Gallbladder Surgery or Cholecystectomy

SHOULD I HAVE MY GALLBLADDER REMOVED?
IS GALLBLADDER REMOVAL REALLY NECESSARY?
Over 1/2 million people in America have their gallbladders removed every year. Is it necessary? Not that often it isn't. Sometimes it is absolutely necessary, but not always. How do you know for sure? That's not easy to determine. Most doctors advise gallbladder removal with any diagnosis of a gallbladder problem. Large gallstones, small gallstones, low-functioning gallbladder, few symptoms, no symptoms. If the diagnosis warrants surgery, you are advised to take it out. But the same diagnosis in thousands of people does not mean the same condition exists. For example, gallstones can be silent which means you are unaware of any probelm going on. There are no symptoms at all and the gallstones are found by routine lab tests done for a separate issue. You may eventually develop symptoms or you could live a long life and never experience symptoms of gallstones. Or you may be one of those people who have frequent attacks and on-going pain who just can't live with it. The majority of people we hear from here at GallbladderAttack are in the middle. They had an attack; it's behind them now, but they still have discomfort that gets worse when they are under stress or when they eat the wrong foods. If you are in that camp, you have a choice to make. Part of that choice involves whether or not you are willing to make both lifestyle and dietary changes.

If you do opt for gallbladder removal, will your digestion be perfect afterwards? That's what everybody's hoping for, to be pain free, gas free, bloat-free and to be able to eat whatever they like. You have a 60% chance of that happening. Out of every 10 cholecystectomies, 4 people will still have symtpoms. Those symptoms are rarely, if ever, equal to that of the previous gallbladder attack. They are more often discomfort, or dull pain. But you need to be aware.

So read the research and find out what your chances are of that happening before you give your body parts up. And scroll over to the right of this page to read what my readers are saying about their experiences. And if you've had a good experience and are symptom-free 2 and 3 years after surgery, please write and tell us about it. We want to hear from you too. I say 2 or 3 years because it sometimes happens that uncomfortable symptoms resolve after a year or so.

The most frequently asked question I am asked from people who have had surgery is this: "Why is that that I still have pain even though my gallbladder has been removed?"
If you think of your problem as a biliary (bile) problem as opposed to a "gallbladder" problem you are more on the right track to understanding how to take care of it. Removing the gallbladder does not always address the problem in the body that is causing these symptoms. In order to break down and digest fats, your body must produce bile, which is done in the liver. Your gallbladder is merely a sac for holding some of the bile that the liver produces. Whether or not you have had your gallbladder removed, your liver is still producing bile in order to digest fats. Without the gallbladder, however, the bile is not as readily secreted in the body, and the liver can become overwhelmed when faced with large amounts of any fats, especially saturated fats and hydrogenated fats. And for some people even small amounts of fats can cause discomfort.

One of the side effects of gallbladder removal can be the dumping of bile which is now not as easily regulated and can send someone running to the bathroom immediately after eating. A more common side effect is a decrease in the secretion of bile. If the bile produced by the liver becomes thick and sluggish, painful symptoms and bile stones can occur. Bile stones can form in the liver as well as the gallbladder. One woman had her gallbladder removed only to end up back in surgery again two or three days later where they found stones in the bile ducts of the liver causing her alot of pain.

However, removing the gallbladder may be an absolute medical necessity. But, unless it is diseased, ruptured or otherwise sick, know that just having cholelithiasis or gallbladder stones does not mean you have to take it out. If you have gallbladder attacks, pain or discomfort or digestive problems but not a diseased gallbladder, this does not mean you necessarily have to have gallbladder surgery. Get a second opinion. You do have an option of cleaning up your diet, doing some work on your gallbladder and liver and keeping your organ of fat digestion. If you happen to think that nature made a mistake and that you don't need it anyway, you probably wouldn't be reading this page in the first place.

What's the worst thing that can happen? You try to fix a huge contributing factor which is based on cleaning up your diet and eating real food and real fats and not the "pretend food" that can sit on a shelf for 6 months to 2 years. What kind of a food takes two years to go bad? Nothing that will give health to your body, that's for sure. And if the gallbladder still needs to come out later, you've only gained by eating better anyway.

