By Maria A. Palafox, MD
You might be sleeping peacefully hours after enjoying pizza and cheesesticks, or maybe it hits you at work after having a couple of carne guisada tacos for breakfast. You know it’s coming because you felt bloated to the point of nausea after eating. Now it has hit you: a sharp pain in the middle of your chest and to the right, under your ribs. It hurts when you breathe—you can’t get comfortable, and now your back hurts, too. Eventually the pain goes away and you feel fine—until the next time you have pizza or tacos. This is not how your body should be reacting to food, even spicy foods. It may be your gallbladder giving you trouble.
The job of the gallbladder is to store bile; green bile is produced by the liver to help the intestines digest fatty, cholesterol-rich foods. When we eat, the stomach sends a signal to the gallbladder letting it know that the intestines need help in digesting the food. The gallbladder will begin to squeeze the bile it contains through a duct into the first part of the intestines. When the gallbladder is full of stones, the gallbladder gets clogged and cannot pass the bile into the duct. If this happens, the gallbladder will get large and distended. Your body will tell you this is happening because you will become bloated and nauseated; you will develop right-sided upper abdominal pain and back pain. Eventually, the food will pass through the GI tract, and the signal from the stomach to the gallbladder will eventually turn off. The pain and bloat and nausea eventually disappears. Sometimes these pain episodes can be avoided by avoiding heavy foods, but for some patients the pain episodes become so frequent that surgery is a reasonable alternative.
What about those people with similar symptoms but no gallstones on CAT scan or ultrasound of the abdomen? It may be that the gallbladder is squeezing inadequately or not at the right times; those patients will get symptoms but they are not strictly associated with food intake. A HIDA scan may show abnormal gallbladder function. In the last 15 years, it has been found that these patients will also benefit from having their gallbladder removed. Eighty-five percent of patients will have resolution of their symptoms with gallbladder surgery; almost all patients will get better eventually after having surgery.
Sometimes confused with laser surgery, gallbladder surgery is done using small incisions, tiny instruments and a TV camera which shows the inside of the abdomen on a TV screen in the operating room. The attachments of the gallbladder to the intestine are cut and the gallbladder is pulled out through the belly button. Most patients have this done as an outpatient surgery and go home the same day. After surgery, some people will have long-term changes, such as loose stools after heavy foods. The pain episodes will be gone—you may think you can go back to eating all the meat and cheese and grease you want. Sometimes this may not be the case, and eating habits may have to be permanently improved. Make no mistake about it—gallstones are made of cholesterol. The typical gallbladder patient in the U.S. is Hispanic, age 50-60, female, overweight and has had children. In South Texas, however, the average patient is significantly younger—my youngest patient was 17 years old. The reason for that has mostly to do with our fast-food, high-carb, low-fiber, high-cholesterol diet.
If you think you may be having trouble with your gallbladder, please make an appointment with us. We will walk with you on your path to better health!
Dr. Maria A. Palafox is a general surgeon and active member of the medical staff in the Methodist and Baptist Health Systems. Her office is located in San Antonio at 8235 S. New Braunfels, Suite 201, in the Brooks City Base, near the UIW Medical School Campus. Please call 210-504-5053 to schedule an appointment.