Most people think of fall as the season for football, deer hunting and holiday feasts. I also think of it as gallbladder season. I don’t know if the incidence is truly increased during this time, but it sure seems like it.

Most people think of fall as the season for football, deer hunting and holiday feasts. I also think of it as gallbladder season. I don’t know if the incidence is truly increased during this time, but it sure seems like it.


The gallbladder is a small organ below the liver in the right upper quadrant. The liver makes bile, and the gallbladder stores it. Whenever we eat a fatty meal (such as fast food), the body releases a hormone that causes the gallbladder to contract and empty bile into our intestines to aide our digestive process.


Gallstones are made of bile salts, fats and cholesterol. When these are in equilibrium, there are no stones. When one of these substances is out of proportion or there is stasis, crystals fall out of solution and precipitation occurs (like too much sugar in a cold glass of tea). The crystals continue to grow (kind of like a pearl in the oyster) and the gallstone forms. The stones can cause blockage of the gallbladder or the liver. They can be subject to infection. When there is stasis or dyskinesia, the gallbladder doesn’t empty as it should. Symptoms from this can be just as bad as those in people who do have stones.


Textbook symptoms of gallbladder disease are pain in the right upper part of the abdomen and midepigastrum. Some people report shoulder pain, back pain or chest pain. The pain usually occurs about 30 minutes after eating and can last up to five hours. Most people report nausea and vomiting. Some report indigestion, belching, increased reflux, flatus and diarrhea. Most say that antacids, Tylenol, Motrin, or change in position do not relieve the pain. Most people associate the pain with eating certain foods (fatty, greasy, spicy, tomato). The textbook patient is female, obese, has lost a large amount of weight in short period of time, post pregnancy, Native American or Hispanic.


An ultrasound is the test of choice for looking for gallstones, inflammation of the gallbladder wall or blockage of the gallbladder and liver. A nuclear medicine scan is also used to evaluate for dyskinesia when no stones are noted but symptoms suggest disease.


General lab testing is also done to evaluate for infection, liver complications and pancreatic complications.


Intervention is surgical removal for most, and laparoscopic cholecystectomy is the most common operative intervention in the US. A lighted camera and instruments are placed into the abdomen and the gallbladder is removed from the liver. The procedure is done under anaesthesia and usually takes less than an hour to perform. Sometimes an open procedure with a larger incision is needed. The open procedure is usually indicated for severe infection (gangrene), multiple gallstones blocking the common duct, severe adhesions from prior surgery, cancer or other complications. A routine hospital stay for the laparoscopic intervention is several hours to 48 hours. Most patients go home the next day, and many go home the same day of the surgery. Most recover and go back to work one to two weeks post surgery. For an open procedure, the hospital stay is usually three to five days. Return to work is usually within four to six weeks. The patient after surgery does not have to make any dietary changes or activity changes. If anything, eating should be improved as they no longer have pain and other symptoms.


So this year, if you are enjoying your sister’s famous Cajun fried chicken and some other fine food item that started with two sticks of butter and you start having pain with nausea; keep in mind that your gallbladder might be begging for attention.


— Michelle Eckert, M.D., FACS, specializes in General, Vascular, Thoracic and Laparoscopic Surgery. She is a member of the JRMC Medical Staff and in practice at Surgical Associates of South Arkansas. If you have a question for Dr. Eckert, you can e-mail her at healthbytes@jrmc.org.