Weight Stigma And The Five Fs Of Gallstone Disease
In medical school, we were taught a multitude of mnemonics to help us memorize lists related to basic science and clinical care. One of those mnemonics was the 5 Fs, a list of risk factors for the development of gallstone disease: Female, Fertile, Fat, Fair, and Forty. If a patient came in to the hospital or clinic with upper abdominal pain, we were taught to use this mnemonic to determine if the patients symptoms may be caused by gallstones. The gallbladder is a small organ adjacent to the liver that holds bile, a liquid that helps the body digest food. Gallstones are small, hard masses that form in the gallbladder and are made up of cholesterol, calcium salts, and bile pigments. About 10-15 % of the population has gallstones, and this incidence varies among ethnic groups. However, only 15-25% of those with gallstones will have symptoms related to gallstones. In some individuals, gallstones can push against the opening of the gallbladder, leading to increased pressure in the gallbladder and associated abdominal pain, known as biliary colic.
Dont Confuse Gallbladder Disease With Gastric Pain
The next time you complain of gastric pain, think twice before dismissing it offhand. That sporadic pain in the centre of your upper central abdomen, which seems to get worse at times, could be a symptom of gallbladder disease.
“The gallbladder is a small sac on the underside of the liver that is used to store bile, which is produced by the liver to aid in fat digestion,” explains Dr Victor Lee Tswen Wen, consultant surgeon at the Department of General Surgery at Singapore General Hospital.
“Bile consists of water, cholesterol, bile salts, fats, proteins and bilirubin ,” adds Lee. “If the liquid bile contains too much cholesterol or bilirubin, it can harden into gallstones.”
Gallstones are the most common result of gallbladder disease. Lee says: “When formed, gallstones can be of varying number and size. Some are as small as a grain of sand, while others are as big as golf balls.”
Types of gallstones
There are three main types of gallstones, and their formation is affected by factors such as age, diet and ethnicity.
Cholesterol stones: Made of hardened cholesterol, these are yellowish in colour. In Western countries, most gallstones feature cholesterol stones.
Pigment stones: Made of bilirubin, these are small, dark-coloured stones most commonly seen in the developing world.
Mixed stones: These are a combination of cholesterol and pigment stones. In Singapore, most gallstones feature mixed stones.
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What Exactly Is The Gallbladder Anyway
Most of the time, the gallbladder just stores bile produced by the liver. Bile helps to break down fats, so when you eat a meal, the gallbladder gets to work squeezing some of that bile into the intestine to help with digestion.
If bile contains too much of one or more of its components, it can harden into pebble-like gallstones, which can block the flow of bile.
In most people, stones never cause any symptoms, Dr.Kirsch says. If thesesilent stones are discovered accidentally during other medical tests orprocedures, theres no need to do anything about them.
But sometimes, the blockage creates a buildup of pressure in the gallbladder and causes pain. Thats a gallbladder attack.
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What Is The Diagnostic Approach If This Initial Evaluation Fails To Identify The Cause
The presence of sphincter of Oddi dysfunction in a patient that still has his/her gallbladder is a very controversial area, as this is generally felt to be a postcholecystectomy pain syndrome. Although referral to a tertiary center to consider an ERCP with manometry can be made, often those centers would prefer not to do that study in patients with a gallbladder in situ.
Empiric cholecystectomy in patients with a normal functional test and normal structural testing is selectively performed. However, a tertiary opinion should be obtained, other causes should be ruled out, and other empiric therapies exhausted. Patients should understand that it is very possible that gallbladder surgery will not help their pain.
What is the effectiveness of treatment?
Treatment consists of laparoscopic cholecystectomy.
Treatment efficacy varies from study to study but is as low as 30% to 50% in patients with atypical pain, nausea, or dyspepsia however, the efficacy can be much higher in highly selected patients with typical biliary pain. A small percentage of patients can have complications such as a bile leak or other duct injury, among others, but mortality is rare. Conversion to open cholecystectomy occurs uncommonly and takes on the risks of that laparotomy longer recovery time, wound infections, etc.
