Gallstone issues

DEAR DR. ROACH: My husband’s doctor is telling him to have his gallbladder removed because sometimes he has pain in his right side.

They did all kind of tests, but he has pain when he drives long hours or when he eats salads, not fried or fatty foods. Can you tell me more about the surgery, and what it might be like for him after the surgery?

ANSWER: Almost every time a gallbladder needs to be removed, it is because of gallstones. Gallstones are common. Six per cent of men and 9 per cent of women have them, but most of the time, people have no symptoms.

It isn’t always clear whether the symptoms people have are due to the gallstones that are found on imaging studies, such as CT or ultrasound, but there are some clues to help decide whether a gallbladder that contains stones needs to be removed.

The classic symptoms are pain in the right upper abdomen, especially after eating a fatty meal, such as fried food (some people eat salads with lots of fatty dressing).

Sometimes gallbladder pain is not food-associated. Symptoms at nighttime are not uncommon. Nausea, bloating, lower chest pain, belching and burning pain are all well-described with gallbladder disease, and the proof comes when surgery relieves the symptoms.

Sometimes, the imaging test can give clues. Thickening of the gallbladder wall or pain with pressure on the gallbladder (Murphy’s sign) are suggestive of acute gallbladder inflammation.

Unfortunately, doctors aren’t always right. Occasionally a person’s gallbladder is removed, and it doesn’t help the symptoms at all. Then, a new search needs to be done to discover the true cause of the symptoms.

Most people do very well after gallbladder surgery. The liver itself takes over the job of storing bile, in the ducts of the liver, and bile is released into the intestines appropriately after eating.

However, it takes time for the system to get adjusted to not having a gallbladder, and only 60 per cent of people are completely back to normal after three months. A few people have persistent symptoms for years. Thus, it’s wise to be as sure as possible that symptoms are due to gallbladder disease before undergoing surgery.

Readers may email questions to ToYourGoodHealth@med.cornell.edu