HOUSE CALL: Life without your gallbladder


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Gallbladders are removed in approximately 700,000 people annually in the U.S. due to gallstones or gallbladder attacks. Risk factors leading to surgery include obesity, family history, hypertriglyceridemia (high blood levels of triglycerides), diabetes, diets rich in trans-fatty acids or cholesterol and rapid weight loss. Women are more prone to these risk factors.

The gallbladder is a reservoir that stores bile produced by the liver, releasing this bile into the intestine after meals to break down and absorb fat.

Life after gallbladder surgery is fairly normal for most, but some people experience greater digestive changes than others.

After surgery, bile drains continuously, even between meals. Smaller amounts of fat usually are easily digested, while larger amounts of fat will remain undigested, causing gas, bloating and diarrhea.

Following surgery, foods need to be gradually reintroduced into the diet to avoid straining the digestive system. Eating sensibly with smaller and more frequent meals ensures a better mix with available bile. With time, the intestine becomes better at digesting fat. This should not be a license to eat more fat, particularly saturated and trans-fatty acids — a risk factor for cardiovascular disease, hypertension, diabetes and several cancers linked to obesity.

Fat intake should be no greater than 30 percent of daily calories and include mostly non-saturated fats. Limit red meats, fried foods, sauces, dressings and gravies, and focus on fruits and vegetables along with lean protein such as chicken, turkey, seafood, non-fat dairy and whole grains. Drink plenty of zero-calorie beverages such as water and green tea. Increase fiber gradually to help normalize bowel movements and reduce incidents of diarrhea or constipation. Activity should be increased as much as feasible and pain medications should be seriously limited.

One-third of patients experience abdominal pain, bloating, flatulence (excessive stomach or intestinal gas) and diarrhea beyond the first few days. If symptoms are tolerable, more dietary adjustments including elimination of caffeine or other stimulants, very sweet foods and low-fat dressings can be made.

Call your physician if unrelenting diarrhea occurs. Seek prompt medical evaluation if you have trouble breathing, there are increases in symptom severity, concurrent fever, nausea, malaise, weakness, yellow skin, light-brown/yellow stool and dark yellow/light-brown urine. Retained bile duct stones hindering drainage, leaks from the liver ducts, infections or an inflamed pancreas, need to be ruled out.

In 5 to 35 percent of individuals, abdominal pain after eating, fatty food intolerance, nausea, vomiting, bloating, belching, heartburn, low-grade fevers may recur. This post-cholecystectomy syndrome might arise subtly, months or years after surgery, or immediately after, leading to multiple visits to the ER or hospital admissions.

Typically, testing is normal and the patient feels like an enigma. This mystery illness might represent Sphincter of Oddi Dysfunction, where the muscular opening of the bile duct to the small intestine becomes scarred or spastic and hinders adequate drainage.

Dr. Giuseppe Aliperti, a gastroenterologist, is on staff at Missouri Baptist Medical Center. He is board-certified in gastroenterology and internal medicine, and specializes in complex GI conditions. For a referral call 314-996-LIFE.

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