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From Washington University Physicians, posted March 12, 2012, written by Mary Jo Blackwood, RN, MPH

Learning about the symptoms of early gallbladder disease makes it easier to get treatment before complications develop, says Washington University GI surgeon, Steven Strasberg, MD.

Dr. Strasberg is considered a world expert in the diagnosis and treatment of diseases of the liver, pancreas, and gallbladder. He says that gallbladder health is in the hands of the patient, and most of the causes of gallbladder disease are, in fact, modifiable.

Eighty percent of gallstones are cholesterol stones. Risk factors include:
Age and Being Female: Women between 20 and 60 develop gallstones three times more often than men. By age 65, 25 percent of American women have gallstones. Estrogen seems to play a role, because it increases the concentration of cholesterol in bile.
Pregnancy, especially multiple pregnancies close together, contributes to gall stone formation, due to the rise in estrogen levels.

Oral contraceptives: The estrogen in oral contraceptives and hormone replacement therapy affect gallstone disease similarly.

Family history of gallstones: No gallstone genes have been yet identified. But because obesity and diet/eating habits tends to be similar within families, the family history is important in diagnosing the disease.

Obesity: Women with a body mass index (BMI) over 30 have twice the risk of gallstone disease as women who are not overweight. Estrogen is present in fat cells, which can overload the body with this hormone, It also appears that being overweight increases the cholesterol component of bile, while also slowing down the emptying of the gallbladder.

Rapid weight loss: After prolonged fasting or gastric by-pass surgery, increased cholesterol can move from the fatty tissue and build up in the bile, leading to both diminished gallbladder contractions and the formation of stones.

Western diet high in fat: Gallstones, especially cholesterol gallstones, are less common in vegetarians, and almost non-existent in some ethnic groups.

Symptoms you can recognize

Symptoms of gallstone disease are similar for all ages, says Dr. Strasberg, with the exception of the very elderly who may feel less pain until complications have already developed.

For the most part, people should look for symptoms of biliary colic, which is manifest by:
  • Pain, often severe, in the upper abdomen in the middle or slightly to the right side
  • Pain that starts after eating a fatty meal or which wakes the patient at night
  • Pain that is episodic: The patient develops the pain which lasts for several hours and then may not be repeated for days, weeks or months
  • Nausea and vomiting that may accompany the pain

How the Gallbladder Works

The gallbladder is a small reservoir about three inches long that sits under the liver. It serves as the storage receptacle for bile, which helps the body digest and absorb fat.

The liver makes bile, which flows through ducts to the gallbladder where it awaits food to digest. Eating a fatty meal signals the gallbladder to push bile into the common bile duct, from where it enters the small intestine to break down the fat.

Says Dr. Strasberg, “The biliary colic pain that occurs after eating happens when the gallbladder, in response to fat in the meal, tries to contract and squirt bile into the biliary duct, but is blocked by a stone.

Complications develop when the stone gets lodged at the bottom of the gallbladder and creates inflammation, which can lead to prolonged pain and infection and a diagnosis of acute cholecystitis.

If a stone gets into a duct that blocks bile from the liver, it can lead to jaundice, and infection in the bile duct. If the lower duct is affected, it can involve the pancreas, causing pancreatitis.”

Patients exhibiting high abdominal pain after eating should consult their doctors. An ultrasound exam can find stones in the gallbladder. Once the patient has documented stones and biliary colic, the gallbladder should be removed.

Gallbladder Surgery (Cholecystectomy)

Without complications, the gallbladder is removed laparoscopically through several small skin punctures. If the gallbladder is inflamed and scarred, surgery may be postponed, especially if the inflammation is severe or long-standing.

Multiple attacks of inflammation may require open surgery with an incision. New approaches to removing the gallbladder though a single incision are being tested, but to date there seems to be little or no advantage and a possible increase in complications.

For all ages, Dr. Strasberg’s advice is the same: eat a low-fat diet; keep a normal weight and know the symptoms of biliary colic.
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Copyright 2015 Washington University School of Medicine