Gallbladder

Gallbladder diseases

Bile diseases

Nutrition in patients with bile diseases and gall stones

The patient, who suffers from gall stones must remove from the diet all meals, which lead to strong gallbladder emptying, and thus an attack of gall stones. These are primarily fat, bacon, eggs and fatty meats, and to a lesser extent, all abundant and difficult to eat food. At the same time, abundant and greasy food accelerates the formation of bile disease. Diet will vary in the "acute" period of sharp attacks from the diet in a quiet period.

In the period of major difficulty with the attacks the patient should first fast and only drink chamomile tea, and then we will add liquid food-which should include milk and soups to gradually add solid food. However, we will exclude any significant amount of fat, which will be given to the patient only in the form of cream, butter and oil. Eggs should be completely banned, and the food should be given in small quantities in several meals, and it should be composed primarily of starch and dairy foods, with moderate adding of meat and vegetables.

And after the difficulty ease up, the patient will permanently be given food with little fat, whose amount should not be limited below 50 grams per day. We cannot give fatty meat, particularly pork. Eggs will be permitted only as a necessary addition to a variety of cakes and meals of flour, not as an independent meal.

Basic guidelines for patients are the following: food should contain optimal amounts of protein (1g per kg. of weight), minimum amount of fat and carbohydrate intake to the nutritional status of patients, food should be easily digestible, so recommended are boiled and steamed prepared meals, vegetables cooked in salted water and poured over with fresh oil (preferably olive), pasta should be prepared without eggs or with egg white and yeast with a little oil or margarine, do not take any cold or too hot drinks and meals.

Permitted

Soups: lean meat soup, vegetable soup – you can put all kinds of pasta, rice, wheat grits.

Meat: veal, white meat of poultry, fish, bleak ham.

Vegetables: mashed potatoes boiled in salted water with butter, or in shell cooked, spinach, cauliflower, carrots, asparagus, pumpkins, squash, chard, tomatoes, all as a soup-and this is best cooked and mashed, soaked with butter or oil. Pasta: toast, old bread rolls, biscuits, pretzels, pancakes, all the cooked pasta, which should be prepared with little eggs without yeast and with a little butter. In addition allowed is pasta with potatoes, or potato flour so-called potato dough.

Sweet dishes: grits or rice soufflé, no eggs and yeast, marmalade, preserves, jam, honey.

Other dishes: grits, rice, cottage cheese, corn flour, oat flakes.

Salads: green, swiss chard, tomatoes, cauliflower, beets (prepared with lemon juice).

Fruits: all kinds of fruit-boiled, no peel, fruit juices.

Beverages: tea, cocoa, coffee but not too strong, milk.


Not allowed

Eggs, pork and goose fat, butter, tallow, bacon, smoked meat, sausages, grilled and fried meat, pork, beef, venison, duck and goose fat, goose liver, salami, hot dogs, canned meat, caviar, sardines, garlic sauce, onions, cucumbers, dill and all gravy sauces.

All cheeses matured and of sharp taste, greasy, or dried, baked potatoes, or stewed, beans, lentils, radishes, cucumbers, kale, cabbage, turnips.

Quince, melon, watermelon, almonds, walnuts, hazelnuts.

Bread and yeast dough and a lot of butter and eggs.

Paprika, pepper, beans salad and cabbage salad, spices-pepper, paprika, cinnamon, clove, Muscat.

All alcoholic beverages.

Thursday, November 18, 2010

Gallbladder Removal

Gallbladder Removal - Gall bladder surgery

The gall bladder is not a vital organ, so the body copes quite well without it. Cholecystectomy, or surgical removal of the gall bladder, is therefore recommended if gallstones (or other types of gall bladder disease) are causing problems.

Surgical techniques

Techniques to remove the gall bladder include:

• Laparoscopic cholecystectomy - or ‘keyhole’ surgery. A number of small incisions are made through the skin, allowing access to a range of instruments. The gall bladder is removed through one of the incisions.
• Open surgery (laparotomy) - the gall bladder is accessed through a wider abdominal incision. Some of the factors that may predispose a patient to open surgery include scarring from prior operations and bleeding disorders.

Laparoscopic cholecystectomy

The general procedure includes:

• A number of small abdominal incisions are made, allowing slender instruments access to the abdominal cavity.
• A tube blowing a gentle stream of carbon dioxide gas is inserted. This is to separate the abdominal wall from the underlying organs.
• The gall bladder is viewed on a TV monitor by the surgeon using a tiny TV camera attached to the laparoscope.
• Special x-rays (cholangiograms) during the operation can check for gallstones wedged within the bile ducts.
• The ducts and artery which service the gall bladder are clipped shut. These clips are permanent.
• The gall bladder is cut free using either laser or electrocautery.
• The gall bladder, along with its load of gallstones, is pulled out of the body through one of the abdominal incisions.
• The instruments and the carbon dioxide gas are removed from the abdominal cavity. The incisions are sutured and covered with dressings.

Open gall bladder surgery

The general procedure is the same as for laparoscopic surgery, except the gall bladder is accessed via a large, single incision in the abdominal wall. Sometimes, an operation that starts out as a laparoscopic cholecystectomy turns into open surgery if the surgeon encounters unexpected difficulties, such as not being able to properly see the gall bladder.

Tuesday, October 26, 2010

What does the gallbladder do?

We all know that blood flows through all regions of our body. It brings nutrients and waste from cell to cell. The Liver acts as the main filter for this blood and it is the main eliminator of waste in our body. Its job is to remove all forms of waste, including dead blood cells and toxins. The waste product that is created as a result of the Liver cleansing out toxins - is bile, which is being manufactured at all times. Not being wasteful, the design of the human body actually has a use for this bile other than simple elimination.