The gallbladder does facilitate and regulate the flow of bile in your body. When that facilitator is taken away it is quite possible that the flow will be not as efficient, ie. too much at one time, or more commonly, not enough.

Whether you choose gallbladder surgery or not, consider taking products and changing your diet as well as doing a series of gallbladder and liver flushes to take care of the root of your gallbladder problem.

The most common problems, apart from actual pain are impaired digestion: bloating, gas, heartburn, constipation or diarrhea. You are/were already having trouble digesting fats. So why would removing the organ that regulates the metabolizer of fats improve your digestion? It may help with the pain, but know that 34% of people who have their gallbladder removed still experience some abdominal pain. (4)

The easiest way to avoid this is to take a supplement of bile salts or choline with meals to help your body with the digestion of fats. And do a series of gallbladder flushes. Flushes are especially helpful after gallbladder removal to help flush out the bile ducts. Supplemental bile salts, (unless you are experriencing bile dumping) available separately or in the After Gallbladder Removal Kit, should be taken frequently along with the digestive stimulant (also in the kit) to help stimulate your own digestive juices. Alternating the dosage of bile salts will help to mimic the body's way of secreting bile. For example, take one with breakfast, two at lunch, three at dinner, two with breakfast the next day, and so on in rotation.

If you have the less common, but not unusual side effect after gallbladder removal of needing to run to the bathroom immediately after eating, you are probably getting too much bile instead of too little. This, unfortunately is much harder to control. Try the Dumping Syndrome Kit. Read more about postcholecystectomy diarrhea towards the bottom of this page.

CAN I FUNCTION WITHOUT A GALLBLADDER
Yes you can. The bile will still be produced in the liver and find its way to the small intestine. It will continue to break down your dietary fats and to remove toxins from the liver. What is different is that the bile will no longer be as concentrated (the gallbladder removes 90% of the water from the bile) and its function as a regulator will be gone. Some people have no problem with this at all; others have problems with getting the right amount of bile at the right time, either too much or too little.
IS GALLBLADDER SURGERY EFFECTIVE
What is meant by effective? Will you never have another gallbladder attack? I mean, how could you if you have no gallbladder, right? Will you never suffer from indigestion again? Will your gas and bloating disappear? Will the constipation go away? Will diarrhea resolve?

The answer to all of the above is "sometimes". Actual attacks are rare, but other forms of pain and discomfort are possible and new symptoms can also develop. Read on...

Let's look at gallbladder attacks. Gallstones can also be found in the liver and the bile ducts leading to the gallbladder. The attack is often (but not always) caused by a stone blocking a duct. And yes, this can still happen. As seen by research above, stones are formed partly due to what we eat. If we take the gallbladder out and continue to eat the same lithogenic forming diet that we did before, why should stones not form? They will. You may never know it. You may be asymptomatic for the rest of your life. Or, you may get a stone stuck in a bile duct. This is one of the reasons for the most frequently asked question on this site: "I had my gallbladder removed months (or years) ago. Why do I still have pain?" (See testimonials to the right for examples.) Removing the gallbladder does not always address the problem in the body that is causing these or other symptoms listed above. It has probably taken years for your body to form these stones. Your fat digestion has been impaired for a long time. In order to break down and digest fats, your body must produce bile, which is done in the liver. To address the root of the problem you must study and reflect on the causes of gallbladder disease. There could be an underlying thyroid problem which research connects with both gallstones and a low-functioning gallbladder. Food allergies may also be a big part of it and stress as well.