The efficacy of empiric cholecystectomy in patients with normal gallbladder testing, including ultrasound and HIDA, is not known but anecdotally may be helpful in selected patients.
Pain On Both Sides Of The Abdomen
There are some organs, such as the intestines, that are present in more than one quadrant. Some disorders of the intestines can cause pain in any quadrant, like an:
- lactose intolerance
In some cases, the pain may not be only on one side of your abdomen. If your upper abdomen is causing you pain , the culprit could be a stomach issue , pancreatitis , or even a heart attack.
If you have pain in your lower abdomen , it could be due to a disorder of the bladder or appendix, diverticulitis, kidney stones, or gynecologic problems .
No matter where your abdominal pain is located, your doctor will also have other questions about your abdominal pain, such as:
- When does the pain occur?
- Is the pain sharp/dull/constant/intermittent/radiate to other areas?
- How long does the pain usually last?
- What makes the pain better/worse?
- Do you have any other symptoms in addition to the pain?
Its important to see a gastroenterologist if youre having persistent and/or severe belly pain. You may need an endoscopic procedure to appropriately diagnose/treat your disorder. Contact our gastroenterologists at Digestive Health Associates of Texas today!
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Can A Bad Gallbladder Cause Black Stools
Other conditions that can cause changes in stool color include certain medications, hemorrhoids, ulcerative colitis, gallbladder disease, and celiac disease, among others. Any condition that can cause bleeding into the gastrointestinal tract can cause blood in the stool and a change in color to bright red or black.
Watch And Wait Approach
For people with asymptomatic gallstones, a “watch and wait” approach is taken, meaning surgery to remove their gallbladder is only done if and when their gallstones begin causing symptoms.
Only about 50% of people with asymptomatic gallstones will go on to develop symptoms, whereas surgery does carry some risks. A low-fat diet can be beneficial in preventing gallstone formation, as 80% or more of gallstones are made of cholesterol.
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Mimics Of Gallbladder Pain : Gastroenterologist Explains
Our content is not intended nor recommended as a substitute for medical advice by your doctor. Use for informational purposes only.
The most common cause of gallbladder pain is biliary colic resulting from gallstone.
Uncomplicated gallstones produce characteristic biliary-type gallbladder pain.
The characteristic of biliary colic is explained in the below table:
|Biliary colic .|
|Usually, The right upper quadrant of your abdomen|
|2. Spread||The pain may spread to the back of the right shoulder. Also, it spreads to the epigastric area.|
|3. Character||Constant builds up then disappeared gradually.|
|4. Duration||At least 30 minutes. It may last up to 6 hours.|
|5. Relation to food||Triggered by foods (especially fatty food and large meals. However, it can start spontaneously.|
|6. NOT related to:||Movement, bowel movements, nor the passage of flatus.|
|Vomiting, sweating during the attack.|
|6. Unusual symptoms.|
|Prolonged pain for more than 6 hours. Extreme tenderness over the gallbladder . Vomiting of blood, blackish stool .|
The following condition can mimic gallbladder pain:
- Gastritis and gallbladder disease.
- Acute cholecystitis: gallbladder infection as a complication of gallstones.
- Cholidolethiasis: The obstruction of the common bile duct with gallstones.
- Sphincter of Oddi dysfunction.
- Others: gallstone pancreatitis, hepatitis, liver abscess, liver cancer, and right rib cage pain.
Treatment For Acute Pancreatitis
Inflammation in acute pancreatitis involves the whole pancreas, so diabetes can result due to damage to the parts which normally produce insulin, known as islets of Langerhans. Patients may need multidisciplinary care in an intensive care unit, including artificial ventilation and other forms of life support.
When gallstones cause a severe attack of acute pancreatitis, the treatment plan may include attempts to remove the stone. This is usually first attempted by ERCP, but can also be done with a standard surgical operation.
