Submitted by Lewis Zulick, MD, Chief of Surgery for Rochester Regional Health Eastern Region including Clifton Springs Hospital & Clinic and Newark-Wayne Community Hospital.
One of the most common conditions I treat is gallbladder disease. The gallbladder is a small, sac-like organ tucked under the liver in the right upper corner of the abdomen. The gallbladder’s job is to hold liquid called bile that is produced by the liver and flows through a system of ducts into the intestine where it helps to digest food. The gallbladder is a blind sac that branches off the duct and holds bile till it is needed for digestion.
From the time of Hippocrates until as recently as 200 years ago, yellow and black bile were thought to be two of the four “humors” that controlled health. Imbalance of these “humors” (yellow and black bile, blood and phlegm) was thought to cause illness. Restoring that balance was the aim of most treatments at the time including, most commonly, to “let” (remove) the most accessible humor: blood. In the past, this was done by “barber-surgeons” (who also cut hair) which is why the barber pole is traditionally red and white, symbolizing their job to remove blood. Of course, this “treatment” was not effective and could be harmful.
Today, we understand how bile and the gallbladder work and the kind of illnesses that can develop from gallbladder problems. Unfortunately, problems with the gallbladder are quite common and are usually related to the development of gallstones. About 6% of men and 9% of women will develop gallstones. Of those people with gallstones, about 20% will develop abdominal pain symptoms from the gallbladder. Typically, the pain from gallbladder disease is felt in that right upper corner of the abdomen often radiating around to the back on that side and will happen soon after a meal, especially a fatty meal. Nausea usually occurs and sometimes may be the most noticeable symptom. The pain may be relatively mild but usually is quite severe. Once pain occurs from gallbladder disease it is very likely to occur again: sometimes just once every couple of months and sometimes almost daily. Testing to determine if the gallbladder is responsible for abdominal pain symptoms is simple and painless.
Once gallbladder problems develop the treatment usually recommended is surgery to remove the gallbladder. Though diet can sometimes control the symptoms and there is a medication to dissolve gallstones, these treatments do not have a good track record of success and usually are reserved for patients who are not good candidates for surgery. Fortunately, long term consequences from gallbladder removal are rare and surgery can be done using minimally invasive techniques with quick recovery. Still, it is considered a major procedure with significant possible complications which should be thoroughly discussed with the patient by their surgeon.
If you suspect you may be having a gallbladder issue it is important to discuss that with your primary care provider who can obtain the necessary testing to investigate the problem and make a referral to surgeon as necessary.
Monday, March 30, 2020
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