Article
Symptoms of Gallbladder disease
By Michael Murphy on April 10th, 2008(viewed 6112 times).






Symptoms of Gallbladder disease Anatomy of the upper abdomen WHAT ARE THE SYMPTOMS OF GALLSTONES AND Gallbladder DISEASE? Take a Gallbladder Test What is the Gallbladder? The Gallbladder is a structure on the underside of the liver on the right side of the abdomen. The function of the Gallbladder is to store bile that is produced in the liver before the bile is secreted into the intestines. Bile secreted into the intestines helps the body digest fats. Symptoms of a Gallbladder  attack usually starts with steady, gnawing pain in the upper right abdomen that progresses until the pain is quite severe and accompanied by nausea and vomiting. The pain may sometimes be referred to (felt in) the right shoulder or between the shoulder blades, and may last for several hours. The immediate symptoms of an irritated Gallbladder often resembles a heart attack or angina ? many times this is first diagnosed in the emergency department. The frequency of attacks varies among individuals, sometimes once a month, sometimes once a year. Most can expect that once they ve experienced one attack, they are more likely than not to have another at some point. What are gallstones? Bile is composed of three major components: cholesterol, bile salts, and bilirubin. When the Gallbladder is not functioning properly, the components of the bile become out of balance leading to the formation of solid crystals. The majority of stones (80%) are composed of cholesterol, the remainder are pigmented stones consisting of bilirubin. Stones can be large or small, single or multiple. These factors do not necessarily predict the frequency of symptoms or the severity of the disease. In many cases Gallbladder symptoms are caused by the dysfunctional Gallbladder that is forming stones rather than the stones themselves. The exception to this is when stones block off the cystic or common bile duct. What are the symptoms of Gallbladder disease? Asymptomatic cholelithiasis - The great majority of patients with gallstones have no symptoms at all. Stones in these patients are found incidentally during medical tests for other conditions. Biliary Colic - For patients who do have symptoms, Gallbladder symptoms can be variable. Classic Gallbladder attacks consist of right upper quadrant abdominal pain which is pain just under the rib cage on the right side.) The pain often radiates around the abdomen to the back and is associated with nausea and sometimes vomiting. The pain is severe and lasts from 30 minutes to several hours. Often this is followed by less intense soreness in the area that lasts for a day or so. Attacks are often instigated by a fatty meal. Gallbladder disease can also cause chronic nausea. Cholecystitis - A more serious form of Gallbladder disease, cholecystitis is an infection or inflammation of the Gallbladder often caused by obstruction of the cystic duct. The symptoms are similar to biliary colic but more prolonged. Patients can also have fever, chills and an elevated white blood cell count. Choledocholithiasis (common bile duct stones) - Stones can drop out of the Gallbladder into the common bile duct. These stones often pass into the intestines without incident. Sometimes they can cause obstructions in the bile duct leading to jaundice and life threatening infections of the bile ducts. Biliary pancreatitis - When stones pass by the pancreatic duct the pancreas can be irritated leading to this potentially serious condition. Symptoms usually consist of mid-abdominal pain radiating to the back with nausea and vomiting. How are Gallbladder problems diagnosed? Some tests used to evaluate the above conditions include:        Lab tests to check for jaundice and signs of liver inflammation        Blood Amylase level to check for pancreatic inflammation        Ultrasound: Uses sound waves to image the intra-abdominal organs including the Gallbladder        CT scan: Computer constructed x-ray images of the abdominal organs        Heida scan: Uses a low level radioactive tracer that is taken up by the Gallbladder to measure Gallbladder function.        MRCP: A type of MRI scan that visualizes the common bile duct to check for bile duct obstruction.        ERCP: A test where a scope is passed via the mouth into the common bile duct allowing dye to be injected into the common bile duct. X-ray pictures are then taken. This test gives the most accurate assessment of the common bile duct. It also is sometimes required to extract stones from the common bile duct. How are Gallbladder problems treated? In most situations Gallbladder problems require surgical treatment. Since gallstones are often just a sign of the problem, treatment is directed towards the Gallbladder rather than the gallstones. The treatment involves removing the Gallbladder. This is done in most cases using laparoscopic surgery. Non-surgical treatments such as dissolution therapy and lithotripsy have a poor success rate and a high recurrence rate so are used only in very limited circumstances. What Are Gallstones and Gallbladder Disease What Are the Symptoms of Gallstones and Gallbladder Disease? What Other Diseases Produce Symptoms Similar to Gallstones and Gallbladder Disease? How Serious Are Gallstones and Gallbladder Disease? Who Gets Gallstones and Gallbladder Disease? How Can Gallstones and Gallbladder Disease Be Prevented? How Are Gallstones