Factors for Gallstones:

THE SIX "F"s OF GALLSTONE RISK

FEMALE
FERTILE(pre-menopausal)
FORTY
FAT(obesity is a strong risk factor)
FAIR(higher risk in caucasians)
FLATULENT(intestinal gas is common as people with gallstones digest fat poorly allowing it to pass undigested into the colon where bacteria consume it and cause gas)
The fundamental causes of gallbladder stones are not entirely understood, but the disease is felt to start when the gallbladder becomes "lazy" and fails to ever completely empty. Although the mechanisms for stone formation are obscure, the risk factors are not and as every medical student learns, the risks for gallstones include the "four 'F's" (I actually include six here):

Bear in mind that many people with all the risks factors never get gallstones and many people with gallstones do not have all, most or even any of the risk factors. Still, a 43 year-old obese white woman with severe pain in the right upper abdominal quadrant who shows up at the emergency room at 2:30 AM after eating a rich meal earlier is likely going to be scrutinized very closely for evidence of gallstones.

Bear in mind that many people with all the risks factors never get gallstones and many people with gallstones do not have all, most or even any of the risk factors. Still, a 43 year-old obese white woman with severe pain in the right upper abdominal quadrant who shows up at the emergency room at 2:30 AM after eating a rich meal earlier is likely going to be scrutinized very closely for evidence of gallstones.

Weight Loss and Gallstones

Although obesity is a risk for the development of gallstones, weight loss, especially rapid weight loss, can precipitate an actual "attack". This presents a dilemma in treating weight.

Treatment of Gallbladder Disease

Although there are a few drugs that can help slowly dissolve gallstones in some people, the treatment of choice in the United States today is surgical removal of the gallbladder (called "cholecystectomy") which is commonly performed laparascopically leaving a very tiny set of scars on the skin of the abdomen and from which most patients fully recover in several days. Cholecystectomy is 99% effective at curing a patient of gallstones and people generally have few symptoms or problems related to lacking a gallbladder.


Comments