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You just ate a large fatty meal and suddenly have a sharp pain in your upper right abdomen! It takes your breath away! What is going on? Is it a heart attack, or could it be a gallbladder attack?
Our gallbladder is a small pear-shaped sac located below the liver. It stores bile, a fluid made by the liver that helps with fat digestion. We usually don’t think much about our gallbladder if it is working properly. However, if the tube leading from the gallbladder gets blocked or infected, the gallbladder can become painfully inflamed, causing an attack.
Gallstones (hard particles comprised of cholesterol, calcium, and bilirubin) can form in the gallbladder. They can become lodged in the cystic duct, which leads to the common bile duct and allows for the flow of bile into the small intestine. The bile then helps digest fatty foods. If a gallstone lodges in the duct, the bile can back up in the gallbladder leading to inflammation or infection, a condition known as cholecystitis.
Common Signs and Symptoms of a gallbladder attack:
Belly Pain: Pain usually starts in the upper right abdomen, and then can radiate to the middle of the abdomen and toward the back and right shoulder. The pain can last from a few minutes to a few hours, and attacks may occur frequently or not occur again for several months.
Indigestion: A gallbladder issue can cause heartburn or indigestion after meals. If gallstones block the cystic duct, the amount of bile that enters the small intestine decreases, resulting in poor digestion of fatty foods and discomfort known as indigestion.
Nausea and Vomiting: Vomiting and continued nausea can be a sign of a gallbladder attack. Vomiting after a large meal can provide temporary relief from the pressure and discomfort, but the nausea may continue. Nausea is most likely at night when certain sleeping positions may cause pressure on the affected area.
Loss of interest in food: If you are experiencing a gallbladder issue, eating can increase pain and nausea. It is common to lose your appetite and avoid eating to minimize the symptoms.
Jaundice: If a gallstone becomes lodged in the cystic duct or common bile duct, the bile in the gallbladder has no place to go. The bile then backs up and accumulates in the liver. Part of the bile is bilirubin which is produced when the liver breaks down red blood cells. Bilirubin is a deep yellowish/orange color. If enough bilirubin accumulates in the liver, the skin and whites of the eyes will start to take on the yellowish color which is known as jaundice. If you notice a yellowing of your skin or eyes, an immediate call to your healthcare provider would be a wise decision.
Urine changes: If a gallstone is lodged in one of the ducts and bile is backing up into the liver, the liver may not be able to efficiently process waste products. If waste products are abundant, the urine may become very dark in color, turning brown or even maroon. Dark urine is also a sign of dehydration which can also occur if nausea and vomiting are persistent.
Diarrhea: Explosive and frequent stools may also be indicative of a gallbladder attack. The stool may change color, turning tan or clay-colored due to insufficient amounts of bile reaching the small intestine. The stool may also be lighter in weight so it may float or be looser.
Fever: One-third to one-half of gallstone sufferers may experience a fever and chills with episodes. The fever is usually due to the inflammation of the gallbladder. If the fever is persistent and accompanies nausea and vomiting, seek medical attention as the condition could be serious and could lead to gallbladder perforation.
Chest Pain: Both a heart attack and a gallbladder attack can involve chest pain, so it is easy to mistake one for the other. Chest pain after eating a heavy meal is most likely due to a gallbladder attack. Heartburn is often part of a gallbladder attack as well, so avoid lying down which can make the heartburn worse. Try to keep your head elevated on a wedge pillow to prevent the reflux of acid from the stomach.
Risk factors for Gallbladder attacks:
Certain Foods: Diets high in calories, cholesterol, animal proteins, and high in refined carbohydrates are linked to increased risk for gallbladder attacks. A French study conducted in 2017 found that those who followed a Mediterranean diet were much less likely to need to have their gallbladder removed. So, food choices bear significant weight in the gallbladder health picture.
