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The gallbladder: The digestive holding tank

   A person can live normally without a gallbladder, but controlling the diet is necessary.

The gallbladder is a holding tank for bile, the body's digestive detergent. A greenish brown fluid produced in the liver, bile is stored in the pear-shaped gallbladder next door until a meal reaches the small intestine. There, the bile breaks up fat globules into tiny fragments, which helps the small intestine absorb the fat.

Bile contains cholesterol, bile acids, bile salts and lecithin, which are the detergents, and bilirubin, a pigment left over from destroyed red blood cells. Bilirubin is further broken down during digestion. Its products give urine and stools their characteristic color. Jaundice occurs when the liver does not remove bilirubin from the blood, causing yellowish skin, and lightening the stool color.

The gallbladder can cause trouble when it's infected or inflamed, or blocked with gallstones. Nearly 10 percent of the American population is estimated to have gallstones. Usually, gallstones don't cause any inconvenience. But in severe cases, they can block the gallbladder and cause liver damage.

Most gallstones are formed from cholesterol, some from bilirubin. Weight, diet, sex and ethnicity are risk factors for gallstones, according to the National Institutes of Health. Obese people, especially women, are prone to get gallstones. Another cause is an elevated level of the female sex hormone estrogen, which can occur during pregnancy, or be caused by hormone replacement therapy or birth control pills.

American Indians are especially prone to gallstones, according to the NIH. In Arizona's Pima Indians, 70 percent of women have gallstones by the time they're 30. Latinos also have high rates of gallstones. Diabetes, rapid weight loss and fasting can also contribute to gallstone formation.

Severe pain in the upper abdomen or right side is usually the first sign of a gallstone attack. Pain can also occur between the shoulder blades or under the right shoulder, along with nausea or vomiting. Fatty meals often bring on the pain. Fat also can cause bloating, colic and gas. See a doctor immediately if these symptoms are combined with jaundice, clay-colored stools, chills or low-grade fever.

Removal of the gallbladder is the most common treatment for problem-causing gallstones. Less often, the gallstones can be removed, leaving the gallbladder in place. Small gallstones can be dissolved by drugs taken in pill form. However, gallstones recur about half the time when the gallbladder is left in place.

The gall bladder may also harbor food poisoning bacteria called Listeria monocytogenes that "hide out" from the body's disease-fighting immune system. The bacteria escape with the stool and through poor hygiene, can infect others, according to a study published in the Feb. 4, 2004, issue of the journal Science.

It's possible to live a normal life without a gallbladder, but careful control of diet is necessary. Diarrhea is a fairly common complication, which can be controlled with medication. It's made worse by eating too much fatty and spicy foods and consuming excess dairy products, caffeine and alcohol.

Patients may adjust differently to life without a gallbladder. Here's a fairly detailed and sometimes graphic first-person account of a gallbladder removal operation and its aftermath, written by an Australian blogger: http://www.hgriggs.com/gallbladder.html.

Contact staff writer Bradley J. Fikes at [email protected] or (760) 739-6641.


Source: NCTimes.com, July 22, 2006

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