Unfortunately, there is no specific treatment for pancreatitis. Treatment for acute pancreatitis is largely supportive, such as:
- adequate pain control
- replacement of fluids and nutrition
- bowel rest to reduce the production of enzymes by the pancreas, thereby reducing swelling
Antibiotics are needed when an infection is detected in the pancreas or other organs. There are experimental medicines aimed at reducing the secretion of pancreatic poisons, and neutralizing their effects.
Patients may require treatment for local complications of pancreatitis, such as pseudocysts and abscesses. When pseudocysts cause continuing symptoms , the fluid must be drained. This can be done by:
- passing a tube through the abdominal wall
When these are performed, it is usually necessary to leave a tube behind for continuing drainage.
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Gallbladder Attacks Very Common Around Seasons Of Large Social Gatherings
Rich foods, larger portions all play role in increased incidences
DAYTON, Ohio A local surgeon says weight gain isnt the only downside of big social events where many tend to over-indulge in rich foods high in fat. Its also the perfect setting in which an increase of gallbladder attacks often occurs.
The weekend after Thanksgiving is notorious for a time in which we see an increase in gallbladder attacks, said Steven Sutherin, MD, FACS, a general surgeon with Miami Valley Surgery Associates. We tend to see patients in the emergency room that weekend for gallbladder attacks more than any other part of the year. But it can occur during any social gathering where people tend to each lots of rich food higher in fat.
The gallbladder is one of the bodys digestive organs that serves as a depot for bile. Bile is a liquid created by the liver that travels down into the intestines and helps digest foods, particularly those that are high in fat. Since the body doesnt require bile 24 hours a day, it is stored in the gallbladder until it is needed.
A gallbladder attack is when the liquid in the gallbladder crystalizes to a consistency similar to sugar candy or into small stones that act as a barrier to the exit door of the organ. An attack occurs when the liquid is unable to exit the organ.
Consider the following points of action to avoid suffering from a gallbladder attack or to reduce your risk of experiencing another one:
Gallbladder Attack Symptoms To Look Out For
Chances are you barely know what your gallbladder is, let alone the gallbladder attack symptoms to look out for. When you have really bad stomach pain, its easy to chalk it up to that double bean burrito you ate an hour ago. Or, if its abnormally painful, your mind may jump to appendicitis.
But theres another health condition that can cause bad stomach pain and probably isnt on your radar: a gallbladder attack. Keep reading to learn what the heck your gallbladder is and what it does, plus the signs of a gallbladder attack you should know about.
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How Do I Know If Pain Is Caused By My Gallbladder Or Heartburn
Tuesday, September 6th, 2016 | Written by Premier Surgical Staff
The causes of heartburn and abdominal pain are often bewildering for many patients of Premier Surgical Associates in Knoxville. The leading symptoms of both heartburn and gallbladder disease are upper abdominal pain and heartburn, which understandably sends peoples minds racing.
Adding to the confusion is the fact that what typically causes heartburn can also trigger a gallbladder attack a diet of fatty or spicy foods, lying down after eating, being overweight, and genetics.
If the symptoms and the sources of both heartburn and gallbladder are so overlapping, how do you know which you may be experiencing? Upper abdominal pain can be caused by a variety of disorders, including acid reflux and gallbladder disease, and even medical professionals may have difficulty distinguishing among these causes. However, the location, nature, and timing of your symptoms may help clarify a diagnosis.
The gallbladder is a sac that sits in the upper right abdomen that stores bile produced by the liver. The bile aids in the digestion of the food you eat. Most of the time, the gallbladder functions normally, but when it becomes blocked or infected it can become a painful and potentially dangerous medical condition.
Heartburn, or GERD
When to stop guessing and seek immediate help
A Dull Burning Or Hunger
Approximately 1 in 5 senior citizens suffering from abdominal pain are likely to have a peptic ulcer. Peptic ulcer disease accounts for 16 percent of older patients complaining of abdominal pain.5
The most predominant symptom of a peptic ulcer is abdominal discomfort a gnawing or burning pain between the navel and the breast bone being most evident.6
- Duodenal ulcers generally cause a gnawing pain in the upper abdomen that encroaches on an empty stomach hours after eating.7 Eating some food may offer some relief.
