Gallbladder disease

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Gallbladder disease
University of Maryland Medical Center

Introduction:
The gallbladder is a sac located under the liver. It stores and concentrates bile produced in the liver. Bile aids in the digestion of fats, and is released from the gallbladder into the upper small intestine (duodenum) in response to food (especially fats).

Types of gallbladder disease include:

Cholecystitis (inflammation of the gallbladder)
Cholelithiasis (gallstones)
You can have gallstones without any symptoms. However, if the stones are large, they can block the duct that leads from the gallbladder. This can cause pain and require treatment. At first they may block the duct and move away, causing only occasional pain. Continuous blockage of the duct, however, can be life threatening and requires surgical removal of the gallbladder.

Signs and Symptoms:
Pain, mostly on the upper right side of the abdomen
Pain following meals, intolerance of fatty foods
Nausea, vomiting
Loss of appetite
What Causes It?:
Inflammation causes a gallbladder attack. This usually happens because a stone is blocking a passageway in the gallbladder. Gallstones develop in the gallbladder when substances in bile form hard particles. They can be as small as a grain of sand or as large as a golf ball.

What to Expect at Your Provider's Office:
If you are having a gallbladder attack, you will feel tenderness when the upper right side of your abdomen is touched. Jaundice (yellowing of the skin) occurs when the bile duct (a tube between the liver and gallbladder) is also blocked. If your health care provider thinks you have a gallstone, you will probably need an ultrasound. During an ultrasound, sound waves take pictures of your gallbladder. This test is painless and can be performed quickly, which is important if you are in a lot of pain.

Treatment Options:
Gallbladders that cause pain are usually removed. There are no known problems caused by living without a gallbladder. Doctors use a laparoscope to perform most gallbladder surgeries today. This instrument shows the surgeon pictures of your gallbladder as it is being removed. The minimally invasive procedure allows for a smaller incision and a shorter hospital stay than traditional surgery.

Some drugs can dissolve stones, avoiding the need for surgery. However, it can take 2 years for a stone to dissolve, and gallstones often recur later.

An oral bile acid, ursodeoxycholic acid (Ursodiol), can dissolve cholesterol stones that are quite small (less than 15 mm in diameter). The drug is successful in about 40% of patients.
Methyl tert-butyl ether and monooctanoin (Moctanin) are solvents that are infused directly into the bile duct or the gallbladder to dissolve stones.
Doctors may use shock wave therapy (lithotripsy) to break up stones.
Complementary and Alternative Therapies
You should see your provider for tests before you start any alternative treatment. This will help determine the remedies that are right for the size of your stone and your condition.

Nutrition and Supplements
These nutritional tips may help reduce symptoms:

Eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives and chemical food additives. Eggs, especially, may irritate the gallbladder (as well as being high in cholesterol). Your health care provider may test you for food allergies.
Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell pepper).
Avoid refined foods, such as white breads, pastas, and sugar.
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
Eat more fiber. Consider fiber supplements, such as flaxmeal (1 tsp. one to three times per day). Combine 1 heaping tsp. of flaxmeal in 8 oz. of apple juice for a drink high in fiber and pectin.
Use healthy cooking oils, such as olive oil or vegetable oil.
Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
Avoid alcohol, and tobacco. Some evidence suggests that people who drink caffeinated coffee have a lower risk of gallstones, though study results are mixed. Talk to your doctor before increasing your caffeine intake, as caffeine can affect several conditions and interact with medications.
Exercise lightly, if possible, 5 days a week.
You may address nutritional deficiencies with the following supplements:

A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc and selenium.
Vitamin C, 500 - 1,000 mg daily, as an antioxidant and for immune support.
Phosphatidylcholine, 300 - 2,000 mg daily, may help dissolve gallstones.
Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
Magnesium, 400 - 600 mg daily, for nutrient support.
Taurine, 1.5 - 3 gm daily, for nutrient support.
Herbs
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not take tinctures. Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink two to four cups per day. You may use tinctures singly or in combination as noted.

Green tea (Camelia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant effects. You may also prepare teas from the leaf of this herb.
Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg two to three times daily, for liver and galbladder detoxification support.
Globe artichoke (Cynara scolymus) standardized extract, 250 - 500 mg two to three times daily, for support of galbladder and liver function.
Turmeric (Curcuma longa) standardized extract, 300 mg three times daily for support of liver function.
Homeopathy
Few clinical studies have examined the effectiveness of specific homeopathic remedies. However, a professional homeopath may recommend one or more of the following treatments for menstrual pain based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

Some of the most common remedies are listed below. A common dose is three to five pellets of a 12X to 30C remedy every 1 - 4 hours until your symptoms improve.

Colocynthis for colicky abdominal pains that are lessened by pressure or bending double
Chelidonium for abdominal pain that moves to the right shoulder area
Lycopodium for abdominal pain that is worse with deep breaths
Physical Medicine
Castor oil pack. Apply oil to a clean, soft cloth and place on abdomen. Cover with plastic wrap, place a heat source (hot water bottle or heating pad) over the pack, and let sit for 30 - 60 minutes. For best results, use for 3 consecutive days. Apply to abdomen, especially the gallbladder area, to help reduce swelling.

Acupuncture
Acupuncture may be especially helpful in pain relief, reducing spasm, and easing bile flow and proper liver and gallbladder function.

Following Up:
Early surgery usually ends symptoms and recurrence. Stones may appear again in the bile duct, however.

Special Considerations:
If you have diabetes or are pregnant, you have a higher risk of complications from gallbladder attacks. If you are pregnant, use choleretic herbs with caution. Milk thistle and dandelion rootare safe in pregnancy. Talk with your health care provider before you take any medication or supplement.

Reviewed last on: 2/12/2008
Steven D. Ehrlich, NMD, private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources.
Supporting Research
Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Rai A, Tewari M, Mohapatra SC, Shukla HS. Correlation of nutritional parameters of gallbladder cancer patients. J Surg Oncol. 2006;93(8):705-8.

Shaffer EA. Gallstone disease: Epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol. 2006;20(6):981-96.

Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL. Long-Term Effect of Magnesium Consumption on the Risk of Symptomatic Gallstone Disease Among Men. Am J Gastroenterol. 2007; [Epub ahead of print].

Venneman NG, van Erpecum KJ. Gallstone disease: Primary and secondary prevention. Best Pract Res Clin Gastroenterol. 2006;20(6):1063-73.

Völzke H, Baumeister SE, Alte D, et al. Independent risk factors for gallstone formation in a region with high cholelithiasis prevalence. Digestion. 2005;71(2):97-105.

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