Your Health Matters
By Claudia Parks, R.N.

When it rains it pours- an old cliché but sort of fits the episodes in my life at the moment. After nursing my daughter who had surgery on her broken foot and ankle, down in Florida, I returned to find my husband- who is almost always healthy, and with good genes (a mother who is 102 and in and about her home) having these off and on attacks of severe pain! My question to him, "Where is this pain and on a scale of one to ten where would you rate it?" His answer was "ten"! He pointed to the upper area of his abdomen and to the right side. In medicine we say, RUQ (right upper quadrant). I told him that I'm thinking gallbladder!

We visited the doctor and then over to UG Hospital and had some blood tests and abdominal and chest x-rays along with an ultrasound of the gallbladder. Yessirree! Three gallstones! Now to visit the surgeon! What ever happened to the typical gallbladder patient? The textbooks would say. "Expect gallstones in a fat, forty, female!" Now you see stones in young and older people, skinny and plump, male and female. Many general surgeons say that next to hernias it's the thing upon which they operate most- (not counting breast biopsies).

The gallbladder is a sac located under the liver. It stores and concentrates bile produced in the liver. Bile aids in the digestion of fats, and is released from the gallbladder into the upper small intestine (duodenum) in response to food (especially fats). Conditions which slow or obstruct the flow of bile out of the gallbladder result in gallbladder disease.

Cholecystitis ("co-lee-sisti tis) which is inflammation or infection of the gallbladder. Acute cholecystitis is a sudden inflammation of the gallbladder that causes severe abdominal pain. In 90% of cases, it is caused by gallstones in the gallbladder. Severe illness, alcohol abuse and, rarely, tumors of the gallbladder may also cause cholecystitis. Acute cholecystitis causes bile to become trapped in the gallbladder. The build up of bile causes irritation and pressure within the gallbladder. This can lead to bacterial infection and perforation of the organ.

The main symptom is abdominal pain- particularly after a fatty meal- that is located on the upper right side of the abdomen (under the right rib cage). Occasionally, nausea and vomiting or fever may occur. Often pain radiating to the back or below the right shoulder blade may be present. A doctor's examination of the abdomen by touch (palpation) may reveal tenderness.

You may have episodes of severe pain lasting for a short period of time or up to four to six hours and then subside. These attacks may come several times a week or several times a month. You need to contact your health care provider if severe abdominal pain persists. Ease your mind by a few painless tests to see if you have gallstones or an infection and need antibiotics!

My Bill is scheduled to have laparoscopic gallbladder surgery at the end of this week. Oh, how I remember when patients had a cholecystectomy- years ago and it was major, major surgery and spent at least a week in the hospital with all kinds of tubes coming out of you!

Laparoscopic gallbladder surgery removes the gallbladder and gallstones through several small incisions in the abdomen. The surgeon inflates your abdomen with air or carbon dioxide in order to see clearly. Now the surgeon inserts a lighted scope attached to a video camera (laparoscope) into one incision near the belly button. The surgeon than uses a video monitor as a guide while inserting surgical instruments into the other incisions to remove your gallbladder. General anesthesia will be needed for this surgery, which usually last less than two hours. Often patients are able to go home within 12 to 20 hours.

After surgery, bile flows from the liver through the common bile duct and into the small intestine. Because the gallbladder has been removed, the body can no longer store bile between meals. In most people, this has little or no effect on digestion. Many of you that have had it removed are now happy people!

Claudia Parks, RN, is a former doctor's office and emergency room nurse and retired as an educator from Fulton County Schools. She writes Your Health Matters as a public service; the information here is designed to help you make informed choices about your health. It is not intended as a substitute for the advice of your physician. Claudia and her husband make their home in the beautiful north Georgia Mountains, near Blairsville. Claudia can be reached at yhm@windstream. net