In medical school, they teach you that fat, female, fertile, 40, and frisky are the “F’s” of the classic patient with gallbladder disease. Okay, I made up the one about being frisky, but the others are legitimate.
Does this mean every woman who is overweight with kids will have gallbladder disease and elderly males are in the clear? Certainly not. I have often found that the “classic” patient types that surgeons are taught in medical school are not always a match to the patients who come through the hospital doors.
In that case, who should be concerned about gallbladder disease, and what are the general indications for surgery?
There is a broad spectrum of presentations for gallbladder disease. Some common symptoms include abdominal pain, nausea and vomiting. Work-up generally starts with an abdominal ultrasound — a non-invasive study that carries little risk to anything.
If an individual comes through the emergency department, the physician may order a CT scan as this allows better imaging of other intraabdominal organs to rule out other causes of abdominal pain.
When an ultrasound or CT is performed, the physician will look at a number of things: the thickness of the gallbladder wall, the presence or absence of stones within the gallbladder, the presence or absence of fluid around the gallbladder, and the size of the main duct that connects the liver to the small intestine.
If a CT scan and an ultrasound do not explain symptoms, the next step may be a HIDA scan. A HIDA scan is a nuclear medicine scan in which the flow of bile from the liver to the gallbladder and small intestine is measured. If less than 35 percent of the bile is released from the gallbladder, it is considered abnormal and would be a reason for one to get a consultation with a surgeon.
A surgeon might suggest gallbladder removal for a range of reasons starting from an obviously inflamed gallbladder to long term abdominal pain.
Keep in mind, that there is also a subset of patients who have had a long history of vague abdominal pain for which a cause cannot be found. Generally, those patients have had several different types of imaging all of which have been non-revealing.
For those patients with vague abdominal pain, a surgeon might suggest removing the gallbladder with the patient understanding that it may not improve their symptoms. Often, these patients have suffered for an extensive period of time and would try anything for the possibility of symptom relief. However, most surgeons will not take out a “normal” gallbladder as the first rule of medicine is “do no harm.”
This all may seem like a lot of work for an organ that seems to have little use for most people. Why not take out the gallbladder if patients have pain?
The purpose of the gallbladder is to store bile which is made by the liver. When one consumes a meal, the gallbladder then releases bile into the small intestine to help digest the food. Ninety-five percent of the bile is reabsorbed at the end of the small intestine with the remaining five percent being excreted in one’s stool.
Many gallbladder surgeries can be performed laparoscopically with four small incisions; however, if there is ever any concern about injury to other organs, then one large incision is created in order to perform the operation.
Are there any means to prevent gallbladder disease? Not really. Gallstones are less likely to form in those who eat a balanced, healthy diet and exercise regularly. However, once a person has a single stone then it could always become symptomatic. Genetics also plays a role with the highest incidence of disease occurring in Native Americans.
At TCMH, both Dr. Milolen and myself are trained to performed gallbladder surgery and either of us would be more than happy to evaluate a patient with potential gallbladder disease.
Jason Loden, DO is a general surgeon at Texas County Memorial Hospital. Call 417-967-1252 to schedule an appointment or to learn more.