Oral Estrogens: there is evidence in a study in the Journal of the American Medical Association that taking oral estrogen can lead to gallbladder disease. It seems that oral estrogen increases cholesterol saturation in the bile, leading to more gallstone formation. This was true for both men and women who were undergoing estrogen therapy as well as for women taking estrogen-containing oral contraceptives.
Excess Weight: Like the oral estrogen effect, obesity also increases the cholesterol saturation in the bile. The gallbladder is also larger and empties less efficiently in the overweight person. Weight-loss surgery increases the likelihood of gallbladder attacks, so weight loss of five to ten percent of starting weight over six months is recommended to reduce the risk of gallstone issues.
Genes: Gallbladder attacks seem to run in families and researchers hold the genes as a likely cause. Some ethnic groups have higher rates of gallbladder attacks than others with studies pointing to significantly higher rates among Hispanic populations in Central and South America and among Native Americans. Researchers cite genetic and dietary differences for the disparity.
Diabetes: More and more evidence suggests that those with diabetes are at higher risk for gallbladder attacks. Diabetics are more likely to be overweight and have higher triglycerides that may encourage gallstones. Fortunately, people with diabetes can mitigate their risk by developing healthy eating habits and treating their diabetes with appropriately prescribed medications. These efforts can help with weight management and help the digestive and nervous systems fend off gallstone formation.
Diagnosis of gallbladder issues:
Ultrasound: An abdominal ultrasound is the best way to detect gallstones. Ultrasound can also show if fluid is present around the gallbladder or if the walls are thickened which often happens with acute gallbladder inflammation.
Blood tests: Liver enzyme tests can determine if the liver is damaged, but that is not definitive for gallbladder issues, as enzymes could be elevated for other reasons. Other blood tests like a white blood cell count can help point to inflammation or infection such as abscess, gangrene, or gallbladder perforation.
Computerized Tomography (CT): CT of the abdomen can show some complications such as pancreatitis or a tear in the gall bladder.
Treatment of Cholecystitis (inflammation of the gallbladder):
Hospitalization is often needed with an acute gallbladder attack. Intravenous fluids are given. The patient usually cannot eat or drink and may have a nasogastric tube placed so fluids can be suctioned from the stomach so the digestive tract can rest. Intravenous antibiotics are usually given to treat gallbladder inflammation or infection. Pain medication is also provided as needed. Once the pain has subsided and the patient can drink fluids again, discharge is usually allowed.
If gallbladder attacks are frequent occurrences, surgery may be the best option. Surgical removal of the gallbladder (Cholecystectomy) is usually done using a long flexible tube called a laparoscope which has a tiny camera at the end. Several tiny incisions are made and with the camera to guide the surgeon, instruments are used to remove the gallbladder without having to make a large incision.
Conservative Treatment: In recent years, numerous studies have been done comparing conservative treatment with surgical treatment. The findings consistently show that conservative treatment (watchful waiting) is a safe option, particularly if the patient is elderly, frail, or weak.
With conservative treatment, dietary changes are paramount. Eating a low-fat diet with plenty of fruits and vegetables, lean cuts of meat, and plenty of fiber can help prevent future gallbladder attacks. Avoiding processed foods is also important as processed foods are typically high in fat and cholesterol. Including healthy grains and nuts also encourages gallbladder health. Making your own healthy food at home is a much better choice than eating out where you have limited control over ingredients.
A surprising recommendation in addition to a low-fat diet is to drink coffee! The caffeine in coffee helps with gallbladder contraction which helps prevent gallstones. If you already have gallstones, you may not want to drink coffee until your gallbladder is removed as the gallbladder contractions may cause more pain and symptoms.
In conclusion, if you are faced with acute abdominal pain of unknown origin, be proactive and call your healthcare provider. You will likely be sent to the emergency room for care, possibly leading to hospitalization. If a gallbladder attack is identified, you will likely have at least two options, surgery or conservative treatment. If conservative treatment (watchful waiting) with dietary changes eliminates future gallbladder attacks, then watchful waiting is a win-win!
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Authored by June Pomeroy RN BSN Assessed and Endorsed by the MedReport Medical Review Board