What do you know about your Gall Bladder?

Written by Dr Harold Gunatillake-FRCS, FIACS, FISC, AM(Sing), MB,BS

A few decades back gall bladder disease was common, we used to say, among the-“Fat, forty, fertile females”. That was true when I was a medical student, when most fat ladies getting hospitalized for upper abdominal colicky pains and the first suspicion was GB disease. Today, the scenario has changed due to the more prevalence of obesity, metabolic syndromes, diabetes and fatty diets and all age groups in both sexes are shared, including young adults. It is rare in children.

Your gall bladder is a pear shaped squeezable bag that holds bile secreted by the liver, and is situated on the right side of the upper belly hidden under the right lobe of the liver with a visible tip projecting beyond the lower margin of the liver. This slight exposure is very important to diagnose clinically gall bladder inflammation, when the doctor feels for this organ, you feel tender as the inflamed gall bladder tip touches the area of the abdominal wall when you breathe in and out slowly.

The bile that is stored in the gall bladder is ever ready to be pumped out through the common bile duct when required for the digestion of fatty food and certain vitamins. Fats are broken down to fatty acids through enzymatic action in the small gut with the help of bile that is squeezed out of the gall bladder.

Through this process the cholesterol excreted in the bile is re-absorbed through the hepatic veins to the liver for re-cycling. The whole system is fine-tuned and coordinated and the gall bladder takes a vital role in the process.

What happens when you have a diseased gallbladder and is removed? The system seems to continue with the treacle of bile that pours into the gut continuously, and the
process will be less efficient and jeopardize the absorption of fatty acids from the food. It is rare that an empty gall bladder gets inflamed without stones, unlike the appendix that can get inflamed more frequently. Most people get into trouble with their gall bladders due to gallstones, such stones are formed when the squeezing effect is weakened in the gall bladder wall and the thick greenish bile gets stagnant, dehydrated and clumps together and form solid masses. Sometimes, a single large stone is found as big as a golf ball- then we call it a solitaire formed of hardened cholesterol. There may be in addition daughter stones formed in the gall bladder. People with certain conditions like cirrhosis and sickle cell diseases can form other kinds of stones due to the pigment in the bile… These are made of concentrated bilirubin secreted as a breakdown product of red blood cells in the liver.

It is the accumulation of bilirubin due to the obstruction of the outflow through the bile ducts that causes jaundice- a yellow coloration of your eyes and skin. Cancer of the head of the pancreas is a common condition that produces jaundice, or may be an obstructed stone in the main common bile duct.

Biliary sludge- Increased biliary sludge can cause bile pigment stones. The risk factors for biliary sludge include pregnancy, drugs like ceftriaxone, octreotide, and thiazide diuretics. Diseases like cirrhosis, chronic hemolysis and ileal Crohn’s disease are other risk factors for black pigment stones.

In Sri Lanka pigment stones from biliary sludge seems to be the commonest stone type found in a study population and the prevalence of it’s associated with advancing age. Mixed stones were associated with high serum total cholesterol levels. Pure cholesterol stones seem to be rare in Sri Lanka.

Gallstones can obstruct the flow of bile from the gallbladder, especially when stuck in the cystic duct. In such a situation the wall of the gallbladder inflames due to the irritation of the acid bile. As I said before, non-calculus GB disease is rare The word,”cholecystitis” is used when the GB gets inflamed. Clinically, the earliest symptoms would be nausea, vomiting and colics in the region of the gallbladder. Acute appendicitis gives a similar pattern of early symptoms but the tenderness causes by the GB differentiates the diagnosis.

Gall bladder pain could be scary. Sometimes you will not be able to differentiate from a heart attack or other situations like GERD. You need to go to the outpatients in the closest hospital to differentiate and diagnosis.

Your doctor will take a sample of blood from your arm vein to look for signs your body is fighting an infection. When the gallbladder is inflamed without stones (non-calculus) we attribute that to some bacteria in the GB causing the redness (inflammation). The white cell count would be very high in such as such a situation. Your doctor will have an imaging test, like an ultrasound to check for stones.

Non-calculus cholecystitis is treated with a course of antibiotics, intra-venous drips and the condition subsides within a few days.

In calculus cholecystitis when the inflammation is due to an obstructed stone your doctor will recommend surgery called cholecystectomy- removing the gall bladder totally with the bag of stones.

Some believe that hormone estrogen plays a role in gallstones. The estrogen- the female sex hormone can boost the amount of cholesterol in your bile. Prevention Obesity is a cause of calculus GB disease. Keeping your weight down within the normal range through diet restrictions and exercise do help.

Losing too much weight also could produce gallstones, because weight loss surgeries and low calorie diets can be hard on your gallbladder.

Fatty food: Foods high in cholesterol and fat can raise your chances of getting gallstones. Eating unprocessed, high fiber foods prevents gallstone formation.

Birth control contraceptive pills and hormone replacement therapy can raise your chances of getting gallstones.

High triglycerides in your blood due to metabolic syndrome and diabetes can cause gall stones.

Studies done in Indian villages have revealed a prevalence of gallbladder disease. They found a high incidence among men with diabetes. Chickpea consumption and drinking unsafe water were other causes found in the rural Gangetic basin of North India. A positive correlation was found that nickel, cadmium and chromium in water in the villages in Vaishali district and Bihar.

Cancer: GB cancer is uncommon in developed countries. In the US. it accounts for only 5,000 cases per year. High incidence is recorded among North and South American
Indians.

Cancer of the GB seems to be rare in Sri Lanka compared to cancer incidence in other organs.

Conclusions:
Stay within the normal range of your body weight; eat sensibly a low fat, low carb diet with daily exercise. Control your diabetes, if you are a diabetic. Staying healthy can prevent gall stones and from gallbladder disease. Hope this article was useful.