Bile is the main substance responsible for the breaking down of fat in the digestive system. The gallbladder is the organ that receives the bile from the liver and stores it until it is needed in the digestive system to break down fats and cholesterols.

Where is your gallbladder?

The gallbladder is located in the upper right quadrant of the abdominal cavity under the liver. It's a sac that receives and stores bile from the liver and has a duct that empties the bile into the digestive tract's small intestine (duodenum). The bile provides an emulsifier of fats/lipids to aid in digestion.
Gallbladder is under the lowest ribs on the right side of your stomach in the abdomen. The gallbladder is in the abdominal cavity and is part of the digestive system.

Who suffer from gall stones and gallbladder disease?

Between 10 and 20 percent of all adults above 40 have gallstones, however, only one to three percent of them are complaining about the gall bladder  symptoms. Gall stones occur in almost 25% of women in the age of 60 and up to 50% at the age of 75 and above. About 20% of men have gallstones until the age of 75 years. Gall stone disease is relatively rare in children. Women have probably greater risk because estrogen stimulates the liver to remove more cholesterol from the blood and directs it into the bile. It is more likely that pregnant women with stones have symptoms. Increased risk of gallstones has been noticed in women taking oral contraceptives and in those who use estrogen replacement therapy after menopause.

It is more likely to develop gallstones in men and women with excessive body weight or obese and those who take food with lots of saturated fat and refined sugar. Variations in body weight (weight loss and then return of the weight) also increase the risk of bile stones. Drugs for lowering cholesterol reduce blood cholesterol levels by increasing the amount that is excreted in bile, which increases the risk of bile stones. Other risk factors that reduce the flow of bile and thus increase the risk of gallstones include starvation, pregnancy, and intravenous nutrition. Cirrhosis is a great risk for gall stones, especially the pigment ones. Gallbladder disease may progress faster in patients with diabetes, which usually suffer from severe infections.

Sunday, September 5, 2010

Guidelines for nutrition in patients with gallbladder disease

In the acute phase for pain is given only carbohydrate- sweetened water, fruit juices, tea, later mushy and puree food - potatoes, rice, semolina, pasta, all cooked in milk, puree vegetables - spinach, cauliflower or fruit puree. Then one starts taking the abundant food.

Permitted
Soups: meat soup, vegetable soup with browned flour with butter or oil - in the soup one can put all types of pasta, rice and wheat semolina
Meat: veal, white meat from poultry, fish, bleak bacon
Vegetables: Potatoes – mashed, cooked in salt water and sprinkled with butter, or cooked in shell, spinach, cauliflower, carrots, asparagus, pumpkins, swiss chard, tomatoes - all as stew and is best cooked and pureed, sprinkled with butter Pastas: white bread - overdone, or toast, the old bread, biscuits, pretzels, pancakes, all cooked pasta, which should be prepared with a little egg, without yeast, and with a little butter. In addition also are allowed pasta with potatoes, or potato flour
DESSERTS: grits or rice soufflé, no eggs and yeast, marmalade, jam, honey.
Other dishes: grits, rice, cottage cheese, corn flour, corn flakes.
Salads: Swiss chard, tomatoes, cauliflower and beetroot - all prepared with lemon juice or oil.
Fruits: all fruits - cooked without the peel and fruit juices.
Beverages: tea, cocoa, coffee, not too strong, milk.

Important: Do not eat too hot food or drink hot drinks, eat more often, never too much for one meal. After eating lie down for at least half an hour, on the gallbladder area put a warm compress or hot water bottle. I again emphasize: carbohydrates first, flour, rice, semolina, sugar, jam, honey, fruit juices, cooked fruit and bread.

Not allowed
• Eggs
• pork and goose fat, margarine
• bacon, dried meat, sausages, baked and fried meat, pork, beef, venison, fatty goose and duck, foie gras, salami, hot dogs, canned meat
• caviar, sardines
• garlic sauce, onions, cucumbers, dill and all the sauces and gravy
• All mature cheese of sharp taste, greasy, or dried
• potato fries, onion potatoes, beans, radish, cucumber, kale, cabbage, turnip
• quince, melon, watermelon, almonds, walnuts, hazelnuts
• bread and yeast dough and lots of butter and eggs
• paprika, pepper, beans and cabbage salad, spices - pepper, paprika, cinnamon, clove
• all alcoholic beverages, especially brandy and cold beer

Tuesday, June 22, 2010

Gall bladder diet - FOOD FOR PATIENTS with diseases of gall bladder

Shortly on gall bladder diseases

Gall bladder is a pouch that has a role as a reservoir which collects the bile that the liver produces about 1 liter per day. This liquid, which contains bile salts, cholesterol, bilirubin, phospholipids and water, allows the digestion of fats in the small intestine. Until we eat, in the gallbladder the solution is concentrated 4-10 times and ends in the intestine when food from the stomach enters the duodenum. The activity of gallbladder particularly reacts on cream, butter, egg yolk, etc.

Most common diseases of gall bladder are stones and inflammation. Generally are associated with obesity, older age, female sex, family history, western diet, diabetes. Gall stones can cause typical gall attacks that occur after fatty meals and can lead to serious problems and can be life threatening (inflammation of the gallbladder, obstructive jaundice, pancreatitis ...), but they can also be for years without any problems.
Treatment begins with correcting the dietary habits - the so-called gall diet and because of potential complications gall bladder surgery is usually recommended. In the absence of symptoms and signs of inflammation of the gallbladder, proper nutrition is usually enough.

