Gallbladder Disease

Normal Gallbladder:

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.

Risk Factors for Gallstones:

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):

Female
Fertile (pre-menopausal)
Forty
Fat (obsity 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)

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:
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.

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

Pain often (but not always) radiates to the back.

Attacks usually occur after a fatty meal and almost always at night.

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.

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