The gallbladder is an important organ that is located behind the right lobe of the liver. The primary function of the gallbladder is to store, concentrate and secrete the bile that is produced by the liver. For this reason, the health of the gallbladder and liver are often intertwined.
High cholesterol in the bile causes 80 percent of gallstones. While high doses of saturated fats can increase circulating cholesterol and the risk of gallstones, cutting fat completely from your diet is unnecessary.
Listen in as Joel O. Bautista, MD, a general surgeon at Florida Hospital DeLand, is here to assure you that there are plenty of things you can do to keep your gallbladder and your other organs healthy.
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Keeping Your Gallbladder Healthy
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Learn more about Dr. Bautista
Joel O. Bautista, MD
Dr. Bautista is a general surgeon who lives and practices in DeLand, Florida. He received his medical degree from Washington University in St. Louis, Missouri. He fulfilled his general surgery residency at the Charity Hospital System of Louisiana State University Medical Center in New Orleans, Louisiana. Dr. Bautista is board certified in general surgery by the American Board of Surgery, and he is a fellow of the American College of Surgeons.Learn more about Dr. Bautista
Transcription:
Keeping Your Gallbladder Healthy
Melanie Cole (Host): The gallbladder isn't an organ that gets a lot of attention unless it's causing you pain. My guest today is Dr. Joel Bautista. He's a general surgeon with Florida Hospital. Welcome to the show, Dr. Bautista. Tell us a little bit about the gallbladder. People don't even know what this organ does.
Dr. Joel Bautista (Guest): Well, good morning. Thank you for having me. The gallbladder--consider it like a bag in the abdominal cavity underneath the liver. It's connected to the bile duct, which connects the liver to the bowels and what it does is, it stores the bile that the liver produces so that when you eat, it squeezes that bile down into the bile ducts and into the bowels so the digestion of the food--typically fatty foods--is more efficient.
Melanie: So, it's basically a storage organ for bile until it needs to be excreted?
Dr. Bautista: Yes. Yes.
Melanie: What can go wrong with the gallbladder?
Dr. Bautista: Well, this bile is composed of several components and one of them is cholesterol. Sometimes, some of this bile can very thick and you get sludge which can become problematic. Sometimes, crystals will form out of this; they'll precipitate out, as we say, and they'll coalesce, come together and they form gallstones. The most common type of gall stones are actually cholesterol stones. Now, the sludge and stones, by themselves, may not cause any problems, and if they're not too problematic, they could probably be monitored. Obviously, they can cause symptoms that may warrant treatment.
Melanie: What would be some of those symptoms? Would people experience severe episodes of pain? What would they experience?
Dr. Bautista: There are classic symptoms. Typically, those are sharp abdominal pain in the right upper portion of the abdomen; the area where the liver, below the liver would be. Sometimes, this pain may radiate to the back, to the shoulder. Typically, this pain will be exacerbated, or made worse, when you eat. Again, remember the gallbladder is stimulated when you eat, so it may result in the discomfort or spasm of the gallbladder and the symptoms. The symptoms also may elicit more vague symptoms of nausea, vomiting, maybe loose stools, and, in more complicated cases of gallbladder disease, you could have progressive infection that could cause fever, chills, and even jaundice--yellowing of the skin and--eyes because of possible blockage of the biliary system.
Melanie: Dr. Bautista, are there certain people that are more predisposed to gallbladder disease? Excessive alcohol use or obesity? Are any of these lifestyle type behaviors something that can contribute to problems?
Dr. Bautista: Well, we learn in medical school there's a group of patients most commonly, classically that could develop gallbladder disease. Fair, fat, in their 40’s, but it, obviously, could occur in a lot of other people. In this area of Florida, we often see it in the Hispanic population. People with blood disorders like sickle cell may have gallstones and not from cholesterol stones but from the breakdown of their hemoglobin and those stones are typically darker, as well, too.
Melanie: How do you know if something is going wrong if someone is experiencing some of those symptoms? Do they rush themselves off to the emergency room? What do you do there?
Dr. Bautista: It depends on the intensity of the symptoms. More often than not, people will have some discomfort, they'll have recurrent episodes, they'll progress, and, at some point, depending on their threshold, they may seek medical attention. That's the typical pattern that we will see. Sometimes, the pain can become so intense that you're not able to wait to make it to your appointment to your primary care physician; you may go to the emergency room. But, obviously, if you're having those symptoms in addition to having fevers and the jaundice, then that would probably require more a urgent evaluation through the emergency department, for sure.
Melanie: Can the gallbladder get cancer?
Dr. Bautista: Yes. It's not a common cancer but when it does occur, it can be potentially very aggressive. Part of the reason for that is, we often don't find these cancers until much later because we don't typically identify symptoms related to gallbladder cancer until they're much larger and they're causing other problems maybe to the bile duct and surrounding structures. Sometimes, when people are evaluated with imaging, CAT scan, or ultrasound, it's not uncommon to find polyps in the gallbladder and the patient may not have any symptoms. If the polyp is typically less than 5-10 millimeters, or about a quarter inch, those can be usually monitored and followed, especially if they're not having any other symptoms or significant risk factors. Larger than 10 millimeters size, which is about 1/3 of an inch, then that's the time you might want to consider having something done about it at that point before it becomes more problematic.
Melanie: So, what are some treatments for gallbladder diseases or some of these things we've been discussing? Is it always to remove the gallbladder, or are there other interventions?