Sunday, June 20, 2010

Ultrasound in diseases of gall bladder and bile ducts

One of the leading indications for abdominal ultrasound examination is the need for diagnostic assessment of biliary system - gall bag and bile ducts.
Application of modern Ultrasonology in bile bag and bile ducts diseases reveals and identifies major congenital anomalies, acute or chronic inflammation of the gall bladder, benign or malignant tumors, and usually - gallstone.
Gall bladder is of elongated pouch of pear-like shape, located in the lower side of the liver, where bile is concentrated and “stored ". Bile is a fluid produced by liver cells and is necessary for the process of digesting food in the small intestine. Through the liver bile ducts and bile ducts outside the liver it flows in the small intestine and in the time between meals it is collected in the gallbladder. After taking a meal gallbladder shrinks, thus pushing the content to the main bile duct (ductus choledochus), which flows in the initial part of the small intestine – duodenum. The strongest stimulus for gall bladder contraction provides eggs and foods rich in fat.

Chronic inflammation of gall bladder (chronic cholecystitis)

Chronic Cholecystitis is long-term inflammation of the gall bladder characterized by severe seizures, severe pain in the abdomen. Damaged gall bladder has thickened walls, and it is shriveled and small. Gall bladder wall is composed mainly of fibrous tissue. The inner membrane can be full of scars and gall bladder is containing sludge and gall stones, which often clog bile duct. Such condition often repeats itself and causes new inflammation of the gall bladder.

Wednesday, June 16, 2010

Gall bladder attacks, part II

There is a risk of complications of infection of gallbladder for the development of inflammation of the gall bladder bile ducts, development of localized bacterial infections of gallbladder which can lead to gallbladder perforation or inflammation of the pancreas, which can be life threatening inflammatory disease that requires immediate hospitalization.

Diagnosis:
It is set based on patient symptoms, laboratory tests of blood and urine and ultrasound of the abdominal cavity. Initially, blood test results can still be good, but often within a few hour in the blood there is an increase of the number of white blood cells, and ultrasound examination of the gallbladder shows visible increase of the gallbladder with content that usually cause inflammation (sand, stones ) with or without gallbladder wall thickening.
Treatment:
Depending on the state of patients, it can be conservative (medication and diet), or it can be in hospital (application through the infusion of antibiotics) or operative (surgery). This decision is on the doctor, depending on the condition of patients.

Gall bladder attacks

Typically, gall bladder attacks stop after 2-3 days and completely disappear after a week. If this doesn’t happen, one can have serious complications. High fever, shivering, significant increase of the number of white cells and stopping of the normal intestine running show inflammation of the gall bladder (abscess), gangrene or breakage of gall bladder wall.

In such situations an urgent operation is required. There is particular sensitivity to the pressure under the right costal arch while breathing. In any case, patients with pain in the upper right abdomen, nausea, vomiting, should immediately contact a doctor who will determine by diagnostic tests if it is some other disease or inflamed gallbladder.

Inflammation of the gall bladder

Inflammation can occur after injuries, surgery, burns, on the flesh extended infection (sepsis) and in critical patients, often those who take food for a long-time intravenously. Such inflammation of the gallbladder can be very serious and can lead to gangrene or rupture of gallbladder. Then an emergency surgery is needed.

Symptoms:
Pain in the upper right abdomen is often the first sign of disease. Pain may be stronger with a deep breath, and often is extending to the lower right armpit. Pain can become unbearable and nausea and vomiting are present. Suffered patient feels severe pain when the doctor presses under the right costal arch while breathing. At the beginning of the development of inflammation of the gallbladder with the above symptoms, a patient may have chills and then a gradual increase in body temperature.

Acute gall bladder (Acute cholecystitis)

Acute gallbladder inflammation is inflammation of the gallbladder wall, which usually occurs because of stones or sand in the bile duct or gallbladder neck. Symptoms are sudden, extraordinary pain that is often accompanied by nausea, vomiting, chills and fever.

Sometimes, acute gallbladder inflammation can be encountered in patients who have no stones or sand. Such inflammation may be due to some serious disease and it can be a gallbladder or bile duct tumors. There are also some less common causes of blockage of bile ducts or gallbladder neck. Here we should mention the blockage as a result of damage created during gall bladder surgery in bile duct, then when the bile ducts pass through the chronically diseased pancreas. Less common causes of blockage of bile duct and gallbladder inflammation can be parasitic infections.

Gall bladder surgery

Laparoscopic surgery, also known as 'keyhole surgery' or 'minimally invasive surgery', is now accepted as having major advantages over traditional surgery. This form of surgery leaves minimal scarring and involves less cutting of tissues.
Patients therefore experience less pain after surgery and return to full fitness faster than after open surgery.

What happens after the gall bladder surgery?

Will I again have the pain and all the problems I had and do I have to watch what I eat after gall bladder surgery?
After surgery it is necessary to comply with the diet for 4-6 weeks. After this period the patient is proposed to gradually introduce all the food except for highly fatty food that is not recommended at all in the daily diet, not just after gall bladder surgery.



In an interview with the patients I have learned that after surgery some patients can eat without any digestive problems, some may not eat some kind of food, and some after the surgery are only slightly better. If you have removed all possible other causes of problems before surgery (stomach, duodenum, liver, pancreas, intestine) then the most likely cause is a combination of a few factors. One of the reasons is inadequate or insufficient creation of digestive juices, their inappropriate biochemical composition, and hormonal dysfunction, followed by various psychological problems of anxiety, panic disorder or depression.
Usually surgery goes well, postoperative course of the patient also but a few months after the surgery patient is still not very good. Such patients also often appear in my office with a whole series of different problems and each one must be carefully considered in order to help them.

Is there any other way beside surgery for treating gall stones or sand in the gall bladder?

