Gallstones; why they form and how they can be prevented
It’s a small organ on the right side of the body behind the liver. It’s three inches long, shaped like a pear and it can cause us severe pain if our cholesterol builds up -- but we can live without it. Can you guess what it is?
The gallbladder is the organ that fits this description. This week on “Take Care,” Dr. Salam Zakko enlightens us on what this organ does and why it's sometimes removed. Zakko is a gastroenterologist and the executive director at Connecticut Gastroenterology Institute and Clinical Research Foundation at Bristol Hospital. He is also a clinical professor in medicine at the University of Connecticut.
The gallbladder is connected to the liver and the small intestine, and its main function is storing bile that comes from the liver, according to Zakko. As the gallbladder collects bile, it makes the fluid more concentrated over time by absorbing water. Then, once a person eats, the intestine sends a signal to the gallbladder to contract and release bile to help us digest the fat in the food we eat, says Zakko.
“Gallstones are small concretions that … start as small little sand particles that grow over time,” Zakko said.
The average gallstone is the size of a pea, says Zakko, which may seem small, but in relation to the size of the gallbladder, is actually pretty big.
“As the gallbladder is trying to contract to secrete bile into the intestine, it squeezes against those stones growing and it causes pain,” Zakko said.
This pain mostly occurs in the upper right abdomen and the chest, but can also radiate to other parts of the body, such as the back and right shoulder, says Zakko. These symptoms usually strike about an hour after eating, and can be especially painful if the meal was high in fat. However, Zakko says if you’re trying to prevent gallstones, cutting fat out of your diet completely is not the solution.
“If there is no fat whatsoever … then the gallbladder does not contract,” Zakko said. “If it does not contract over time it becomes lazy, and then the bile that is sitting in it … becomes over concentrated, and it starts precipitating cholesterol and stones form.”
Zakko says many people go through life without ever knowing they have gallstones because they are asymptomatic. But in these cases the stones are not usually life-threatening, and it’s actually recommended that treatment is not administered if they are found.
“Research and studies have shown that their risk of trouble from the treatment is more than their risk of developing problems from the gallstones over their lifetime,” Zakko said.
Instead, these patients should be educated on what symptoms would feel like, and if they do occur to then see a doctor about possible treatment, Zakko says.
There are three available options to treat gallstones, according to Zakko. The first being a procedure called a cholecystectomy. This is an open surgery that removes the gallbladder and its stones completely. However, this can lay you up in the hospital for days and put you out of work for weeks.
The newer approach to gallbladder removal is laparoscopic surgery. This surgery virtually does the same thing, but is done with tubes and a camera so no muscles have to be cut open. Recovery time for laparoscopic surgery is much faster, allowing patients to walk around just a few hours after it’s complete, says Zakko.
The third option is an oral medication, which you may think sounds the most appealing. However, Zakko says this is only effective 50 percent of the time, and can leave you taking medication for up to three years.