Another thing to keep in mind is that you could have another gallbladder disease that has not yet been diagnosed. For example, if an ultrasound is done and gallstones found, a cholecystectomy or gallbladder removal will be recommended without doing any further exploration. This is because the most obvious and easily diagnosed cause of gallbladder attacks is gallstones or cholelithiasis. And ultrasound is quick and non-invasive. However, if your gallbladder is ejecting bile below 33%-40% which is considered normal range, you would be diagnosed with a low-functioning gallbladder or biliary dyskinesia. This can only be determined with a HIDA scan which is an invasive procedure using radioactive dye. Symptoms of biliary dyskinesia are not always resolved with cholecystectomy either for various known and unknown reasons. One reason is that the problem could be with the Sphincter of Oddi rather than the gallbladder itself.
DIET AFTER GALLBLADDER SURGERY
If you understand that co-existant with your gallbladder disease is usually a problem of stagnant bile, cholestasis, or some imbalance in the bile composition itself, you will realize that most people are not out of the woods after surgery or able to eat anything they like. Treat your lack of a gallbladder as you would any gallbladder disease and eat the same way. Exactly what that means depends upon your symptoms. Some people have surgery having had few symptoms and others were in bad shape. If you are in the latter category, and are now still having some discomfort, you may be most comfortable giving your gallbladder a rest by following the strict 30-60 Day Gallbladder Menu Plan. Most people after surgery will be able to start with the 2nd Menu Plan which is more relaxed. Others will be comfortable just following the Gallbladder Foods Guidelines in the Helpful and To Be Avoided lists.


There is a whole page on gallbladder diet with foods that are good for the gallbladder (think "bile") and liver and foods that are hard on the biliary system. You still have a biliary system. Treat it gently and feed it nourishing foods. Of particular importance is the understanding of good fats and harmful fats. Follow the links on gallbladder diet for more information on both of these.
When should the gallbladder be removed?

Many doctors recommend gallbladder removal if you have had only one attack. Others will do so if you have repeated attacks. Some will do so if you have stones; others will say unless you are having attacks with the stones you can leave it. This is a place to get a second opinion and above all, to educate yourself; read all you can.

If your doctor finds that you have an infected gallbladder it will almost certainly have to come out. If it bursts you are in similar danger as with a burst appendix. Infection is then lose in the peritoneal cavity. This is like an explosion of infection from a place of contaiment to the body at large and is difficult to clean up.

If you have a motility problem or a problem with gallbladder contraction or low-functioning (see biliary dyskinesia under gallbladder diseases) gallbladder surgery is also recommended. Yet some doctors do not recommend gallbladder removal for biliary dyskinesia.
Complications of surgery
Apart from complications of surgery such as damage to the common bile duct with laparoscopic surgery (due to lack of visibility) or infection from an incision, one may develop postcholecystectomy syndrome. (See below.)
"During laparoscopic cholecystectomy, gallbladder perforation with leakage of bile and/or gallstones into the abdominal cavity occurs frequently." or 33% according to this study. However, there were no complications of infection or blockages in any of the subjects.(3)

POSSIBLE SIDE EFFECTS FROM GALLBLADDER REMOVAL

LIFE AFTER GALLBLADDER SURGERY
Abdominal pain, nausea, gas, bloating, and diarrhea are common following surgery. Postcholecystectomy syndrome (after gallbladder removal syndrome) may include all of the above symptoms plus indigestion, nausea, vomiting and constant pain in the upper right abdomen. Sound familiar? You're right -- gallbladder attack symptoms. Up to 40% of people who undergo gallbladder surgery will experience these symptoms for months or years after surgery. How is this possible? You no longer have a gallbladder and that was the problem, right? Look to the whole biliary tract. Now that the gallbladder is no longer present to act as a reservoir for bile, the common bile duct may expand as the bile backs up in the bile duct between the sphincter or muscular opening at the small intestine and the liver from which it flows. If it drips constantly into the small intestine this can cause problems of a different kind. However, this syndrome with accompanying pain appears to have the flow of bile obstructed by either a narrowing of the sphincter or a malfunction of the sphincter.(1)
"Functional biliary pain in the absence of gallstone disease is a definite entity and a challenge for clinicians." which is to say that at this point in time, they don't really know what to do with gallbladder problems that aren't related to gallstones (2) and "Often, following cholecystectomy, biliary pain does not resolve..." (2) which means after gallbladder surgery you may just be stuck with the pain.

