Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Medical Author: Jay W. Marks, MD Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
Viewer question: My sister had her gallbladder removed recently. What kind of diet will she need to be on, and will she now be at greater risk for heart disease?
Doctors response: The gallbladder is a sac that
stores bile made by the liver in between meals. After a meal, the gallbladder
squeezes the bile it has stored into the intestine. In the intestine, the bile
mixes with food and fat. Bile is important because it helps with the digestion
of fat and its transfer from the intestine into the body.
When the
gallbladder is removed, bile made by the liver can no longer be stored between meals.
Instead, the bile flows directly into the intestine anytime the liver produces it.
Thus, there still is bile in the intestine to mix with food and fat.
Black pigment gallstones occur when there is increased destruction of red blood cells, and brown pigment gallstones
occur when there is slow flow and infection of bile.
The majority of gallstones do not cause symptoms.
The most common symptoms of gallstones are biliary colic and cholecystitis.
Gallstones do not cause intolerance to fatty foods,
belching,
abdominal distention, or
gas.
Gallbladder sludge is associated with symptoms and complications of gallstones; however, like gallstones, sludge
usually does not cause problems.
The best single test for diagnosing gallstones is transabdominal ultrasonography.
Other tests include endoscopic ultrasonography, magnetic resonance cholangio-pancreatography (MRCP),
cholescintigraphy (HIDA scan), endoscopic retrograde cholangio-pancreatography (ERCP), liver and pancreatic
blood tests, duodenal drainage, oral cholecystogram (OCG), and intravenous cholangiogram (IVC).
Gallstones are managed primarily with observation (no treatment) or removal of the gallbladder (cholecystectomy).
Less commonly used treatments include sphincterotomy and extraction of gallstones, dissolution with oral medications,
and extra-corporeal shock-wave lithotripsy (ESWL). Prevention of cholesterol gallstones also is possible with oral medications.
Symptoms of gallstones should stop following cholecystectomy. If they do not, it is likely that gallstones were left in the ducts, there is a second problem within the bile ducts, or
there is sphincter of Oddi dysfunction.
Continuing research is directed at uncovering the genes that are responsible for the formation of gallstones.
What are gallstones?
Gallstones (often misspelled as gall stones, or gall stone) are stones that form in the gall (bile)
within the gallbladder.
(The gallbladder is a pear-shaped organ just below the liver that stores the bile
secreted by the liver.)
Bile is a watery liquid made by the cells of
the liver that is important for digesting food in the intestine, particularly fat.
Liver cells secrete
the bile into small canals within the liver.
The bile flows through the canals and into larger
collecting ducts within the liver (the intrahepatic bile ducts).
The bile then flows through the intrahepatic
bile ducts out of the liver and into the extrahepatic bile ducts-first into the hepatic bile ducts, then into
the common hepatic duct, and finally into the common bile duct.
From the common bile duct, there are two
different directions that bile can flow.
The first direction is the common bile duct and into the intestine where the bile mixes with food
and promotes digestion of food.
The second direction is into the cystic duct, and from there into the
gallbladder (often misspelled as gall bladder).
Once in the gallbladder, bile is concentrated by the removal (absorption) of water.
During a meal, the muscle that makes up the wall of the gallbladder contracts and squeezes the
concentrated bile in the gallbladder back through the cystic duct into the common duct and then into the
intestine. (Concentrated bile is much more effective for digestion than the un-concentrated bile that goes
from the liver straight into the intestine.) The timing of gallbladder contraction-during a meal-allows the
concentrated bile from the gallbladder to mix with food.
Gallstones usually form in the gallbladder; however, they also may form anywhere there is bile; in the
intrahepatic, hepatic, common bile, and cystic ducts.
Gallstones also may move about in the bile, for
example, from the gallbladder into the cystic or common duct.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Pancreatitis is a rare disease in which the pancreas becomes inflamed, occurring when digestive enzymes are activated and begin attacking the pancreas causing damage to the gland. There are two types of pancreatitis, acute and chronic. Most commonly caused by alcohol or gallstones, it can lead to bleeding in the gland, serious tissue damage, infection, and cysts. Enzymes and toxins may then enter the bloodstream and seriously injure organs, such as the heart, lungs, and kidney.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Dyspepsia (indigestion) is a functional disease in which the gastrointestinal organs, primarily the stomach and first part of the small intestine, function abnormally. It is a chronic disease in which the symptoms fluctuate infrequency and intensity. Symptoms of dyspepsia include upper abdominal pain, belching, nausea, vomiting, abdominal bloating, early satiety, and abdominal distention (swelling). These symptoms are most often provoked by eating.
