FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER’S THEORY ABOUT HER GALLBLADDER PAIN INTERESTING

Question: After 5 days of unremitting discomfort, punctuated by bouts of intense pain, I was hospitalized and tests showed my cystic duct was blocked. When my gallbladder was removed, though, it appeared to be healthy.  I wonder if I had stones that might have passed, but damaged the duct and caused blockage.  The surgeon wouldn’t speculate.  I’ve read that there is also something called a colicky gallbladder and also that the liquid in the bladder can thicken into a “sludge” that won’t pass. Can you tell me more about gallbladder problems?

Answer: While I cannot tell you specifically what caused your blockage, I do find your theory well thought out. But, before we look at that in more detail, let’s first have a brief anatomy lesson and look at some of the common causes of this type of obstruction.

The gallbladder is a small, pear-shaped reservoir attached to the underside of the liver. The gallbladder stores and concentrates the liquid you referred to in your question, which is called bile. It is produced by the liver and released into a portion of the small intestine called the duodenum. Bile, released after a meal containing fats, aids in absorption and digestion of the fat.

Bile duct blockage, a condition doctors call biliary obstruction, can occur anywhere along ductwork that carries the bile from the liver to the gallbladder to the small intestine. When one of these ducts is obstructed, the bile backs up into the liver and that causes jaundice. In this condition, the skin and eyes turn yellow, because a pigment known a bilirubin accumulates in the blood.

Several problems can cause the bile ducts to become obstructed. Gallstones are the primary cause of obstruction. If a person with gallstones passes a gallstone that is too large to fit through a bile duct, it gets caught and obstructs the duct. Trauma can occur to the bile duct from an auto accident or upper abdominal trauma, such as a severe fall. The bile ducts can have cysts in them that can narrow the passageways and cause obstruction. Tumors of any part of the digestive system, including the pancreas, can lead to blockage.

Pancreatitis, pancreatic cancer, gallstones, and abdominal trauma are all risk factors for developing a bile duct obstruction. Any blockage of a bile duct can cause what you called “gallbladder colic,” which is really colic of the duct.

I didn’t find anything that directly supports your interesting theory about a delayed reaction from stones that had already passed. But, it is possible for people to have “silent” gallstones, ones that cause no symptoms, which can also pass without notice. This could cause inflammation of the ducts, and inflammation is a cause of biliary obstruction.

Finally, let me answer your question about gallbladder sludge. This highly descriptive term refers to an increased viscosity in the bile due to crystallization but without stone formation. Sludge may eventually lead to the formation of stones in some cases. In one study, in 71 percent of cases sludge resolved on its own, in 9 percent it became stones, and in 7 percent of cases it developed into a serious condition called acalculous cholecystitis.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.