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| Dr. Manuel Perez |
Gallbladder disease is one of the leading indicators for surgery in the United States, with approximately 500,000 cholecystectomies (removal of the gallbladder) performed yearly. As many as 10 to 20 percent of the population will develop gallstones at some stage of their life, and the incidence increases with age. But having gallstones does not mean you will need surgery. Of the patients who have them, only 10 percent develop symptoms within five years of their diagnosis.
Gallstones and Complications
The gallbladder is a small sac located below the liver in the right upper abdomen. Bile, which helps in the digestion of fat, is produced in the liver and stored in the gallbladder. When the bile contains too much cholesterol, bile salts or bilirubin, it hardens into gallstones.
Gallstones may become lodged in the neck of the gallbladder, causing the gallbladder to become inflamed (cholecystitis), which can bring on severe pain and fever. Other complications from gallstones are blockage of the common bile duct, which can cause jaundice; or infection of the bile duct, called cholangitis. A gallstone blocking the pancreatic duct can cause the extremely painful and potentially dangerous condition of gallstone pancreatitis, usually requiring hospitalization.
Indicators of Gallbladder Disease
Symptoms of gallbladder disease usually occur after a meal, often one that is high in fat. They are generally impossible to ignore, and can include the following:
- pain in the upper right abdomen
- back pain between the shoulder blades
- pain in the right shoulder
- nausea or vomiting
- fever
Risk Factors
Women are twice as likely as men to develop gallbladder disease. Other factors include:
- family history
- being overweight
- diets that are high in fat and low in fiber
- rapid weight loss
- diabetes
- taking cholesterol-lowering drugs
- taking medication that contains estrogen
- American Indian or Mexican-American
- pregnancy
Getting an Accurate Diagnosis
Symptoms of gallbladder disease can mimic other problems, such as a heart attack, so an accurate diagnosis is very important. When gallstones are suspected, the most sensitive and specific test used is an ultrasound. CT scans are also commonly used. Frequently, gallstones are discovered during tests for other health conditions. Depending upon what the doctor is looking for, a HIDA scan may be used to detect acute inflammation of the gallbladder. HIDA scans and MRI’s can detect stones within the bile ducts. Pain without gallstones may be an indication of other conditions such as peptic ulcer disease.
Surgery the Most Effective Treatment
As mentioned previously, gallstones that do not cause symptoms typically do not require surgery. Once symptoms of gallbladder disease start, it is usually best to proceed with surgery. Almost all gallbladder surgeries are performed with a laparoscopy. A small incision is made in the abdomen and a laparoscope with a video camera is inserted through the opening. Watching a monitor, instruments are carefully inserted to separate the gallbladder from the liver.
Recovery is usually rapid, with normal activities resumed after a few days. Most gallbladder surgeries can be performed on an outpatient basis but some patients may wish to stay overnight. Our bodies compensate for the absence of the gallbladder and its removal won’t affect your ability to digest food. Today’s less invasive surgeries offer a relatively simple solution for a potentially very harmful disease.
Manuel Perez, M.S., FACS is a Board Certified General Surgeon affiliated with Franciscan St. James Health, which is a member of the Southland Health Alliance.