There are means for oral dissolution that can partially or completely dissolve radiolucent stones, invisible on the X-ray picture or by ultrasound examination of the stones that show no signs of calcification (acoustic shadow below the visible stones in the gall bladder).

The success of the method on described types of gall stones, according to some statistics, is about 50% of patients with stones. However, these drugs are ineffective in radiological clearly visible stones and bile pigment stones. These medications cannot be used on every patient because of contraindications and possible side effects. Decision on what treatment to use is on the physician in accordance with the appearance and number of stones, gallbladder appearance, general condition and age of the patient. In patients that had the oral dissolution therapy and if it was successful recidivism is possible (re-creation of stones) after stopping the therapy.

There are methods of dissolution of bile stones that are applied only in hospital conditions; again only in stone that show no signs of calcification and are radiological invisible bile stones and a method is called Extracorporeal Shock-Wave Lithotripsy (dissolution of stones using a catheter through the skin from the outside, in the bile lines where a solvent is injected. Extracorporeal Shock-Wave Lithotripsy (ESWL) is a non- invasive procedure where shockwaves are used to break apart the gall stone in the gall bladder. However, it is seldom used, as gallstones are usually too large and thick to be broken down by ESWL, and because of a risk that a shattered stone could injure nearby organs. Also, recent research suggests ESWL can damage capillaries, leading to diabetes or hypertension.

What are my options for treatment of gall stones? part II

Patients after this procedure, if they have no complications, go home on the 4th day, must adhere to diet regime for about a month and after these procedures there is no possibility of postoperative hernias in place of the former classic cuts.
Patients often ask the doctor "Do you have to operate on the entire gall bag or can pull out just a stone or stones from the gallbladder? It is necessary to remove the entire bag because there are no ways of taking just pieces of sand or stones by surgery.

Sometimes, when diagnostic procedure shows that there is a stone, stones or sand in the main bile duct (ductus choledochus), or when there has been a rupture (cracking) due to inflammatory changes and stones in the gallbladder it is necessary to make a classic gall bladder surgery. Then the incision is usually a bit bigger because it is necessary to remove the stones or sand from the main duct and remove the gall bag with stones and take all precautions to avoid postoperative sepsis (spread of infection in the blood, where it continues to spread throughout the body and can cause the state of septic shock and death).

What are my options for treatment of gall stones? part I

Most effective method is the operative removal of bile bag by laparoscopic method. Laparoscopic operation is a minimally invasive method of surgery and today is commonly applied method of gall bladder surgery. It is a method that is performed under general anesthesia where on the abdominal wall there is no classic cut as in the past of 10 or more centimeters, but it is surgery, as patients often say, of "four holes in the abdomen”, through which the surgery is performed. Today, 90% of performed surgeries are laparoscopic gall bladder surgeries.

Laparoscopic gall bladder surgery removes the gallbladder with stones or other pathological content via tube which is inserted through small incisions in the abdominal wall. The entire procedure is performed with the help of the camera (laparoscopy), which is also located in the stomach through the incisions. Laparoscopic gall bladder surgery reduced discomfort after operation, shortened hospital staying and reduced sick leave.

Gall bladder surgery: yes or no?

Usual rule is that it is not necessary to operate the gallbladder with stones in it, if it is not causing any symptoms or any other problems to people having them. However, gallbladder surgery with stones should be suggested to patients who:

1. Have pain (fierce attacks) despite an adjusted diet

2. Patients who had complications due to gall stones (inflammation of the gallbladder, bile ducts or inflammation of the pancreas)

3. Patient regardless of whether they have or have not any difficulties, with increased risk of complications if they do not have gallbladder surgery, and those are patients with non-functioning, then chronic inflammatory changed bile bag, with calcified gallbladder wall, and then increased bile bag which threatens to rupture gallbladder

4. When patients with or without stones have visible polyps (benign tumors) in the gallbladder. Gallbladder polyps usually do not create problems and very often are accidentally discovered by ultrasound of the abdominal cavity

Tuesday, June 8, 2010

What is the easiest way to diagnose gall bladder disease? part IV

Some other diseases that can exist together with discovered gastritis may be gall stones, inflammation or dysfunction of pancreas, liver disease. In some patients who had obvious symptoms of gastritis, such ultrasound with dopplerom discovered the tumor of the colon, which is proven later by colonoscopy and was more serious situation for the patient then gastritis, and was the cause of hidden problems.
This text is not written to glorify the ultrasound diagnostics as the best way for diagnosis of all diseases and conditions but I just want to note that the doctor and his approach to the application of modern diagnostic technology must be smartly, rationally and critically applied to each patient depending on his condition. None of the diagnostic methods is a universal mean of work in medicine because only a doctor with its knowledge and experience can best help its patient with the smart use of diagnostic tests in every moment.

Monday, June 7, 2010

What is the easiest way to diagnose gall bladder disease? part III

Based on such examinations, which can be quickly done in equipped clinics one can proceed to further diagnostic procedures that are sometimes necessary so the situation of patients is fully clarified. Often it happens that patient with these problems is first referred to a gastroscopy. At gastroscopy they find gastritis, give treatment and conclude that that was the cause of all problems. Usually when you find one cause of problems, the patient is not sent for further examinations and then you can ignore some other causes of the problems.

