Gallstones

The gall bladder is a small pear shaped organ on the underside of the liver that is used to store bile. When partially digested food passes from the stomach into the small intestine, the gall bladder expels bile to aid digestion. While gallstones usually form in the gallbladder; they can be found in bile; in the intrahepatic, hepatic, common bile, and cystic ducts. Cholelithiasis as Gallstones are called, often do not cause any symptoms. Gallstones are hard masses formed in the gallbladder or its associated passages. They are often discovered when having a routine x ray, abdominal surgery, or abdominal ultrasound. Cholangiography - radiographic examination of the bile duct is performed after injecting with a special dye to check the condition of Cholangitis - infection or inflammation of the bile ducts. Cholangitis manifests in the form of severe abdominal pain, fever and Jaundice.

When gallstones move from the gallbladder into the cystic duct of common bile duct (Choledocholithiasis), it can lead to a severe cramping pain in the upper right abdomen which can radiate to the right shoulder as a result of the blocked bile flow. This can last from a few minutes to a few hours. Cholesterol gallstones are more often noticed in women who are obese, on HRT or with elevated blood triglyceride. Black pigment gallstones are usually formed when there is increased destruction of RBC. Others who are likely to suffer gallstones are those suffering liver cirrhosis and biliary tract infections or sickle cell anemia. Gallstones can form when the gallbladder does not empty bile properly. Blood tests to check bilirubin, liver function test and pancreatic enzymes are often ordered. In cases of severe painful episodes, Cholecystectomy is performed.

Gallbladder diet

People suffering from gall bladder disease should follow a low fat diet for healthy living. The bile from the gall bladder is necessary for proper digestion of fats. When there is no bile or not enough bile is produced by the gall bladder, fat from food cannot be properly digested and makes one feel ill or causes diarrhea. Hence a long-term dietary therapy is strongly recommended for people who have had gall bladder surgery. If your gall bladder is diseased, a low fat diet reduces stimulation of the organ and allows your gall bladder adequate rest. This eating plan also helps to prevent painful spasms of the bile duct.

Cholecystitis

Cholecystitis refers to severe abdominal pain associated with gallbladder inflammation or gallstones. Acute Cholecystitis can manifest as sharp cramping pain in the right upper quadrant of the abdomen. This pain can spread to the back or below the right shoulder blade. It usually appears after a fatty meal. Cholecystitis might also lead to nausea and vomiting and often jaundice. The person suffering Cholecystitis might notice clay colored stools and fever. Diagnostic tests that are prescribed to detect this condition are Liver function test, abdominal ultrasound and Endoscopy.

In many cases, Cholecystitis can clear on its own, with the right low fat diet and antibiotics. But in other cases, Cholecystectomy may be done to remove the gallbladder. Acute Cholecystitis needs to be treated urgently lest it lead to complications such as a perforated gallbladder or gangrenous Cholecystitis where the gallbladder tissue dies. On the other hand, cholangitis involves infection of the bile ducts either due to biliary obstruction or bacterial infection.

Cholecystectomy

Cholecystectomy or Gallbladder removal surgery is now commonly carried out by laparoscopic method. This has greatly reduced recovery time over the traditional open surgery. Laparoscopic Cholecystectomy is performed with special tools inserted through small incisions made on the abdomen. A tiny video camera is also inserted to aid the process. Typically Cholecystectomy is resorted in cases where the patient suffers gallstones in the gallbladder or bile duct. Severe Pancreatitis or Cholecystitis (Severe pain coupled with rigidity in the upper right abdomen owing to the infection or inflammation of the gallbladder) are other reasons for resorting to a Cholecystectomy. Some patients and conditions are not suitable for a laparoscopic Cholecystectomy and in these cases, the surgeon opts for the open incision method. Cholecystotomy is a surgical procedure where the gallbladder is opened for removal of the gallstones and the excess bile is drained - but the gallbladder itself is not removed. The actual surgical incision into the gallbladder is called as Cholelithotomy.

Cholecystectomy complications

With laparoscopic Cholecystectomy, a patient can leave the hospital within a couple of days. While this is a relatively simple procedure, the possible complications include blood clots, bile leakage, injury to bile duct and infection. Sometimes, a gallstone might still remain within the bile duct and might get pushed into the central bile duct. In case of injury to bile duct, complex corrective surgery has to be done. For gallstones still remaining in the bile duct, an endoscopic retrograde cholangiopancreatography (ERCP) is conducted. After laparoscopic cholecystectomy, patients might experience bloating and diarrhea. Some patients notice indigestion and abdominal pain. Jaundice might be noticed in a few.

Diet after gallbladder removal

After gallbladder removal surgery, many a patient suffers diarrhea for a few months till the bile flow is regulated. Remember that there is no gallbladder to store the bile and release it when necessary. Now, in the absence of a gallbladder, the bile flows directly into the small intestine. Here it is used for the digestion of fats. But some of it might flow into the large intestine causing irritation and resulting in diarrhea. Unregulated bile supply might lead to improper digestion of fat. It is not surprising to note that the fat content of the stool is higher in those who have had gallbladder surgery. A low fat diet must be followed after gall bladder removal. Fluids and high fiber diet help in preventing constipation or diarrhea post gall bladder surgery. The patient may experience burping and feeling of fullness coupled with gas.

• Eating smaller meals at more frequent intervals helps.
  
• Add new foods slowly and watch out for any symptoms.
  
• Pack in lean protein, poultry, fish and low-fat dairy into your meals.
  
• Caffeine tends to worsen abdominal gas and diarrhea in some patients after Cholecystectomy.
  
• Limit your intake of sweets, cake, cookies and chocolate bars. They might result in intestinal distress.
  

Opt for whole grains and generous servings of fruits and vegetables.Ensure that low fat dairy products are used post gall bladder surgery. Avoid convenience foods and fast foods, as they tend to pack in hidden fats. Limit the use of oil to about 2-3 tsp. a day.