Surgical Associates of Corpus Christi
Gallstones / Gallbladder disease
The gallbladder is a small pear-shaped organ found under the liver, whose job is to hold bile (made by the liver) that help in dissolving fats. When fatty foods are eaten, the gallbladder will squeeze its contents into the duct system and out into the small intestine.
Gallstones (cholelithiasis) are the crystallized form of bile that occurs when the concentration of certain bile acids/salts and cholesterol change due to hormone changes in our bodies. These start as sludge then congeal into a stone over time. Up to 80% of people with stones are symptom-free. You do not need stones to have gallbladder pain.
Why do we have a gallbladder and do I need it?
Many feel the gallbladder provided a survival advantage thousands of years ago, when our civilization were hunter-gatherers and would go days without eating. This reservoir that is the gallbladder, when squeezed, allows for more fat absorption, resulting in people living longer to find more food. Nowadays, with people eating 2-3 times per day, this advantage is not needed. Removing the gallbladder changes the amount of bile released when fatty foods are consumed; however, it does not change the fact that bile is constantly being released, by the liver, so fat absorption will continue.
Who is at risk?
Those at increased risk include a patient who is: overweight, pregnant, has sickle-cell disease, takes supplemental estrogen, has a family history of gallstones, is of Native American heritage, or has lost weight rapidly.
Gallbladder pain (or biliary colic) is usually temporary and can present with a variety of symptoms though most include upper abdominal pain that comes and goes, is sometimes crampy in nature and associated nausea at times. This can last from 30 minutes to 24 hours and may occur after a fatty meal. Some will experience a low grade fever, jaundice (yellowing of the skin), or bloating.
Diagnosis / Tests
An ultrasound of the gallbladder, a hepatobiliary or PIPIDA scan, an MRI, and blood work are the more frequently ordered studies as part of the evaluation of symptoms possibly due to gallstones or a disease of the gallbladder.
Surgical and Non-surgical management / treatment.
A cholecystectomy (or gallbladder removal) is recommended when the gallbladder is thought to be the problem (stones, sludge, or inflammation). It can be removed either with the laparoscopic/ robotic approach or by a traditional incision at the right upper abdomen. Your surgeon has been trained in both and based on your safety may convert from one technique to another. At the time of surgery, and based on your blood work, dye may be injected in the gallbladder to evaluate for any stones that may have left the gallbladder and made their way into the duct system (Cholangiogram). If a filling defect is found in the duct, your surgeon may have you stay overnight and consult a gastroenterologist to perform a second procedure to remove these stones safely. Also a needle liver biopsy may be performed if your surgeon sees something on the liver or labs that would result in needing further workup intraoperatively. You must undergo general anesthesia to have this surgery.
Non-surgical treatment is usually held for those patients who are high risk of complications or fetal death (recent heart attack or pregnancy). Surgery may be held if you have gallstones/sludge without symptoms. Patients often ask about natural remedies such as the myth of cleansing the gallbladder with olive oil and lemon juice. Most physicians believe that the ingestion of oils or fats will result in a contraction of the gallbladder possibly leading to gallbladder or pancreas inflammation and an emergency room visit.
Risks of Surgery
Risks of surgery include bleeding, infection, damage to adjacent organs, development of a hernia, a bile duct leak, a bile duct narrowing, chronic diarrhea, bloating, a retained common bile duct stone, pneumonia, and heart complications. Your surgeon has extensive training to lower the incidence of these risks. Generally laparoscopic/robotic surgery results in fewer of these risks and are typically the process by which gallbladder are surgically removed.
Most patients undergoing non-emergent surgery will go home the same day providing the cholangiogram does not demonstrate evidence of gallstones in the bile duct during surgery. You are encouraged to walk and limit lifting to no greater than 8 pounds (e.g. a gallon of milk). Most patients require pain medications for a few days after surgery and can resume driving if pain is managed by over the-counter pain medications only. We recommend a smoothie or liquid diet for the first day while anesthesia is wearing off, and then proceed with your typical diet. Patients who consume a high-fat diet may experience diarrhea and lessening the fat intake will typically make the stools more firm. Mild redness or bruising limited to the incisions may occur.
Call the office number or go to the nearest emergency room if you experience severe pain, nausea, fever, incisional drainage or significant redness, yellowing of the skin or white of the eyes, chest pain or shortness of breath.
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