Sunday, June 6, 2010

What is the easiest way to diagnose gall bladder disease? part II

Figure 1: Picture taken with doppler where it is visible gallbladder wall inflammation. The figure shows thickening and increased blood flow to the walls of the gallbladder.
Figure 2: It is seen a larger stone in the gallbladder, size of about 3 cm and gallbladder wall thickening, which is on one side of the gallbladder more pronounced. Selected part of the walls can refer to the chronic inflammatory changes or the existence of gallbladder cancer. After calming down the inflammation, this patient goes to surgery of the gallbladder.
Figure 3: The picture shows inflammatory altered gallbladder with a larger stone and fine sand and small stones.
Figure 4: Picture showing inflammatory change of the pancreas, thickened, rough edges, colorful and uneven structure. Thus changed pancreas is caused by previous inflammation of gallbladder due to stones.
Figure 5: The picture shows visible gallbladder, enlarged, completely filled with sand and pebbles and various small stones and mud. This patient was referred to surgery.
Figure 6: Ultrasound image shows hiperehogen (bright bump) size of 4x5 mm in the gallbladder. It can match cholesterol gallbladder or polyp (benign tumor) of the gallbladder.

What is the easiest way to diagnose gall bladder disease?

The simplest and most picturesque way is the ultrasound examination of the abdominal cavity. Any pain, bloating, belch, heartburn, feeling of “weight”, burning sensation in the upper abdomen should be, after the clinical examination and palpation of the abdominal cavity, examined by ultrasound. Very often it happens that such patients are first sent to the gastroscopy, or if they are bloated and have gases or diarrhea to the colonoscopy. All such patients with these complaints should first do an ultrasound examination of the abdominal cavity with Doppler.
Such ultrasonic devices of the latest generation are allowing quick, clear and safe access to the patient's situation. Based on such examination, prior history and careful clinical examination, one can see that the problems belong to the gall bladder, bile lines, stomach, pancreas, liver, or even the gut. Such examinations regularly are completed with laboratory blood and urine tests to make sure the doctor evaluates the situation of patients.

Saturday, June 5, 2010

Gall bladder symptoms: can you help me?

I have had ultrasound examination of the abdominal cavity, the gastroscopy, all results were good but I have problems like seizures or constantly feel bloated, I have heartburn, have fealing of "heaviness" after eating, pain in upper abdomen, sometimes I have diarrhea like or mushy stool? What could it be? Can you help me?

Patients with these problems are common visitors of doctors surgery. It is necessary first to determine the cause of their problems in order to be able to help. First, in the conversation we should determine if there is a history of possible circumstances that can lead to such a condition, when a patient feels these problems.
Causes of these problems may be various, such as folded gallbladder, sand and silt in the gallbladder, because these problems may not be caused only by stones in the gall bladder. Some patients have a polyp (benign tumor) in the gallbladder, which usually does not cause problems, but it is possible that there are several in gallbladder (polyps) and in such patients can cause these problems. In addition, patients can often have a combination of two or more problems of the digestive system (gallbladder, pancreas - the digestive enzymes and maybe previous inflammation of pancreas, stomach, intestines, etc.).
These problems that patients often complain about may be psychosomatic. And precisely on these possible causes, doctors must not forget. Here I will mention that undetected or ignored problems with the gallbladder, stomach or pancreas can lead to complications such as one of the most dangerous inflammation of the pancreas or stomach and duodenum ulcer perforation.

Friday, June 4, 2010

Why and when most gall bladder attacks occur and does it has anything to do with a certain food that is consumed?

Pain that is typical for the gall attack caused by gall stones is due to the moving of stones from the larger free area in the gallbladder to a narrow part of the so-called gallbladder neck with large stones or due to moving small or smaller stones in the gallbladder extraction canal or the main bile duct. The most common causes of gall bladder attacks are:

1. Fatty heavy, spicy food especially fried or cooked in onion or garlic, large amounts of fresh fruits and vegetables, cakes with fatty creams and eggs, chocolate and nuts, cakes and bread made from dough especially warm, eggs, beans – it will be further discussed the diet of patients with gallstone.
2. Physical work (lifting, lifting heavy loads or lifting weights in the gym and similar physical effort) - then it is possible, with the existence of large stones in the gallbladder or gallbladder filled with many stones, in such attacks to touch hardening under the right costal arch at the front. It is usually contracted gallbladder filled with stones.
3. Psychological problems (anxiety, permanent nerve tension that lasts longer, associated with irregular or improper diet or without it). Such attacks are often seen in patients who do not even eat food that provokes gall attack that are in the phase of ending of marriage, problems at work, problems with children, students preparing exams).
4. In pregnancy or immediately after it, a cause is most likely hormonal changes in pregnancy that foster the emergence of gall stones or due to pressure of a child to gall duct.

Here it should be noted that most existing gall stones do not cause any problems, regardless of the previously mentioned possible causes of attacks.

What is gall bladder pain attack and what the problems associated with gall stones look like?

Gall attack is characterized by pain under the right costal arch, which is usually spread under the right shoulder, right armpit or chest. Pain can be sharp and interrupted for a period of several hours. The pain goes and comes and it is the type of pain called colic. For bile colic is typical that the pain is slowly growing up to a level and then gradually decreases. Except for described pain with gall attack patients often have nausea and vomits or has urge to vomit. Bile colic is caused by moving of stones or a stone in the bile bag that usually move in a narrower part of the gallbladder or at a time when they enter the bile ducts.

Then people, other than pain, nausea, vomiting, have an inflammation of the gall bladder or bile ducts accompanied by fever, chills and jaundice. Usually, blockage is temporary and is not complicated by infection. Permanent blockage of cystic duct causes inflammation of gallbladder (a condition called acute gallbladder inflammation). Gallstones or sand that blocks the pancreatic duct causes inflammation of the pancreas (pancreatitis).

Sometimes the interrupted pain (colic) in the gallbladder area in the abdominal cavity can occur after operative removal of gallbladder, and such pain can be caused by gall stones in the common bile or pancreatic duct. With such problems it is best that the patient visit the doctor that will determine the matter.

