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Lois M. Collins: Gallstones are common, and not always painful

Published: Friday, Jan. 7 2011 12:51 a.m. MST

SALT LAKE CITY – As many as 25 million Americans have gallstones, so common in women that by age 60 one in four have them, while one in five men have them by age 75. It's just as well that most of those people will never have symptoms or problems with them, because it's sometimes hard to sort that condition from others with similar symptoms including pain in the abdomen or back.

A gallbladder attack shares symptoms with irritable bowel syndrome, pancreatitis, acute appendicitis, Crohn's or ulcerative colitis, pneumonia, stomach ulcers, gastroesophageal reflux, hiatal hernia, viral hepatitis, kidney stones, urinary tract infections, diverticulitis, heartburn – even, in rare cases, a heart attack.

The gallbladder and its woes, including gallstones and inflammation, how to tell what's going on and treatment options, will be discussed in Saturday's Deseret News/Intermountain Healthcare Hotline. From 10 a.m. to noon, Dr. Heidi Jackson, a general surgeon, and Dr. Celia Garner, an internist, both at LDS Hospital, will take phoned-in gallbladder questions. The number is 1-800-925-8177. And for the first time, questions can also be submitted and will be answered during the same two-hour period on the Deseret News Facebook page, www.facebook.com/desnews.

The job of the gallbladder, which lies under the liver, is to store and thicken bile to help with digestion, said Jackson. Gallstones, which cause most gallbladder problems, result from excess cholesterol that collects in the bile. Experts believe estrogen accounts for the increased incidence in women. Hormone replacement therapy increases the risk. So does pregnancy. Other risk factors include obesity, diabetes, rapid weight loss (including in some patients with gastric bypass), getting older and having a first degree relative troubled by it.

The most common gallbladder problem, biliary colic, shows up as pain, typically in the upper right abdomen near the rib cage. It's caused by temporary obstruction. Don't be fooled by the location, though, Jackson warned. It can be felt elsewhere, as well — high or low in the back, left or right side (left is unusual). Nausea and vomiting are common and it usually gets worse after you eat fatty foods. Limiting cholesterol intake may reduce gallbladder attacks. But it won't make the stones go away.

Biliary colic is uncomfortable, but not dangerous. The treatment, if needed, is typically elective laparoscopic surgery, Jackson said.

Acute cholecystitis happens when a gallstone blocks the duct and stays there. The gallbladder gets distended and inflamed and can lose its blood supply, abcess or perforate in severe cases. It can lead to infection and needs treated so it doesn't progress. Gallstones and mild inflammation cause chronic cholecystitis.

If gallstones move out of the gallbladder into the common bile duct, it can cause infection — which Garner said is "always more emergent" — pancreatitis, jaundice, pain, even whole liver obstruction. The pancreas empties through the same hole in the intestine as the common bile duct and if there's blockage, a person can become very sick, with severe pain and need to be hospitalized, Jackson said. Those symptoms need immediate attention.

Surgery is also often recommended to remove the gallbladder if it doesn't empty adequately.

Gallbladder cancer is uncommon, but it's also hard to diagnose because there are no symptoms until it's advanced. Some doctors recommend that someone with gallbladder polyps just have the organ removed. You can do quite nicely without it, Jackson said. And it's seldom a big surgery any more, done laparoscopically in 90 percent of cases, on an outpatient basis.

e-mail: lois@desnews.com

Hotline Saturday

General surgeon Dr. Heidi Jackson and internist Dr. Celia Garner, both at LDS Hospital, will answer question about gallbladder problems, including diagnosis and treatment, Saturday from 10 a.m. to noon for the Deseret News/Intermountain Healthcare Hotline. The number is 1-800-925-8177 or 801-236-6061 on the Wasatch Front. You can also post questions during that time on the Deseret News Facebook page, www.facebook.com/desnews, and the doctors will answer them during the hotline.

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