- Stomach ulcers, on the other hand, cause a dull ache on a full stomach or in the middle of the night.8 Consumption of food does not help and may only make matters worse.
Some individuals may experience an empty feeling in the stomach a pain that feels like hunger 1 to 3 hours after a meal.9
Peptic ulcer pain can last from a few minutes to hours and may intermittently keep troubling you over a span of days and even months.10
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Indicators For Medical Emergencies
Often seemingly harmless peptic ulcers may worsen and cause more injurious, serious, and possibly fatal complications. Here are warning signs to watch out for.
- Bloody vomit : Strong stomach acids may sometimes abrase the stomach mucosa to the extent of exposing blood vessels and causing internal bleeding.20 Vomit resembling coffee grounds is a cause for concern.
- Abnormally dark stools : Because of internal bleeding, stools may be tainted with blood because of which they appear dark in color. This again may signal a more serious complication.21
- A sudden sharp abdominal pain that worsens with time: An expanding peptic ulcer may penetrate the wall of the stomach or duodenum and is likely to cause unsuspecting severe abdominal pain.22
- Shock-like symptoms: Your body may cave under the immense pain and go into shock. So, pay heed to shock symptoms like excessive sweating, breathlessness, and lightheadedness.23
If one or more of these alarm bells ring, dont hesitate to hasten to the nearest medical facility.
Poor Appetite And Inexplicable Weight Loss
Recurrent vomiting may further deteriorate your health by depriving your body of block-building nutrients.
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Gallbladder Symptoms Versus Stomach Pain
There are many people who do not know where their gallbladder is or what gallbladder attack symptoms feel like. The gallbladder is a small pear-shaped organ that helps the body digest fat and concentrates the bile that is produced by liver
After eating a meal, the gallbladder releases bile into the intestines that helps digest the dietary fats. When the gallbladder malfunctions, possible serious outcomes can occur. Gallbladder attack symptoms mimic and are similar to those of other diseases, such as gastric ulcers, heart disease, kidney problems, or indigestion. Often, gallbladder pain is ignored or misdiagnosed.
It is important to remember that stomach and abdominal pain are just one of the symptoms of gallbladder malfunctioning.
If you have stomach pain in addition to the following symptoms, it may help you assess real gallbladder symptoms versus stomach pain.
Gallbladder symptoms can include chest pain on the right side of the body or the upper middle or right abdominal area, often caused by stones in the bile duct. The gallstones can block or slow the flow of the bile in the bile duct from the liver to the small intestine, resulting in either a dull ache or sharp pain in the surrounding area.
Jaundice is a condition where the flow of bile is blocked, backed up into the liver, and is released into the bloodstream, causing the skin and whites of the eyes to turn yellow. If you notice this occurring, you should see a doctor immediately.
What Are Peptic Ulcers And How Are They Caused
Duodenal ulcers are common in the middle-aged and in men, whereas stomach ulcers are common in the elderly and in women.1
Peptic ulcers are open sores that develop in the lining of the esophagus, stomach, or duodenum when the protective mucus overlaying this lining is eroded.
The acid-resistant gut mucosa can be compromised because of:
- An H. Pylori bacterial infection2: This infection disrupts the integrity of the muscosal lining.
- Long-term use of NSAIDs 3: NSAIDS include common OTC drugs like aspirin, ibuprofen, and naproxen.
- Zollinger-Ellison syndrome4: In this condition,abnormal gastrin secretion by tumors in the duodenum or pancreas cause stomach acids to be produced in excess of the normal. High concentrations of acid become too overbearing for the mucosal layer to counteract.
Whatever the reason for erosion of mucus, it leaves the stomach and duodenal lining exposed, vulnerable, and at the mercy of strong stomach acids.
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