and Gallbladder Disease Diagnosed? What Are the Treatments for Gallstones and Gallbladder Disease? What Are Gallstones and Gallbladder Disease? Gallstones are formed from bile, a fluid composed mostly of water, bile salts, lecithin, and cholesterol. Bile is first produced by the liver and then secreted through tiny channels within the liver into a duct. From here, bile passes through a larger tube called the common duct, which leads to the small intestine. Then, except for a small amount that drains directly into the small intestine, bile flows into the gall bladder through the cystic duct. The Gallbladder is a four-inch sac with a muscular wall that is located under the liver. Here, most of the fluid (about two to five cups a day) is removed, leaving a few tablespoons of concentrated bile. The Gallbladder serves as a reservoir until bile is needed in the small intestine for digestion of fat. When food enters the small intestine, a hormone called cholecystokinin is released, signaling the Gallbladder to contract. The force of the contraction propels the bile back through the common bile duct and then into the small intestine, where it emulsifies fatty molecules so that fat and the fat-absorbable vitamins A, D, E, and K can enter the blood stream through the intestinal lining. About three-quarters of the gallstones found in the U.S. population are formed from cholesterol. Cholesterol makes up only five percent of bile; it is not very soluble, however, so in order to remain suspended in fluid, it must be properly balanced with bile salts. If the liver secretes too much cholesterol into the bile, if the bile becomes stagnant because of a defect in the mechanisms that cause the Gallbladder to empty, or if other factors are present, supersaturation can occur. Cholesterol may then precipitate out of the bile solution to form gallstones -- a condition known as cholelithiasis. The process is very slow and most often painless. Gallstones can range from a few millimeters to several centimeters in diameter. The other 25% of gallstones are known as pigment gallstones. They are composed of calcium bilirubinate, or calcified bilirubin, the substance formed by the breakdown of hemoglobin in the blood. These black stones often form in the Gallbladders of people with sickle cell anemia, hemolytic anemia, or cirrhosis. At any point, stones may obstruct the cystic duct, which leads from the Gallbladder to the common bile duct, and cause pain (biliary colic) or infection and inflammation (cholecystitis. About 10% of people with stones in the gall bladder also have stones in the common bile duct (choledocholithiasis), which can lodge in the duct and cause blockage of the bile duct, infection, or inflammation of the pancreas (pancreatitis). Return to top of article What Are the Symptoms of Gallstones and Gallbladder Disease? About 80% of people with gallstones never experience any symptoms. If symptoms do occur, the chance of developing pain is about 2% per year for the first ten years after stone formation, after which the chance for developing symptoms decreases.  Pain is usually the first symptom, but some patients develop other problems from the outset. Biliary Pain The mildest and most common symptom of Gallbladder disease is intermittent pain called biliary colic, which occurs either in the middle or the upper-right portion of the upper abdomen. The pain often is also felt in the back, between the shoulder blades, as well.  Large or fatty meals can precipitate the pain, but it usually occurs about one hour or more after eating, often at night. Biliary colic produces a steady pain, which can be quite severe and may be accompanied by nausea and vomiting. Changes in position, over-the-counter pain relievers, and passage of gas do not relieve the symptoms. Biliary colic usually disappears after several hours. Acute Cholecystitis Acute Gallbladder inflammation (acute cholecystitis) is a more serious problem than biliary colic. It begins abruptly and subsides gradually. Nausea, vomiting, and severe pain and tenderness in the upper right abdomen are the most common complaints; fever is common 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 taking a breath. Acute cholecystitis is usually caused by gallstones, but, in some cases, can occur without stones Eat a healthy diet. A diet that is low in fat, low in cholesterol, low in sugar, and high in fiber will help prevent Gallbladder disease. Fat, cholesterol, and sugar all contribute to Gallbladder disease. Slow intestinal transit can be prevented by increasing fiber in the diet. And eat more vegetables! A British study showed that vegetarians have a lower incidence of Gallbladder disease. Gallbladder Disease by Ronald Hoffman, M.D. Conscious Choice, January 1999 Gallbladder disease is a modern illness. An estimated twenty million Americans have Gallbladder disease. The sole function of the Gallbladder is to store bile, which is produced in the liver and aids in the digestion of fats in the small intestine. The Gallbladder has become a prime target for surgical intervention; in fact, this is the most common type of major surgery. Sometimes it's done to reduce pain, sometimes to remove gallstones. It's especially common among women who are receiving estrogen replacement therapy, since estrogen stimu]ates the production of gallstones. (Accordingly, women with gallstone problems are probably not good candidates for oral estrogen replacement; they