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The tiny gallbladder can become a big pain

By TOM VALEO
Published March 29, 2005


The gallbladder is a small, pear-shaped sac under the liver about 2 inches above the belt line. The gallbladder holds about a shot glass' worth of bile in reserve to help your body absorb and digest fat from food: It squirts bile into the small intestine each time we eat. It's not a vital organ, so if your gallbladder is removed, bile simply finds other pathways from the liver to the small intestine.

The problem with the gallbladder is that it tends to produce stones that grow in the sac the way an oyster grows in a clam shell. Most of the stones get no larger than sugar crystals before the gallbladder expels them, but some stones linger and can grow as large as a golf ball. As long as the stones stay put, even the large ones probably won't cause problems.

The trouble begins when a stone about the size of a pea, or smaller, escapes from the gallbladder and gets stuck in the tubule that leads to the small intestine. This blocks the flow of bile, causing intense pain for several hours in the upper right abdomen. In severe cases pain may be accompanied by nausea, vomiting and diarrhea. You may even think you're having a heart attack. Such an attack may happen only once, but if the pain recurs, you may need to have your gallbladder removed.

How can you avoid gallbladder trouble?

Obesity promotes the formation of gallstones, but so does rapid weight loss. Therefore, the best way to maintain a healthy gallbladder is to maintain a normal weight, and if you must lose a few pounds, do so gradually. Rapid weight loss is such a strong predictor of gallstone formation that some surgeons who perform bariatric surgery on obese patients routinely remove the gallbladder, too.

Many people develop gallstones. By age 70, about 30 percent of women and 20 percent of men have them. By age 80, about 40 percent of women have them, outnumbering men who have the same problem by about 2-to-1.

If gallstones start to cause problems, surgery is the most reliable solution, and a surgical technique involving a laparoscope has made the procedure easier.

About a half-million Americans have this surgery every year, many of them leaving the hospital the same day. The laparoscope requires three or four tiny incisions. The traditional gallbladder operation, involving one incision 5 to 8 inches long in the abdomen, usually requires a hospital stay. "You don't need a gallbladder," said Dr. Steven Goldin, an assistant professor of surgery at the University of South Florida in Tampa. "Most people who have it removed don't even notice that it's gone."

In 90 to 95 percent of cases, Goldin uses laparoscopic surgery, but if patients have developed complications, he may use the open incision technique.

"If you put it off, the operation will become more difficult," Goldin said. "There may be inflammation around the gallbladder, which causes thickening of the organ. There may be adhesions. A big stone in the gallbladder can erode into duodenum. Your gallbladder can die. The best way to prevent significant problems is to deal with them quickly with an operation. The longer people wait, the more likely it is it will be a difficult operation."

Most gallstones consist primarily of cholesterol particles that settle out of the bile and adhere to each other. As people age, the amount of cholesterol in their bile tends to increase and development of gallstones is more likely. You might think that reducing the cholesterol in the bloodstream would prevent gallstones, but that doesn't seem to be the case.

One study, however, found that men who eat more unsaturated fat from olive oil and other plant sources were 18 percent less likely to develop gallstones. Another study showed that men who got 30 minutes of aerobic exercise a day, five days a week, lowered their risk by 34 percent.

Also, drinking moderate amounts of coffee and alcohol seems to lower gallstone production. And one study found that women who take vitamin C supplements have a lower incidence of gallstones and gallbladder disease, presumably because vitamin C helps regulate the conversion of cholesterol into bile acids.

You can live with gallstones indefinitely as long as they don't cause any pain. Once they start to hurt, they demand prompt attention. Untreated, gallstone disease can result in damage to the gallbladder and the pancreas, and the longer you wait, the bigger the problem will become.

- Tom Valeo is a freelancer who writes about medical and health issues. Write to him c/o Seniority, the St. Petersburg Times, P.O. Box 1121, St. Petersburg, FL 33731 or e-mail features@sptimes.com

[Last modified March 24, 2005, 10:16:03]


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