So in conclusion, your best bet may be to try and fix what is wrong if that is possible, before taking it out. Sometimes, that is just not possible.
Postcholecystectomy Diarrhea or Bile Dumping Syndrome

The uncomfortable and inconvenient side effect that some people experience following the removal of their gallbladder is that of running to the bathroom immediately or soon after eating. For some it is rather explosive. Whatever its presentation, it is an increased transit time which means that absorption of nutrients is impaired. Not a good situation for your overall health. You may find help from the Dumping Syndrome Kit on this site. It helps to bind the bile salts that accumulate in the intestine along with extra fluid. However, this quote from a British medical journal suggests that perhaps IBS is part of the problem and may have been there, if somewhat less problematic, before the surgery. If that is the case, try our Dumping Syndrome Kit, by all means. It can be helpful for all sorts of etiologies. But you may also want to read up on IBS and try some products specifically for an irritable bowel condition. I like the products at www.diverticulitisinfo.com.

"13-40% of patients have persisting abdominal pain after cholecystectomy although the vast majority regard their operation as a success. Up to 12% of post-cholecystectomy patients when questioned feel that they have diarrhoea as a consequence of their operation, and at least 4-5% of patients have a definite deterioration in their perceived diarrhoea or perceive that they have developed diarrhoea for the first time. Objective assessments postoperatively, however, rarely demonstrate new onset diarrhoea. Some of these patients may have the irritable bowel syndrome."6
IS THERE SOMETHING I COULD DO FOLLOWING GALLBLADDER REMOVAL THAT WOULD BE HELPFUL
Of course! Always keep following a clean, sensible gallbladder diet that includes good fats, lots of organic fruits and vegetables and lean meats and fish. And for at least 2 or 3 months immediately afterwards, follow the diet religiously and if you haven't done a Gallbladder Starter Kit, do so now to give your digestion and your fat metabolism a kit start. I also suggest a series of coffee enemas about a month after surgery (even years after if it's been that long) to flush all the bile ducts including those of the liver. Your biliary tree can benefit from this at any time as can your liver. I suggest one per day, if possible, for 21 days.
Then order the After Gallbladder Removal Kit and stay on it from now on. You will need the assistance in digestion that it offers, especially for digesting fats. That is the ideal. If it is beyond your means to do this, at least use bile salts with every meal.


(1)Torsoli A, Corazziari E, Habib FI, Cicala M. Scand J Gastroenterol Suppl. 1990;175:52-7 Pressure relationships within the human bile tract. Normal and abnormal physiology.

(2) Shaffer E., Dig Liver Dis. 2003 Jul;35 Suppl 3:S20-5

(3) Surgical Endoscopy Publisher: Springer New York ISSN: 0930-2794 (Paper) 1432-2218 (Online) DOI: 10.1007/BF00188454Issue: Volume 9, Number 9 Date: September 1995 Pages: 977 - 980

(4)Bates T; Ebbs SR; Harrison M; A'Hern RP.Influence of cholecystectomy on symptoms.
Br J Surg. 78(8):964-7, 1991 Aug.
(5)E Ros, D Zambon
Postcholecystectomy symptoms. A prospective study of gall stone patients before and two years after surgery. 1987 BMJ Publishing Group Ltd & British Society of Gastroenterology
(6)S Hearing, L Thomas, K Heaton, L Hunt
Post-cholecystectomy diarrhoea: a running commentary Copyright © 1999 BMJ Publishing Group Ltd & British Society of Gastroenterology.

Gallstones and gallbladder disease - Risk Factors

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of gallstones.

Alternative Names

Cholecystitis; Choledocholithiasis; Bile duct stones

Risk Factors:

More than 25 million Americans have gallstones, and a million are diagnosed each year. However, only 1 - 3% of the population complains of symptoms during the course of a year, and fewer than half of these people have symptoms that return.