might do better with a transdermal estrogen patch.) This is a degenerative disease that's clearly related to diet. A study performed at the University Hospital of Riyadh, Saudi Arabia, found that the incidence of Gallbladder surgery went up by 600 percent in that country as the people shifted from a simpler, nomadic existence, eating traditional foods, to a more sedentary lifestyle "enriched" by all the sugary, fat-laden foods of the developed world. In Gallbladder disease, bile in the Gallbladder becomes concentrated and thickens. Gallstones are born out of this sludge from cholesterol and bile salts. The end result of the disease process is inflammation (cholecystitis) or stones (cholelithiasis). A Gallbladder attack occurs when the gallstone blocks the flow of bile from the Gallbladder and is manifested as a pain in the right side (sometimes perceived in the right shoulder because of referred pain) as severe as the excruciating pain of a heart attack. Some factors that contribute to the development of Gallbladder disease are: ~ Heredity. Gallstones occur slightly more frequently in Mexican Americans and Native Americans but are also common in people of northern European stock. ~ Age. Gallbladder disease often strikes people over sixty years of age. ~ Gender. In medical school, the "five F's" help doctors to remember the usual patient with Gallbladder disease: "fair, fat, forty, fertile, and female." Sexist as it sounds, it describes the group most frequently affected by Gallbladder disease: overweight middle-aged white women with a history of several pregnancies. Excess estrogen may be implicated, since hormone replacement after menopause increases the likelihood of stones. ~ Diet. The propensity of Western diet to predispose one to Gallbladder disease was commemorated by journalists during the Persian Gulf War -- the prevalence of Gallbladder disease among Saudis had gone up 600 percent since the 1940s, when they began "enjoying" more and more Western foods! Most people know that there is an established link between fat intake and Gallbladder disease, but many don't realize that there is also a significant correlation with high sugar intake as well. ~ Obesity. In comparison with people of normal weight, the bile of obese people is supersaturated with cholesterol, predisposing them to the development of Gallbladder illness. ~ Slow intestinal transit. Medical professionals have long known that constipation is common in patients who have Gallbladder disease. Studies confirm that slow intestinal transit contributes to the formation of gallstones in women of normal weight. Having gallstones doesn't mean that one should rush right out, consult a surgeon, and schedule major surgery. You can live with gallstones and be symptom free. Physicians have noticed that certain foods can initiate a Gallbladder attack in patients who have gallstones. When these foods were eliminated from their diet, their Gallbladder symptoms disappeared. In explanation, it is thought there might be a food allergy mechanism at work, wherein the Gallbladder responds to the allergy-producing food with symptoms of a Gallbladder attack. The most frequently offending foods are eggs, pork, onions, poultry, milk, coffee, oranges, corn, beans, and nuts. Rose, a sixty-one-year-old woman from Virginia, came into my office for Gallbladder complaints. She had been advised to have surgery, but her daughter encouraged her to get a second opinion. I determined that she was not in any immediate danger and gave her a modified version of the "Gallbladder disease elimination diet" by Dr. James Breneman. (This is not a "do-it-yourself" diet but should be monitored by a physician.) This diet eliminates the most commonly offending foods outlined above. Besides having Rose increase the fiber in her diet, I also gave her lecithin and certain herbs, like artichoke and dandelion, that help drain bile from the Gallbladder. For several weeks, Rose was symptom free, except on one occasion when she slipped from her diet. This was a gradual, gentle diet plan -- crash diets can actually precipitate gallstones. Still on the diet after three months, she had lost twelve pounds, had a 65 point reduction in her cholesterol level, was symptom free, and felt great. Fifteen years later, she still hasn't required surgery, even though surgical methods are simpler now and are prescribed more often. With the advent of laser laparoscopy surgery in this country, it's much easier to take Gallbladders out. As a result, the surgery rates for this disease have almost doubled. Does it make sense to perfonn so much more surgery merely because its easier? To some extent, yes, because it's not as perilous as before and doesn't require such a long hospital stay. But this new technique has made the Gallbladder an easier and more tempting target for surgeons, and it has made people less reluctant to undergo surgery that may not be entirely necessary. A reaction is setting in, however, as more doctors realize that most painful Gallbladders can be left alone once they're mostly quiescent, with just the occasional painful attack. In fact, the pain can generally be reduced by dietary measures: lowering fat and sugar intake or avoiding problem foods like eggs, poultry, or pork. The presence of gallstones in itself doesn't seem to warrant surgery -- the new belief is that you can happily take them to your grave. There are some exceptions: people with diabetes