Cystic fibrosis is a disease of the mucus and sweat glands. Cystic fibrosis is an inherited disease. The outcome of the disease leaves the body malnourished, bulky and fouls smelling stools, vitamin insufficiency, gas, painful or swollen abdomen, infertility, susceptible to heat emergencies, and respiratory failure. There is no cure for cystic fibrosis, treatment of symptoms is used to manage the disease.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Pleurisy, an inflammation of the lining around the lungs, is associated with sharp chest pain upon breathing in. Cough, chest tenderness, and shortness of breath are other symptoms associated with pleurisy. Pleurisy pain can be managed with pain medication and by external splinting of the chest wall.
Sickle cell anemia (sickle cell disease), a blood disease which shortens life expectancy, is cause by an inherited abnormal hemoglobin. Symptoms may include bacterial infections, painful swelling of the hands and feet, fever, leg ulcers, fatigue, anemia, eye damage, and lung and heart injury. Treatment for sickle cell anemia aims to manage and prevent the worst manifestations of the disease and focuses on therapies that block red blood cells from stacking together, which can lead to tissue and organ damage and pain.
Pancreatic cysts are collections of fluid within the pancreas. Some are benign, malignant, or pseudocysts. There are two major types of pancreatic cysts, inflammatory cysts and non-inflammatory cysts. Non-inflammatory cysts include: serous cyst adenomas, mucinous cyst adenomas, intraductal papillary mucinous neoplasm (IPMN), and solid pseudopapillary tumor of the pancreas. Symptoms of pancreatic cysts include abdominal pain, jaundice, fever, chills, and sepsis. Treatment depends on the type of cyst, and patient health.
Beta Thalassemia is the most familiar type of thalassemia. Thalassemia is not just one disease but rather a complex series of genetic (inherited) disorders all of which involve underproduction of hemoglobin.
Gallbladder cancer is a rare form of cancer with symptoms that include jaundice, abdominal pain, fever, nausea and vomiting, abdominal lumps, and bloating. Risk factors include being female and Native American. Treatment of gallbladder cancer depends upon the stage of the cancer, the type of gallbladder cancer, and whether the cancer can be removed by surgery.
Nausea and vomiting are symptoms that may be caused by many conditions. Antiemetics are drugs that treat nausea and vomiting. Though some antiemetics for motion sickness and mild nausea are available over the counter (OTC), most require a medical evaluation and prescription.
Alpha thalassemia is a disorder in which the alpha globin protein is underproduced. There are two pairs of genes that carry the code for the alpha chains of hemoglobin. When one gene is impaired, that person is in a carrier state and suffers no medical problems. When four genes are impaired, the production of fetal and adult hemoglobin is prevented, resulting in hydrops fetalis and leading to death before birth.
Asbestos exposure lung disease is divided into three main types, asbestosis (lung scarring caused by asbestos fibers), disease of the lining of the lung (pleural plaques, scarring, or fluid accumulation), and lung cancer. Mesothelioma is cancer of the lining of the lung caused by asbestos exposure. Cancers of the larynx, throat, kidney, esophagus, and gallbladder have been linked to asbestos exposure. Treatment is dependant upon the type of condition related to asbestos exposure.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Duodenal diverticula (extramural or intramural), or duodenal diverticulum, is a pouch that is attached to the first part of the small intestine (duodenum). The cause of extramural diverticula is not clear, however, it may be congenital. Complications caused by duodenal diverticulum include rupture, gallstones, or pancreatitis. Extramural duodenal diverticula has no symptoms. Treatment is generally surgery.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Fast food consumption and lack of exercise are just a couple of causes of childhood obesity. Health effects of childhood obesity include type 2 diabetes, heart attack, stroke, high cholesterol, asthma, sleep apnea, gallstones, fatty liver disease, GERD, depression, and eating disorders.
Choledochal cysts are cysts of the bile ducts. There are several different types of choledochal cysts. These cysts are congenital, however, their cause is not known. Symptoms of choledochal cysts in infants include an enlarged liver and jaundice. In older people, the cysts cause abdominal pain, jaundice, cholangitis, gallstones, and pancreatitis. Treatment for choledochal cysts is surgery.
*Pancreatitis facts Medically Edited by:
Charles P. Davis, MD, PhD
Pancreatitis is inflammation of the pancreas, the organ that secretes
digestive enzymes into the gastrointestinal tract; it also synthesizes and
secretes insulin and
glucagon.
Pancreatitis may be caused by
gallstones (by blocking the pancreatic duct
outlet), chronic alcohol use, trauma, medications, infections, tumors, and
genetic abnormalities.
Acute pancreatitis with upper
abdominal pain that is often severe and
constant over several days, and may be accompanied by
fever,
nausea,
vomiting,
tachycardia, and abdominal swelling; severe cases can develop
dehydration,
low
blood pressure, shock, organ failure, and death.
Acute pancreatitis is diagnosed preliminarily by the patient's history,
physical exam and the levels of amylase and lipase in the blood (elevated in
pancreatitis patients); other t...