Risk Factors in Women

Women are much more likely than men to develop gallstones. Gallstones occur in nearly 25% of women in the U.S. by age 60, and as many as 50% by age 75. In most cases, they have no symptoms. In general, women are probably at increased risk because estrogen stimulates the liver to remove more cholesterol from blood and divert it into the bile.

Pregnancy. Pregnancy increases the risk for gallstones, and pregnant women with stones are more likely to have symptoms than nonpregnant women. Surgery should be delayed until after delivery if possible. In fact, gallstones may disappear after delivery. If surgery is necessary, laparoscopy is the safest approach.

Hormone Replacement Therapy. Several large studies have shown that the use of hormone replacement therapy (HRT) doubles or triples the risk for gallstones, hospitalization for gallbladder disease, or gallbladder surgery. Estrogen raises triglycerides, a fatty acid that increases the risk for cholesterol stones. How the hormones are delivered may make a difference, however. Women who use a patch or gel form of HRT face less risk than those who take a pill. HRT may also be a less-than-attractive option for women because studies have shown it has negative effects on the heart and increases the risk for breast cancer.

Risk Factors in Men

About 20% of men have gallstones by the time they reach age 75. Because most cases do not have symptoms, however, the rates may be underestimated in elderly men. One study of nursing home residents reported that 66% of the women and 51% of the men had gallstones. Men who have their gallbladder removed are more likely to have severe disease and surgical complications than women.

Risks in Children

Gallstone disease is relatively rare in children. When gallstones do occur in this age group, they are more likely to be pigment stones. Girls do not seem to be more at risk than boys. The following conditions may put children at higher risk:

• Spinal injury
• History of abdominal surgery
• Sickle-cell anemia
• Impaired immune system
• Receiving nutrition through a vein (intravenous)

Ethnicity

Because gallstones are related to diet, particularly fat intake, the incidence of gallstones varies widely among nations and regions. For example, Hispanics and Northern Europeans have a higher risk for gallstones than do people of Asian and African descent. People of Asian descent who develop gallstones are most likely to have the brown pigment type.

Native North and South Americans, such as Pima Indians in the U.S. and native populations in Chile and Peru, are especially prone to developing gallstones. Pima women have an 80% chance of developing gallstones during their lives, and virtually all native Indian females in Chile and Peru develop gallstones. Such cases are most likely due to a combination of genetic and dietary factors.

Genetics

Having a family member or close relative with gallstones may increase the risk. Up to one-third of cases of painful gallstones may be related to genetic factors.

A mutation in the gene ABCG8 significantly increases a person's risk of gallstones. This gene controls a cholesterol pump that transports cholesterol from the liver to the bile duct. It appears this mutation may cause the pump to continuously work at a high rate.

Defects in transport proteins involved in biliary lipid secretion appear to predispose certain people to gallstone disease, but this alone many not be sufficient to create gallstones. Studies indicate that the disease is complex and may result from the interaction between genetics and environment. Some studies suggest immune and inflammatory mediators may play key roles.

Diabetes

People with diabetes are at higher risk for gallstones and have a higher-than-average risk for acalculous gallbladder disease (without stones). Gallbladder disease may progress more rapidly in patients with diabetes, who tend to have worse infections.

Obesity and Weight Changes

Obesity. Being overweight is a significant risk factor for gallstones. In such cases, the liver over-produces cholesterol, which is delivered into the bile and causes it to become supersaturated.

Weight Cycling. Rapid weight loss or cycling (dieting and then putting weight back on) further increases cholesterol production in the liver, which results in supersaturation and an increased risk for gallstones.

• The risk for gallstones is as high as 12% after 8 -16 weeks of restricted-calorie diets.
• The risk is more than 30% within 12 - 18 months after gastric bypass surgery.

About one-third of gallstone cases in these situations have symptoms. The risk for gallstones is highest in the following dieters:

• Those who lose more than 24% of their body weight
• Those who lose more than 1.5 kg (3.3 lb.) a week
• Those on very low-fat, low-calorie diets

Men are also at increased risk for developing gallstones when their weight fluctuates. The risk increases proportionately with dramatic weight changes as well as with frequent weight cycling.