Gall stones

When there is for any reason, obstacles in bile tract (stones or tumor in the bile duct on the way to the duodenum) then there is no secretion of bilirubin in the small intestine and the stool becomes pale like light clay without the pigment bilirubin. Then the amount of bilirubin in the blood is increased and jaundice appears (yellow skin and whites of the eyes with the occurrence of itchy skin). These stones are most often encountered in patients who have come to quickly or the mass destruction of red blood cells. It can be seen in certain types of anemia as hemolytic anemia - anemia where hemolysis means premature or pathological breakdown of red blood cells.

In adults hemolysis- breakdown of red blood cells, can appear at inflation of the spleen where red blood cells can be destroyed faster than they live (72 hours), then in some inherited diseases of red blood cells as spherocytosis, and it is a special form of red blood cells as a spheroid, then in all diseases where creation of bilirubin is increased, and excreted more slowly as well as with cirrhosis (chronic liver cell damage of various causes). Unlike cholesterol stones that occur exclusively in the gallbladder, pigment stones may occur after surgery of gall bladder in the bile duct.

Friday, February 26, 2010

Pigment stones

Pigment stones are small and usually dark black stones composed of bilirubin, which is an integral part of gall juice and is created when breakdown of erythrocytes occurs (red blood cells). Bilirubin is deposited partly in the liver from which the pigment bilirubin goes to gall bladder.

As the bile juice, from food stimuli, in the stomach secretes into duodenum (beginning of the small intestine) so is bilirubin excreted partly by stool, and partly is again, by the intestinal mucosa of the small intestine, returned into the bloodstream because it is essential to the creation of hemoglobin (the ingredient in red cells) .

Risk factors for development of cholesterol stones

• Family history (the existence of the disease in the family)
• Gender Women: Men - 4-1
• Increased weight and obesity
• Rapid weight loss

• Diets based on animal fat
• Operational removal of the small intestine
• Pregnancy
• Taking certain medications (oral contraception, corticosteroids, cyclosporine-Immune-suppression drugs for autoimmune diseases, drugs for lowering cholesterol in the blood)
• Diabetes
• Acromegaly -a disorder of the pituitary-gland in the brain
• liver cirrhosis

Monday, February 22, 2010

What types of gall stones are CHOLESTEROL STONES and how are they formed?

CHOLESTEROL STONES

They constitute 80% of all gallbladder stones. Usually yellowish-green in color and are formed from hardened cholesterol. Cholesterol is an integral part of gall juice. There is an opinion that cholesterol stones occur only in the gall bladder in which bile juice there is a greater concentration of cholesterol and the relative lack of the total amount of gall juice and other ingredients as well as phospholipids (fatty particles of fat-lipid).
It is believed that cholesterol stones may also form due to reduced contractibility (gallbladder squeezing due to the food stimuli), which explains the reduced irregular discharge of gall juice and "old" stale gall juice which is then deposited in to cholesterol stones. In addition to these causes of occurrence, there are many other causes, and some of the risk factors for the occurrence of gall stones are listed below.

Thursday, February 18, 2010

What is bile juice for?

About half of the extracted bile between meals comes through cystic duct to gallbladder. The rest of the bile flows directly through the combined bile duct in the small intestine. Between meals bile salts concentrate in the gall bladder so only small amount of bile juice flows from the liver. After bile secretion by food stimuli to the combined bile duct and then in the small intestine, gall salts in the small intestine re-absorb (enter back into the body through the intestinal mucosa), go to the liver, which then occasionally squeezes them in the gallbladder.

This re-circulation of bile salts is known as within the hepatic circulation (enterohepatic circulation of bile). All the bile salts are circulating the body about 10-12 times a day. Each time they pass a small amount of bile salts reach the colon, where bacteria break them down into different component parts. Some components of gall juice are re-absorbed again (go back into the body), and the rest are excreted by stool.

Where is bile juice created?

Bile juice is created in the liver and from it will flow through the right-left hepatic line, which is combined to form a common hepatic line. That line combines with bile duct that comes from the gall bladder called cystic line and together creates combined bile duct. Combined bile duct enters the upper part of the intestine-duodenum, several cm below the stomach, through an opening (Sphincter -muscle that controls the entry of combined bile duct to duodenum). Pancreatic bile duct joins the combined bile duct where the joint duct extracts into the duodenum.

What is the bile juice?

Bile juice is composed of bile salts, electrolytes, bile pigments - bilirubin, cholesterol and other fat-phospholipids. Bile is responsible for two important functions in the body: assists in the digestion and absorption of fat and is responsible for removing some of waste substances from the body, especially the hemoglobin from red blood cells (RBC), and excess cholesterol. Bile is particularly responsible for these activities:
1st Bile salts increase the solubility of cholesterol, fat and the fat soluble vitamins, and thus contribute to their absorption
2nd Bile salts stimulate secretion of water from the colon, which encourage the movement of content in the intestine
3rd Bilirubin (main gall color-pigment) is excreted from bile as waste matter of destroyed red blood cells
4th In the bile are excreted drugs and other waste materials that are later excreted through the intestines from the body
5th In the bile juice is secreted different proteins that play an important role in the action of bile
6th Bile salts increase the solubility of cholesterol, fat and fat soluble vitamins (A, D, E vitamins) to help their absorption (introduction of ingredients from food through bowel wall)

Sunday, February 7, 2010

Information on gallstones

Given the chemical composition there are known three types of gallstones: cholesterol, pigment and mixed
Frequently asked questions of patients on the topic of gallstones:
Where is a gall bag, what is in it and what is it?

Gall bag is located below the liver and is located in the upper right corner of the abdominal cavity below the right rib arch. It looks like a pear, consisting of a lower, wider part where usually stones are created, and of a narrow part called the "neck of gallbladder," which is so much narrower that continues into gallbladder tract. Gall bladder is a muscle storage that contains bile; greenish-yellow, thick digestive fluid that is produced by liver.

