Gall bladder disease and gall stones

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The text books will tell you this condition affects fair, fat, fertile females of forty. It is a disease of people eating Western diets. People eating stoneage diets do not suffer gall bladder disease. This is because stoneage diets rely on fats as fuels. Bile is a fatty liquid in which bile acids are dissolved. If fat is in short supply the bile acids will be concentrated and precipitate out in the gall bladder as sludge or stones.

Symptoms

Classically this presents with bouts of pain under the ribs on the right which often radiates round into the back. There is nearly always nausea and vomiting, often a mild fever, the sufferer feels ill. If the bile duct is involved, this can cause biliary colic - a fluctuating severe pain which comes and goes over several hours. The pain may be so severe as to require admission to hospital for pain control with morphine. Admission may also be necessary if the vomiting is severe enough to cause dehydration. If the bile duct is blocked for a short time by a stone, there may be an episode of jaundice, dark urine and pale stools.

Tests taken at the time of the pain may show raised white cell count (sign of inflammation - ask for haematology) or abnormal liver function, or raised amylase if inflammation spills over into the pancreas. However, tests may also be normal.

Causes

Gall bladder disease can either be due to gallstones or cholecystitis. Cholecystitis means inflammation of the gall bladder and is caused by:

  • Irritation by sludge and/or Gallstones. Stones are easily diagnosed by ultrasound scan. Gallstones result from a low fat diet- one needs fat in the diet to make bile, if insufficient then bile crystallises out to form gallstones.
  • Infection associated with this sludge or stones: one cannot easily take samples from the gall bladder and antibiotics are often prescribed "blind".
  • Allergy to foods.
  • Tumours: pancreatic tumours are very difficult to diagnose at an early stage because there aren't any cheap, simple investigations to pick them up. Most patients are diagnosed late, either at operation, or through having an MRI body scan.

Gallstones may result from insufficient production of bile salts. This can be tested for as part of the Comprehensive Digestive Stool Analysis but do ask for bile salts as an extra because it is not a routine part of the basic testing.

Treatment

In the short term the treatment is a low fat diet. This is because fat makes the gall bladder contract and this may be painful if it is full of stones.

With established gall bladder disease and large stones, the only effective curative short term treatment is surgery. Fortunately, this is a fairly straightforward operation and the new techniques using endoscopy means this is even less traumatic now.

For small stones it may be possible to dissolve them using bile acids. These are available on NHS prescription for this purpose as ursodeoxycholic acid 150mgs tabs 6-12mgs per kg daily taken with food. One can also purchase them without prescription. Indeed it may be that gall stones arise because of poor production of bile acids! That may be a symptom of a low fat diet - another problem of Western diets. Eating a high fat (but the right sort of fats - see Phospholipid exchange ) will further help to dissolve stones.

Gall bladder disease can be largely avoided by doing a Stoneage diet. I say that because gall stones are not seen in societies eating primitive stoneage diets. having gallstones should be a wake up call to do a Stone Age Diet!

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