Bariatric Surgery. Patients who have either Roux-en-Y or laparoscopic banding bariatric surgery are at increased risk for gallstones. For this reason, many centers request that patients undergo cholecystectomy before their bariatric procedure. However, doctors are now questioning this practice.

Metabolic Syndrome

Metabolic syndrome is a cluster of conditions that includes obesity (especially belly fat), low HDL (good) cholesterol, high triglycerides, high blood pressure, and high blood sugar. Research suggests that metabolic syndrome is a risk factor for gallstones.

Low HDL Cholesterol, High Triglycerides and Their Treatment

Although gallstones are formed from the supersaturation of cholesterol in the bile, high total cholesterol levels themselves are not necessarily associated with gallstones. Gallstone formation is associated with low levels of "good" HDL cholesterol and high triglyceride levels. Some evidence suggests that high levels of triglycerides may impair the emptying actions of the gallbladder.

Unfortunately, some fibrates (drugs used to correct these conditions) actually increase the risk for gallstones by increasing the amount of cholesterol secreted into the bile. These medications include gemfibrozil (Lopid) and fenofibrate (Tricor). Other cholesterol-lowering drugs do not have this effect. [For more information, see In-Depth Report #23: Cholesterol.]

Other Risk Factors

Prolonged Intravenous Feeding. Prolonged intravenous feeding reduces the flow of bile and increases the risk for gallstones. Up to 40% of patients on home intravenous nutrition develop gallstones, and the risk may be higher in patients on total intravenous nutrition. It is suspected that the cause is lack of stimulation in the gut, because patients who also take some food by mouth have less risk of developing gallstones. However, treatment for gallstones in this population is associated with a low risk of complications.

Crohn's Disease. Crohn's disease, an inflammatory bowel disorder, leads to poor reabsorption of bile salts from the digestive tract and substantially increases the risk of gallbladder disease. Patients over age 60 and those who have had numerous bowel operations (particularly in the region where the small and large bowel meet) are at especially high risk.

Cirrhosis. Cirrhosis poses a major risk for gallstones, particularly pigment gallstones.

Organ Transplantation. Bone marrow or solid organ transplantation increases the risk of gallstones. The complications can be so severe that some organ transplant centers require the patient's gallbladder be removed before the transplant is performed.

Medications. Octreotide (Sandostatin) poses a risk for gallstones. In addition, cholesterol-lowering drugs known as fibrates and thiazide diuretics may slightly increase the risk for gallstones.

Blood Disorders. Chronic hemolytic anemia, including sickle cell anemia, increases the risk for pigment gallstones.

Heme Iron. High consumption of heme iron, the type of iron found in meat and seafood, has been shown to lead to gallstone formation in men. Gallstones are not associated with diets high in non-heme iron foods such as beans, lentils, and enriched grains.

Resources

• http://digestive.niddk.nih.gov -- National Digestive Diseases Information Clearinghouse
• www.gastro.org -- American Gastroenterological Association
• www.acg.gi.org -- American College of Gastroenterology
• www.liverfoundation.org -- American Liver Foundation

References

Afdhal NH. Diseases of the Gallbladder and Bile Ducts. In: Goldman L, Ausiello D. (eds.). Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007.

Chambrlain RS, Sakpal SV. A comprehensive review of single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy. J Gastrointest Surg. 2009 May 2 [Epub ahead of print].

Chari RS, Shah SA. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. St. Louis, MO: WB Saunders;2007:chap 54.

Dray X, Joy F, Reijasse D, et al. Incidence, risk factors, and complications of cholelithiasis in patients with home parenteral nutrition. J Am Coll Surg. 2007;204(1):13-21.

Gurusamy, KS, Samraj K. Cholecystectomy versus no cholecystectomy in patients with silent gallstones. Cochrane Database Syst Rev. 2007;(1):CD006230.

Ito K, Ito H, Whang EE. Timing of Cholecystectomy for Biliary Pancreatitis: Do the Data Support Current Guidelines? J Gastrointest Surg. 2008 Jul 18 [Epub ahead of print].