Gallbladder tightens - contracts after the arrival of food in the duodenum. Food in fact stimulates nerve cells in the duodenal wall, which then trigger the secretion of hormones that cause contractions of gallbladder and discharge of gallbladder juice (bile) through the bile ducts, which reaches the duodenum. The bile juice digests fat, and other food ingredients in the intestine.

About gallstones

Gallstones and "sand "
Gall stones are a collection of crystals, mostly masses that looks like gravel, of various sizes from very small 1-2 mm or smaller, which resemble to sand to large stones like chicken egg. However, there is often a mixture of sand, smaller and larger stones, or one large stone in one patient.
They are present in 20-30% of the population. One of three women and one in five men aged over 75 years have gallstones. They often occur in women and so known is the ratio of the presence of gallstones in women compared to men 4:1. Gallstones are solid deposits of stones that may occur in the gallbladder or bile tract. They are formed when some of the ingredients of gall juice sediments as a harden mass in the gall bladder.

What are the symptoms of gallstones?

Prognosis and course of disease

Gallstones produce symptoms in about 50% of people who have them. The greater is the likelihood of reporting symptoms in younger people compared to people older than 60 years.
Most spectacular symptom which gallstones produce is biliary colic. It is presented as a strong, constant, dull pain in the upper right quadrant of the abdomen or under the right costal arch. Pain begins suddenly, lasts a few hours, and then you have a feeling of dull pain for the next 24 hours. Patients are often unrest and are looking for the position of the body which would reduce the pain. Pain can expand under the right shoulder blade.

Obstruction of bile ducts can lead to inflammation of gall bladder, cholecystitis. As a result of acute inflammation of the bladder there may occur bladder hydropsy, gangrene and perforation of bladder.

Gallstone removal without surgery

Dissolution of stones can be done in two ways. The first way is the medicament dissolution of bile stones or dissolution by specific drugs. Commonly are used two products: chenodesoxycholic acid and ursodeoxycholic acid. Side effects of this therapy can be diarrhea, and increased LDL cholesterol in the blood. Success and progress of therapy is monitored by using ultrasound tests. After the cessation of therapy, return of the stones can be expected in approximately 30% of people with previous stones.

In addition to melting stones with medication there is also dissolution by contact solvents for direct dissolution, such as methyl-tertiary-butyl ether (MTBE).
Today is especially "popular" a method of lithotripsy, or breaking the stones. For this procedure is applied a method of breaking stones by so-called extracorporeal shock wave. Therapy is particularly successful if patients meet the criteria for using this method (stones up to 3 cm in diameter, up to 4 stones in the gall bladder, absence of acute inflammatory process).

Thursday, February 4, 2010

Gallstones treatment

Surgical therapy has been the first choice of therapy for bile stones for a long time. Today, however, more space is given to new therapeutic methods.

Indication for surgical treatment are gallstones, which gives the symptoms, clinical complications of calculus, as well as the presence of large stones in the bile tract (in which the bile flows from the liver, where it creates a new bile and from the gall bladder, where bile is stored).
Operating around the "peaceful" stones that do not show any clinical symptoms, there are permanent differences about. However, there are states where the risks are present that may cause probable complications and then it is indicated to perform surgery. The risk groups are patients with diabetes prone to sepsis, then so called porcelain gallbladder because of the risk of developing cancer and with the presence of stones larger than 2.5 cm in diameter because it was shown that they more often cause inflammation.

For people younger than 50 years that did not show any symptoms, nor fall into any of the before mentioned risk groups a preventive surgery is not necessary. When surgery is not possible or is highly risky, stones can be removed by endoscopic techniques.

Diagnosis of gallstones

Gallstones are usually the problem after studying history and clinical features described below.
Of specific searches there is native abdominal X-ray that will denounce stones in approximately 20% of patients with stones in which there is sufficient amount of calcium.
However, today the method of choice is diagnostic by ultrasound. This method can detect very small stones, from a diameter of 2 mm. The exam is more successful in the gall bladder, as compared with searching bile ducts.

Monday, February 1, 2010

How cholesterol stones occur?

Cholesterol, the main ingredient of most gall stones is very non-soluble in water. For cholesterol stone to create the most important is the presence of cholesterol saturated bile. After creating the initial nucleus, the stone gradually increases and at the same time causes inflammation in the bladder, which favors the further growth of stone. An important role in the creation of stones has reduced mobility, or peristalsis of gall bladder.

Sunday, January 31, 2010

Something about gallstones

Gall stones are relatively common disorder, which proves the fact that about 10% of the total population has gall stones. Gallstones belong to a group of diseases that often attack the female part of the population; in women is seen as much as 4 times more often.
Stones are more often present in the gall bladder than in the bile tract. When present in the bile tract, they represent the most common cause of obstructive extra hepatic jaundice and can cause potentially fatal infections (cholangitis), pancreatitis, or chronic liver disease.
According to the appearance and the chemical structure, gallstones are divided into two main groups: cholesterol and pigment stones.
Most gall stones, about 80% of them belong to a group of cholesterol stones, and they are again divided into pure cholesterol stones, which are usually larger and more solitary, and mixed stones which are usually fragmented.
Pigment stones in our patients belong to the so-called western type of pigment stones, and are usually small, black like coal. This form of stone is present with chronic hemolysis, alcoholic cirrhosis and chronic biliary tract infection and aging. Other forms of pigmented stones are stones that are oriental in type and brown. It is mainly present in rural areas of Asia. The latter type is rarely encountered in our country.
gall bladder symptoms

Gall bladder diet (IV)

Soups
YES - no fat soups, clear or thick soup of vegetables, soup of lean meat, lean soup from bones, soup of rice, semolina and potato soup (without cream), tomato soup, small pasta, grits or rice can be cooked.
NO - cream soups, soups with added fat, all fat from chicken soup, beef, bone, dried meat and soup concentrates, soup of cabbage.

