Gallbladder removal better than meds?
DEAR DOCTOR: How necessary is the gallbladder? I recently had two flare-ups. My doctor said that if I have another gallbladder attack, he would recommend removal.
DEAR READER: The liver, which is next to the gallbladder, produces bile, which contains bile salts. These salts are secreted into the small intestine after eating, helping emulsify fats so they can be absorbed more easily. Some of the bile is stored in reserve within the gallbladder. While bile is important, the benefit of bile storage in the gallbladder is more complex.
Gallstones occur when the bile in the gallbladder is saturated with either cholesterol or bilirubin, formed by the breakdown of red blood cells. The problem with these stones is that they can lead to inflammation and infection of the gallbladder; they also can get trapped within the duct that leads to the small intestine. Both cases require surgery.
However, a gallstone can also block a duct leading from the gallbladder; this occurs when the gallbladder contracts during eating. The contraction of the gallbladder, in addition to the blockage of the duct, leads to increased
pressure in the gallbladder and pain in the upper abdomen toward the right side. A fatty meal can cause greater contraction of the gallbladder and thus more pain.
To prevent further attacks of what is termed biliary colic, you could consider staying away from high-fat foods and taking medication to help dissolve the stone. However, the success rate of these combined measures in preventing further attacks is only 30 percent. To prevent more attacks, not to mention the possible complications of gallbladder or bile duct infections, the majority of people opt for the removal of the gallbladder.
Because bile is helpful for the absorption of fats, one would think that gallbladder removal would create a problem in this respect. That’s not the case. The liver still produces the bile needed to absorb fats.
There are benefits to having a gallbladder, but you can live a long and healthy life without it.
Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA 90095.