Konstantinidis IT, Deshpande V, Genevay M, Berger D, Fernandez-del Castillo C, Tanabe KK, et al. Trends in presentation and survival for gallbladder cancer during a period of more than four decades. Arch Surg. 2009;144(5):441-447.

Liu B, Beral V, Balkwill A, Green J, Sweetland S, Reeves G, et al. Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women. BMJ. 2008;337:a386. Doi: 10.1136/bmj.a386.

Portenier DD, Grant JP, Blackwood HS, et al. Expectant management of the asymptomatic gallbladder at Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007; 3(4):476-479.

Rosing DK, de Virgilio C, Yaghoubian A, et al. Early cholecystectomy for mild to moderate gallstone pancreatitis shortens hospital stay. J Am Coll Surg. 2007;205(6):762-766.

Strasberg SM. Acute calculous cholecystitis. N Engl J Med. 2008;358(26):2804-2811.

Tse F, Liu L, Barkun AN, Armstrong D, Moayyedi P. EUS: a meta-analysis of test performance in suspected choledocholithiasis. Gastrointest Endosc. 2008;67(2):235-244.

Verbesey JE, Birkett DH. Common bile duct exploration for choledocholithiasis. Surg Clin N Am. 2008;88(6):1315-1328.

Williams EJ, Green J, Beckingham I, et al. Guidelines on the management of common bile duct stones (CBDS). Gut. 2008;57(7):1004-1021.

• Reviewed last on: 6/26/2009
• Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Source: http://www.umm.edu/patiented/articles/who_gets_gallstones_gallbladder_disease_000010_4.htm#ixzz2QnxUrMTi
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IBS and Gallbladder Problems

Although irritable bowel syndrome (IBS) is a disorder of the large intestine, having IBS is no guarantee that the rest of your digestive system works perfectly. One very important organ in the process of digestion is the gallbladder. Problems with the gallbladder can result in a variety of symptoms. The following discussion will provide you with an overview of your gallbladder, educate you as to the more common gallbladder diseases, and discuss any possible overlap with IBS.

What Does the Gallbladder Do?

Your gallbladder is a small, sac-like organ, located on the right side of your upper abdomen, tucked in under your liver. The gallbladder's main job has to do with a substance called bile, which is important in our ability to digest the foods we eat. Bile is first produced by the liver and then stored in the gallbladder. When we eat foods that have fat in them, the gallbladder secretes bile into the small intestine. There, the bile breaks down fat, allowing it to be absorbed into our bloodstream.

Symptoms of Gallbladder Problems

Although some gallbladder problems, including gallstones, may exist without any noticeable signs, the following symptoms may be indicative of gallbladder disease:

• Bloating after meals, particularly meals with a high fat content
• Chronic diarrhea
• Indigestion
• Nausea after meals
• Pain in the middle or right side of your abdomen

Gallbladder Attacks

Some gallbladder conditions announce their presence through what is commonly referred to as a "gallbladder attack," and officially known as "biliary colic." Such an attack may occur within a few hours of eating a large or fatty meal and may wake you up from sleep. You may experience pain in your upper right abdomen and this pain may also radiate to the upper back, between your shoulder blades, under your right shoulder, or behind your breastbone. Some gallbladder attacks result in nausea and vomiting. Usually these attacks only last for an hour or so. Such an attack should be reported to your doctor, even if symptoms subside.
If you are experiencing the following symptoms, you need to seek immediate medical attention:

• Clay-colored stools
• Fever and chills alongside nausea and vomiting
• Signs of jaundice
• Severe and persistent pain in your upper right abdomen

Gallbladder Diseases

The following are some of the more common gallbladder diseases:

5 Tests to Diagnose and Evaluate Gallbladder Disorders

Are you worried you might have gallstones? Has your doctor suggested you could have a disorder of the gallbladder such as gallstones, or another biliary tract disorder? Here’s a quick look at tests and procedures commonly used to diagnose and/or evaluate gallbladder and biliary tract disorders.

