FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

HIGH-TECH GALLBLADDER SURGERY MEANS QUICK RECOVERY

Question: My husband has a gallbladder problem that comes and goes. Can you give me some information about this condition?

Answer: The gallbladder a muscular, sack-like structure that is attached to the liver is an important but not essential part of our digestive system. This organ collects bile as it is slowly produced by the liver. Then, when needed for digestion of certain types of food, it rapidly squirts the bile into the digestive tract just "down-stream" from the stomach in an area called the duodenum.

Bile is made from cholesterol, other lipids, pigments that are the residue of recycled blood cells, and other components. These chemicals aid in the emulsification, digestion, and absorption of foods, particularly fats. The liver is capable of excreting these products into the gallbladder in a concentration so strong that crystals precipitate out of the solution. These crystals are what form gallstones. This gallstone formation process is similar to that used for growing sugar crystal candy, for those of you who have done this with your children.

Gallstones are very common. Somewhere between 10 and 18 percent of U.S. citizens have gallstones by the time of death, but only two percent ever have symptoms. The typical symptoms are discomfort ranging from sharp, knifelike pain to mild discomfort in the upper abdomen or chest. The pain usually begins 30 to 90 minutes after a meal and may radiate to the area of the back between the shoulders. Belching, flatulence and bloating often accompany gallbladder attacks, and these symptoms may also be present without any pain at all.

Gallbladder attacks are usually due to gallstones, although infection, calcification, cancer and other rare abnormalities of the gallbladder can be the cause. Gallstone attacks usually "come and go" just as your husband's do because some meals are easily digested without the benefit of bile.

The typical "gallbladder attack" occurs when the gallbladder contracts in response to a meal with fats, cabbage, onions, raw apples or other foods that need bile for digestion. The contraction forces a stone into the narrow duct connecting the gallbladder with the duodenum either partially or totally blocking it. The attack subsides when the stone passes on through into the duodenum or is pushed out from in front of the duct so that it is no longer blocked.

Now for the really important information: What should your husband do now that he is having gallbladder attacks? Since he is already in that small portion of the population who has stones and also has symptoms, he should consider seeing a surgeon about having his gallbladder removed. Following a "gallbladder" diet will reduce the amount of discomfort he has, but it doesn't change the 50 percent chance of having a serious complication that would make emergency surgery necessary.

Cholecystectomy, the doctor and insurance company term for removal of the gallbladder, is typically done today using the "high-tech" laparoscopic method. Patients who have this type of surgery are usually out of the hospital the next day, after an overnight stay, and have a quick and total recovery.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.