Aging Begins at 30

A Useful Gallbladder May Get Stoned

People with gallbladder disease complain of steady pain in the mid or upper right abdomen, often acute and sporadic, lasting 1 to 3 hours or more, especially after a heavy meal. The pain often moves to the right shoulder or shoulder blade because of shared nerve supply. There will also be lack of appetite, bloating, nausea and vomiting, or diarrhea. Sometimes there is yellow skin and eyes (jaundice), fever, and shaking chills called rigors if the common bile duct is blocked. In rare cases, the stone can, by moving, cause intestinal obstruction. In the elderly, there may only be a loss of physical and mental well-being. The clue to the diagnosis is an increase in a blood chemical, alkaline phosphatase, normally excreted in the bile.

Gall bladder disease means there is an infection. People with gall bladder disease generally have gall stones, but it's possible to have gall stones without having gall bladder disease. Diagnosis is by a plain abdominal x-ray or more often by sound wave mapping of the gallbladder called ultrasonography. In special circumstances, the older method of oral cholecystography is used where one swallows 6 tablets of x-ray contrast material the night before an upper abdominal x-ray. Sometimes a nuclear DIDA (di-imino di acetic acid) scinti-scan is used for additional diagnosis.

The gallbladder is a small pear shaped storage sac tucked up under the lower right ribs, about 2 inches above your belt line. Its function is to give squirts of bile when we eat by a chemical signal cholecystokinin (Greek for gallbladder mover). We can live without our gallbladder because without it bile still does pass by the bile ducts into the duodenum. The gallbladder is filled with 50 ml of bitter tasting golden brown to greenish yellow viscous fluid. Bile is made of steroidal bile acids, cholesterol, bilirubin and bicarbonate. Bile excretes cholesterol, helps neutralize stomach acid and aids in the digestion and absorption of fats. The bile duct joins with the liver duct to form the common bile duct which enters the bowel just beyond the stomach. Cholecyst is Greek for gallbladder, thus cholecystitis when it is inflamed.

Almost 20 million Americans have gall stones. About 1 million new cases are diagnosed and half are operated on each year. By the time we reach 80, 33% of white women and 20% of white men have gallstones. Gallbladder problems are especially seen in women aged 20-60. Gallstones are uncommon in slim, moderate drinkers and in vegetarians. A tenth of those with gallbladder stones will also have them in the common bile duct which complicates gallbladder surgery.

There are intriguing little water soluble envelopes in the bile called micelles which allow cholesterol to hide and dissolve to 2 million times its solubility in water. The bile acids which make this possible circulate from the gallbladder 5 to 10 times daily to the lower intestine where they are reabsorbed almost without any loss. The saturation of cholesterol in bile increases with age in both sexes and makes gall stone formation more common.

Eighty-five percent of stones consist of cholesterol. The rest are pigment stones. They form because of excess cholesterol, decreased bile acids, or both. The stones vary from one to hundreds and from a grain of sand size to over 1 1/2 inches across.

You can live a long time with a gallstone without symptoms, and over a 20 year period only 10% need operations. With symptoms, however, something needs to be done.

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See related Patient Topics Digestive System or Gallbladder and Bile Duct Diseases.

See related Provider Topics Digestive System or Gallbladder and Bile Duct Diseases.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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