1. Ultrasound. The ultrasound uses sound waves to visualize the bile ducts, liver, and pancreas. When gallstones are present, they are seen in either the gallbladder or bile ducts. Little risk is associated with the ultrasound test. The ultrasound may not see gallstones in obese patients, or in patients who have recently eaten.
   
2. Endoscopic Ultrasound. An endoscopic ultrasound utilizes a scope that has an ultrasound on the end of the instrument. The special ultrasound scope is passed down into the intestines where internal visualization of the bile ducts, gallbladder, and pancreas ducts can occur. Special training is required to use the endoscopic ultrasound which is sometimes used to locate bile duct stones that may be missed by regular ultrasound. Other uses for the endoscopic ultrasound include the diagnosis of pancreatic cancer and cancer of the bile ducts.
   
3. CT Scan. While the CT Scan may identify gallstones, it is usually not as effective as the ultrasound. The CT Scan is also used to diagnose cancer in the liver and pancreas, and is a preferred method of assessing the severity of pancreatitis.
   
4. ERCP or Endoscopic Retrograde Cholangiopancreatography. ERCP is another type of endoscope that allows access to the bile ducts and pancreas ducts. The ERCP enables the performance of treatments that include removing gallstones from the bile ducts or the pancreas ducts. The measurement of the sphincter of Oddi muscle is often performed, utilizing another specialized test called Oddi manometry, during ERCP.
   
5. MRCP or Magnetic Resonance Cholangiopancreatography. MRCP utilizes the MRI or Magnetic Resonance Imaging equipment in a noninvasive test that uses special computer software that creates images of the bile ducts and pancreas ducts in a way that is similar to ERCP without the necessity of the internal scope. When MRCP reveals abnormal results further evaluation or treatment is necessary with ERCP or surgery.

Source: American College of Gastroenterology

Gall Bladder Symptoms in Women

The gallbladder stores bile produced by the liver until it is released into the small intestine for the digestion of fat. Gallstones, among the most common gallbladder ailment, can cause obstruction and inflammation. The gallbladder tissue may also become tough, the muscles of the gallbladder may spasm painfully, or the gallbladder wall may perforate. Gallbladder symptoms in women are more common than in men, according to the American College of Gastroenterology, which indicates that women are twice as likely to have gallstones due to the female hormones progesterone and estrogen.

Abdominal Pain

Gallbladder pain often begins as a mild pain in the upper middle part of the abdomen. It may also be felt to the right of the midline. The pain may radiate to the back or right shoulder. Depending on whether the pain is due to a stone in the gallbladder, a stone trapped in a duct or inflammation, it may be steady and continuous or episodic, occurring only after a fatty or large meal. Occasionally, pain that begins as mild discomfort becomes severe, accompanied by exhaustion, a fast heart rate, paleness and sweating.

Fever

A woman with an inflamed gallbladder may develop a fever and chills, explains the University of Maryland Medical Center. This often occurs due to a gallstone or sludge blocking the duct that drains the gallbladder. Fever may also be the result of a gallbladder or duct infection.

Yellowed Skin

When the gallbladder becomes inflamed, it may not allow bile to enter. This can cause bile intended for the small intestine to end up in the bloodstream, causing a yellowing of the skin and whites of the eyes. The urine may appear cola-colored.

Clay-colored Stools

When a gallbladder problem stops bile from reaching the small intestine, the bowel movements may be clay-colored. The intestine will be unable to properly digest fat, causing it to be expelled in the stool, explains the text "Medical Surgical Nursing." This may make the stools appear frothy or oily. They may be foul-smelling and float on the surface.

Vomiting

A woman experiencing gallbladder disease may vomit or feel nauseated and lose her appetite. She may have a sense of fullness even though she hasn't eaten. She may have discomfort, belching or intestinal gas when she does consume a meal. Similarly, some women develop chronic diarrhea as the gallbladder becomes scarred due to chronic gallbladder disease, explains the University of Maryland Medical Center.