Desserts and else
YES - sorbet with low fat milk, low fat frozen yogurt, jelly, graham crackers, puddings based on low-fat milk, cakes and cookies without fat, hard candy, jam, marmalade, apple strudel from pealed apples, pancakes with cheese, mash apple or jam.
NO - ice cream, fatty cakes and pastries filled with cream, donuts, puddings from whole-fat milk, chocolate.

Spices
YES - salt, herbs, mild vinegar
NO - all sharp spices - onion, garlic, pepper, strong vinegar, red cayenne pepper, mustard, all sauces,

Gall bladder diet (III)

Meat and replacement - from 150 to 180 g per day
YES - poultry meat without skin, veal, and lean beef (remove all visible fat), lamb (lean), lean pork, lean fish (cooked and roasted), eggs (without added fat), meat preparations: boiled and stewed, possibly roasted without addition of fat or on the permitted amount of fat (see fat).
NO - breaded and fried, fatty meat, fish and poultry, geese and ducks, fatty beef (ribs, grounded), fat pork (ribs, grounded), liver, brain, intestines, fish canned in oil, eggs fried in fat , boiled and raw eggs, egg yolk, processed meats, bacon, all sausages, cans, fatty fish (mackerel, sardines, tuna, catfish, carp from breeding).

Fat
YES - per day you can eat some fat, maximum of three serving (the list is specified for quantity of 1 serving):
- 1 teaspoon of vegetable oil
- Salad dressing -1 tablespoon, diet salad dressing- 2 tablespoons
- pith fruits: 6 almonds, peanuts 20 small ones or 10 large, 2 pieces of walnut, pistachio -18
- 2 tablespoons of sour cream
- Cream cheese 1 tbsp
- 1 teaspoon of margarine, 2 tsp of diet margarine
- 1 teaspoon of butter
- Olive -10 pieces
- Seeds - 1 tablespoon of sesame seeds, sunflower seeds 1 tablespoon
- Dry coconut- 2 tbsp
You should be careful that in the acute phase, each fat exposed to increased temperature (thermally processed) can be harmful.
NO - to a greater quantity of oil, roasted and burned oil, mayonnaise, pork fat, browned flour, food covered in cooked or fried fat.

Gall bladder diet (II)

    

Vegetables - 3 or more servings per day
YES - all vegetables - raw, boiled, steamed, stewed in its own juice with a little oil, no onions, roasted without addition of fat, it is recommended to eat vegetables with less fiber (cellulose): spinach, carrots, chard, beetroot, pumpkin, peeled tomatoes, zucchini. Young vegetables can be eaten as a salad: carrots, spinach salad, tomato and lettuce coated with mild apple vinegar, or diluted lemon juice.
NO - fried vegetables, and with added sour cream, cheese, butter, greasy sauces.
Be aware of the following vegetables, which can cause problems, as it is not recommended in the acute phase of illness: kale, cabbage, cucumbers, peppers, beans, peas, leeks, roasted and stewed potatoes, old beet, endive, soybean, cauliflower.

Fruit - 2 or more servings
YES - All ripe and peeled fruits except avocado (nuts - see: fat), compotes, and puree, banana, apple, peach, apricot, local fruit juices and vegetable juices (tomato, carrot) made at home, without preservatives. You should be careful of fruit that can cause problems: pears, grapes, almonds, walnuts, quince, and hazelnuts.

Gall bladder diet (I)

Cereals, bread and pasta - 4 or more servings per day
Yes - whole grains and whole grain bread when the situation calms down, but not in the acute phase of illness, cereals, low-fat crackers, pasta without eggs (or egg white only), noodles, spaghetti, dumplings with potatoes, grits, rice, corn flour, white bread, biscuits "petit beurre cookies", lady's finger, pop-corn, oats, oatmeal.
NO - pasta with eggs, bread that is made with addition of fat, Biscuits, donuts, waffles, chips, pasta and all the dishes prepared with yeast, eggs and fried pasta, hot bread

Milk Products - 2 or more cups per day
YES - lean skimmed milk, buttermilk, low fat sour cream, yogurt prepared of low-fat milk, cheese, kefir, acidophilus milk.
NO- whole-fat milk, cream, sour cream, fat cheese, cream spreads, strong and smoked cheeses.

      

Biliary composition

Cholesterol comprises bile, bile salts and bile pigments. Involved in the manufacture of cholesterol, bile salts, but it may result in excessive use of gallstones, which may prevent access to the bile in the duodenum. The result is often in great pain, abdominal area, and in addition to fats can not be degraded to the duodenum to the normal way. In most cases, the skin may turn yellow and gray stools. Bile salts allow for absorption of fats in such a way that they are emulsifier in the water-insoluble fatty acids in the small intestine. In this case, a water-soluble secreted by pancreatic lipase enzyme capable of degrading fatty acid diet.

Most of this uptake of fat is in the upper small intestine. If the bile into the intestine can not go, fats and fat-soluble vitamin absorption is more difficult. The majority of bile salts absorbed by the rest of the small intestine, is transported to the liver via the portal vein and from the bile, the rotation is called enterohepatic circulation as an expense, which is also used by some agents. Bile pigments in the body of toxins that cause the color of the bile and feces. The main bile pigment is coloured by liver cells and hemoglobin, myoglobin produce bilirubin. Conjugation with glucuronic acid to change fat soluble bilirubin water-soluble, and thus leaving the body more easily.