A Closer Look
The gall bladder is appropriately named. One definition of the word “gall” is “very bitter”. The gall bladder stores the digestive fluid, bile, which is a very bitter substance, and the pain associated with a “gall bladder attack” is quite bitter indeed!
Bile is made continuously by the liver and is a mixture of water, cholesterol, bile salts, fats, protein and bilirubin (a waste product). The gall bladder, a pear shaped sack located just beneath the liver. When food is eaten, the gall bladder releases the bile through a duct into the first part of the small intestine where it is used to help digest fats. Occasionally, the bile stored in the gall bladder can harden and form stones. The reason that stones form is not completely understood however it may be from an imbalance in the composition of the bile, or it may be due to the gall bladder not emptying correctly. Gallstones can be as small as a grain of sand, or as large as a golf ball.
Gall stones can cause problems if a stone moves into or blocks the passage between the gall bladder and the small intestine. This gall bladder “attack” often follows a meal with high fat content. A high fat content meal stimulates the gallbladder to contract and release bile. Typical symptoms include:
• steady pain in the upper right abdomen that increases in intensity and lasts between 30 minutes to several hours;
• pain in the back between the shoulder blades; or
• pain under the right shoulder blade.
Individuals who are at a higher risk for gall stones include:
• Women: Women are twice as likely as men to develop gallstones
• Family history: Gallstones often run in families
• Overweight individuals have a higher risk for gall stones.
• Daily food intake: a diet high in fat/cholesterol and low in fiber increases risk.
• Rapid weight loss diets and prolonged fasting increase the risk.
• Age: age over 60 years.
• Ethnicity: American Indians and Mexican Americans have a higher risk.
• Diabetes.
• Medications: cholesterol lowering drugs, oral contraceptives, and hormone replacement therapy can increase risk.
Many individuals have “silent stones’. This is a condition in which stones are present in the gall bladder; however they do not cause any problems. These are often discovered during testing for other health concerns. If the gallstones are not causing problems, there is no need to treat the stones.
Researchers began a study in 1983 evaluating “silent” gall stones. Ultrasound studies were done on 1417 individuals to look for gall stones. It was determined that 245, approximately 20%, individuals had silent stones. Researchers evaluated these same individuals 24 years later, in 2006, to determine if the gall stones had ever caused problems for the individual. Results showed that only 14 of these 245 individuals needed medical treatment for the stones, (surgery to remove the gallbladder). And, many of the individuals who had silent stones in 1983 had no stones in the gall bladder when tested again in 2006.
Take Home Message
The presence of stones in the gall bladder does not necessarily mean surgery is needed.
As the saying goes: “If it “ain’t” broke, don’t fix it”!
Editorial Comment
There are situations when gallstones can cause problems that require urgent medical care. These symptoms include:
• pain lasting more than five hours;
• Persistent nausea and vomiting;
• Fever or chills;
• Yellow coloring to the skin or whites of the eyes;
• Clay colored bowel movements.
These symptoms may indicate that a stone has become stuck in the duct that leads to the small intestine, causing additional problems in the gall bladder and/or liver.
Eating a diet lower in fat/cholesterol, high in fiber and avoiding rapid weight loss situations can help minimize the risk of gallstones and related medical problems.
For more information on gallstones visit the Healthwise Knowledgebase at: www.healthwise.msu.edu enter “gallstones” in the search box.
