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Such gall

A look at the gallbladder, and what happens when gallstones form.

MANY people go through life without knowing what the gallbladder in their body does, or that they even have a gallbladder at all. That is, until they experience pain in their abdomen and between their shoulder blades, together with nausea, vomiting, fever and chills. That’s when they find out that they have gallstones. It is believed that women are twice as likely as men to develop gallstones. In this article, I will explain the risk factors for gallbladder disease, and how to tell if you have gallstones.

Finding the gallbladder

What exactly is this organ? It’s a small, pear-shaped sac that is located just under your liver. The gallbladder stores a liquid, called bile, that helps your body digest fats. Bile is actually made in the liver, and then stored in the gallbladder until your body needs it. Bile contains water, cholesterol, fats, bile salts, proteins, and bilirubin – a waste product. Bile salts break up fat, and bilirubin gives bile and stool a yellowish-brown colour.

When food enters the body and needs to be digested, the gallbladder will contract and push the bile into a tube, called the common bile duct. This duct carries the bile to the small intestine, where it does its job of breaking up fats. The gallbladder is part of the biliary system, which also consist of the ducts that carry bile and other digestive enzymes from the liver, gallbladder and pancreas to the small intestine.

Where do the stones come from?

Gallstones are small, pebble-like substances that develop in the gallbladder. They form when the liquid bile contains too much cholesterol, bile salts, or bilirubin, which then hardens into pebble-like stones. There are two types of gallstones: cholesterol stones and pigment stones. Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80% of gallstones. Pigment stones are small, dark stones made of bilirubin. Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or a combination of the two.

Is it serious?

Some people with gallstones can go through life without even knowing it is there because it does not cause them any symptoms or problems – with either their gallbladder, liver or pancreas function. Unfortunately, for others, gallbladders can cause some serious problems and painful symptoms. Gallstones can block the normal flow of bile if they move from the gallbladder and lodge in any of the ducts that carry bile from the liver to the small intestine. These ducts include the hepatic ducts, the cystic duct and the common bile duct.

When the stones trap bile in the ducts, it can cause inflammation in the gallbladder, the ducts, or even the liver and pancreas. Gallstones can cause a “gallbladder attack” when the blocked bile ducts cause pressure to increase in the gallbladder. A typical attack can cause symptoms, including prolonged pain in the right upper abdomen that increases rapidly and lasts anywhere from 30 minutes to several hours.

Other symptoms that should lead you to seek medical advice are pain in the back between the shoulder blades, pain under the right shoulder, nausea and vomiting, fever and chills, yellowish colour of the skin and whites of the eyes, as well as clay-coloured stools. An “attack” can occur suddenly, often after high-fat meals, and sometimes during the night.

Don’t ignore the symptoms above, because bile ducts that remain blocked for a long time can cause severe damage or infection to the gallbladder, liver or pancreas. Left untreated, these organs may rupture and cause death. Gallstone symptoms may be similar to those of a heart attack, appendicitis, peptic ulcer, irritable bowel syndrome, hernia, pancreatitis and hepatitis. Therefore, an accurate diagnosis with an ultrasound examination is important.

Treating gallstones

Gallstones are routinely treated by surgery to remove the gallstones – a procedure called a cholecystectomy. This is commonly done through laparoscopy, which means that the surgeon is able to remove it by making only a small incision and using a miniature video camera to guide him. And don’t worry – removal of your gallbladder will not cause any significant disruption to your digestive system. Most people can live without their gallbladder as the bile will flow out of the liver through the hepatic ducts into the common bile duct and directly into the small intestine.

Who gets gallstones?

I mentioned earlier that women are twice as likely as men to develop gallstones. This is because women may develop excess oestrogen from pregnancy, hormone replacement therapy or birth control pills, causing the cholesterol levels in the bile to increase. You are at higher risk of developing gallstones if you have a family history of gallstones, are overweight or obese, consume a high-fat and high-cholesterol diet, have gone through crash diets, are above age 60, take cholesterol-lowering drugs or have diabetes. The stones also tend to develop in people who have liver cirrhosis, biliary tract infections, or hereditary blood disorders – such as sickle cell anaemia – in which the liver makes too much bilirubin.

Once the condition has been properly diagnosed and the right form of treatment given, gallstones need not bother you any longer.

The Star Newspaper, Sunday July 12, 2009

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