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

LIFE WITHOUT A GALLBLADDER PROVIDES REMINDERS TO "EAT HEALTHY"

Question: What does the gallbladder do, and what problems should I expect if I must have mine removed?

Answer: I'll describe the gallbladder's location and role in good health first. The gallbladder is a muscular, sack-like structure attached to the liver, which is located in the right upper part of the abdomen under the lower ribs on that side. Confused? You thought the lungs were the organs protected by the ribs, didn't you? Well, they are. However, the ribs also form a bony cage that protects the liver. The diaphragm separates the lungs, which are in the chest, from the liver, which is in the abdomen. The liver is one of the most important organs of the body. It is a veritable chemical factory that converts the foods and medicines we consume into substances the body can use. The liver also recycles various by-products of the body's chemical reactions into other useable compounds or waste products. It is in this role as a recycling center that the liver produces the substance called bile. Bile is made from cholesterol, certain fat-like substances, pigments that are the residue of recycled blood cells, and other components. The liver produces bile rather slowly, and then stores it within the gallbladder.

Bile is used in the emulsification, digestion and absorption of foods, particularly fats. The gallbladder collects bile as the liver produces it. Then, when it is called for to help digest that burger and fries you had for lunch, it is "squirted" into the digestive tract at a point just "downstream" from the stomach in an area called the duodenum. Typically this addition of bile begins about 30 minutes after eating a high-fat meal. At times the bile can become so concentrated that stones form within it, thereby creating gallstones. You might be surprised to learn that 80 percent of the population ultimately develops these stones. Most of us, however, are fortunate and our gallstones never cause any problems. On the other hand, about 500,000 people each year do have sufficient pain that they must have their gallbladders removed.

You shouldn't panic if your doctor recommends that you join this large group of "gallbladder-less" individuals. The immediate risks of surgery are relatively small, and I'm sure that he or she will explain these to you and your family. The long-term consequences, fortunately, are also rather small. The liver continues to make bile, just as you would assume. However, now it continually drips the bile into the duodenum instead of being stored in the gallbladder until a high-fat meal is eaten. Eating a high-fat meal after having the gallbladder removed can overwhelm the amount of bile that is available to assist in its digestion. Consequently, a stomachache and or diarrhea ensues. These complications are significantly less frequent and less intense than the discomfort that made it necessary to have the surgery in the first place.

My patients who have had their gallbladders removed rarely complain about their decision. The amount of discomfort associated with eating a high-fat meal is minimal and usually is viewed simply as a reminder to eat a healthy diet rather than an infringement upon their lifestyles.

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. Past columns are available online at http://www.FamilyMedicineNews.org.