in particular may be well advised to have the surgery. Since they sometimes have nerve difficulties and don't get clear-cut pain signals, they run the risk of complications from silent or unperceived Gallbladder attacks, and might wind up with a ruptured Gallbladder. Surgeons are aware of this, and they operate decisively in these cases. I've seen many people, however, who suffered from Gallbladder pain, had the operation, and then suffered from a postoperative syndrome: the stones were out but they still had pain. And that's pretty aggravating, because their doctor suggested that the stones were the source of the pain. In some cases, the Gallbladder is removed only to reveal that it wasn't the source of the pain, that there was some other somatic cause unrelated to whatever stones or sludge might have appeared in the Gallbladder. So if your Gallbladder is really shot and if you're having pain all the time, have it out. But most people can pretty well poke along with an asymptomatic Gallbladder. Sporadic Gallbladder attacks that respond to diet changes, and the presence of gallstones identified by sonogram, are not in themselves an indication for surgery. The pain can be brought under control with dietary modification, and the presence of the stones by itself doesn't mean you need to have them taken out. But this is how it's presented to people. Surgeons will show you a sonogram of a Gallbladder laden with stones as a selling point to get you on board for the surgery. It can be hard to resist this kind of pitch from a medical expert, but unfortunately this represents a situation that patients often find themselves in. If needed, there are several surgical methods of treatment available as well as medical treatments for Gallbladder disease. They include: ~ Laser laparoscopic cholecystectomy. No longer do patients have to suffer the agony of long incision lines just below the rib cage, making postoperative recovery difficult. Surgeons are removing Gallbladders using lasers and a fiberoptic laparoscope (a flexible fiberoptic tube). But if you opt for this surgery, beware! This type of "key-hole surgery" takes considerable skill on the part of the surgeon. A few ullfortunate deaths have been related to lack of proper training and experience in this delicate procedure; complication rates have actually increased since its introduction. Make sure you ask the surgeon where he or she received training in the procedure and how many he or she has performed. Some states impose regulations regarding the training and practice of physicians performing this operation. Though press and publicity for these surgical procedures tout one-day hospital stays, the actual stay is generally three to three and a half days. In some cases there's a need to revert to the older procedure after the laser procedure is attempted. ~ Small-incision cholecystectomy. This is an alternative to the laser procedure. It's a variation of the traditional Gallbladder operation but with a much smaller incision, averaging two to three inches instead of the much larger standard incision. The operation is shorter than the laser procedure, the hospital release time is the same, and the rate of need for reversion to the older surgery is the same. The more sophisticated procedures may not be an improvement. ~ Medication. Actigall, or ursodeoxycholic acid, is taken orally to dissolve stones made of cholesterol. It takes one to two years for complete dissolution of stones. Only sufficiently small stones of a certain type are treatable with this drug. Unfortunately, many people think they can eat fats with impunity after surgery. In reality, Gallbladder disease is a warning sign that your dietary excess is hurting you! People who suffer from Gallbladder disease often have other concurrent metabolic disorders, like a predisposition to cardiovascular disease and diabetes. Prevention of Gallbladder disease is still the best approach. Here are some things you can do to decrease your risk: ~ Lose excess weight. But don't crash diet! Rapid weight loss contributes to the formation of gallstones. ~ Eat a healthy diet. A diet that is low in fat, low in cholesterol, low in sugar, and high in fiber will help prevent Gallbladder disease. Fat, cholesterol, and sugar all contribute to Gallbladder disease. Slow intestinal transit can be prevented by increasing fiber in the diet. And eat more vegetables! A British study showed that vegetarians have a lower incidence of Gallbladder disease. ~ Avoid food triggers. As mentioned before, there's a correlation between Gallbladder attack symptoms and certain foods in people who are sensitive to them. Be on the lookout for food triggers. ~ Take fish oil and nutrients. Omega-3 oil, found in fish, may block cholesterol formation in bile. People with a tendency toward gallstones can take a higher dose than normal: four to six 1000-milligram capsules of fish oil a day. Lecithin has an emulsifying effect on bile, and taurine, an amino acid, binds to bile salts and accelerates their elimination. Dr. Ronald Hoffman is Medical Director of the Hoffman Center in New York City and host of Health Talk, a syndicated radio program heard weeknights in New York on WOR (710 AM) from 9:00 to 10:00 pm, Saturdays noon to 2:00 pm. He is author of several books, including Intelligent Medicine (Fireside, 1997). Dr. Hoffman's website contains useful health information

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