Dr. Bautista: Well, there are always options. Obviously, doing nothing is an option, but depending on their symptoms and their actual pathology what's causing their problems, that might not be reasonable. Usually, the most common thing is an operation to remove the gallbladder. There are some situations where, most commonly, when patients aren't going to be able to tolerate the operation and the anesthesia associated with it, like an older patient with significant heart disease, sometimes, we may do a dissolution therapy, or medication that will help dissolve the stones. But, they have to be a certain type of stone and sometimes you're taking medicines for an extended period of time and you can continue to have problems and even if the medicine works and the gallbladder is still there and it shows that it can make more stones in the future. So, typically, the best option, if you have problematic gallbladder disease, is an operation and this is done laparoscopically, or minimally-invasive, as we say, is the most common technique. It is the standard of doing it surgically that way with the understanding that we may have to convert to an open operation, if there are any issues.
Melanie: What would you like listeners to know about lifestyle behaviors and dietary adjustments that they might have to make if they've had gallbladder surgery or if they're at risk for gallbladder issues?
Dr. Bautista: Well, if they do have problematic gallbladder disease and they want to try to manage it conservatively, the best with regards to diet is maintaining a low-fat diet. Again, it's the fat and the greasy foods that are the ones that are most likely going to release the hormone that stimulates the gallbladder to contract, so if you can minimize that. After an operation for gallbladder, called a “cholecystectomy”, typically patients won't have any significant restrictions with their diet. After they're healed from that operation, there's really no restriction with their activity, as well. There is a small percentage of people that will have chronic loose stools from not having their gallbladder, but that's probably less than 2-3% of people.
Melanie: Some people have heard in the media about gallbladder cleanses. Is there anything to this?
Dr. Bautista: I've had people approach me with that and I really don't feel comfortable to say that I would advocate that. I think it's best maintaining a good, healthful diet, exercise; everything that you would do maintaining your body's health and fitness for the gallbladder, you would do maybe for your colon, for your heart, and all those things. I would think maintaining a healthy lifestyle is the best option.
Melanie: So, in just the last few minutes, Dr. Bautista--it's such great information--give us your best advice about maybe when to call your doctor for symptoms you're not sure of, how to keep a healthy gallbladder, and why they should come to Florida Hospital for their care.
Dr. Bautista: Well, if you should have any symptoms that I've mentioned, I think the first step is going to see your primary care physician, or internist, or family practitioner, and they can help navigate and try to discern what kind of problem are there. Then, based on that, then they may order additional evaluation, typically with lab work or some type of imaging, usually an ultrasound. Sometimes they do a nuclear scan study. If that does confirm gallbladder disease, then the next step may be referrals to a surgeon to discuss that. Sometimes, with complicated cases, you may require a gastroenterologist to help clear the bile duct of any complicated stone. With the need for all these sub-specialties the Florida Hospital Healthcare partners is always a reasonable and good choice because we provide all those specialties to be able to care for the whole patient.
Melanie: Thank you so much for being with us today. You're listening to Health Chat by Florida Hospital. For more information, you can go to fhsurgery.com. That's fhsurgery.com. This is Melanie Cole, thanks so much for listening.
Keeping Your Gallbladder Healthy
Melanie Cole (Host): The gallbladder isn't an organ that gets a lot of attention unless it's causing you pain. My guest today is Dr. Joel Bautista. He's a general surgeon with Florida Hospital. Welcome to the show, Dr. Bautista. Tell us a little bit about the gallbladder. People don't even know what this organ does.
Dr. Joel Bautista (Guest): Well, good morning. Thank you for having me. The gallbladder--consider it like a bag in the abdominal cavity underneath the liver. It's connected to the bile duct, which connects the liver to the bowels and what it does is, it stores the bile that the liver produces so that when you eat, it squeezes that bile down into the bile ducts and into the bowels so the digestion of the food--typically fatty foods--is more efficient.
Melanie: So, it's basically a storage organ for bile until it needs to be excreted?
Dr. Bautista: Yes. Yes.
Melanie: What can go wrong with the gallbladder?
Dr. Bautista: Well, this bile is composed of several components and one of them is cholesterol. Sometimes, some of this bile can very thick and you get sludge which can become problematic. Sometimes, crystals will form out of this; they'll precipitate out, as we say, and they'll coalesce, come together and they form gallstones. The most common type of gall stones are actually cholesterol stones. Now, the sludge and stones, by themselves, may not cause any problems, and if they're not too problematic, they could probably be monitored. Obviously, they can cause symptoms that may warrant treatment.
Melanie: What would be some of those symptoms? Would people experience severe episodes of pain? What would they experience?
Dr. Bautista: There are classic symptoms. Typically, those are sharp abdominal pain in the right upper portion of the abdomen; the area where the liver, below the liver would be. Sometimes, this pain may radiate to the back, to the shoulder. Typically, this pain will be exacerbated, or made worse, when you eat. Again, remember the gallbladder is stimulated when you eat, so it may result in the discomfort or spasm of the gallbladder and the symptoms. The symptoms also may elicit more vague symptoms of nausea, vomiting, maybe loose stools, and, in more complicated cases of gallbladder disease, you could have progressive infection that could cause fever, chills, and even jaundice--yellowing of the skin and--eyes because of possible blockage of the biliary system.
Melanie: Dr. Bautista, are there certain people that are more predisposed to gallbladder disease? Excessive alcohol use or obesity? Are any of these lifestyle type behaviors something that can contribute to problems?
Dr. Bautista: Well, we learn in medical school there's a group of patients most commonly, classically that could develop gallbladder disease. Fair, fat, in their 40’s, but it, obviously, could occur in a lot of other people. In this area of Florida, we often see it in the Hispanic population. People with blood disorders like sickle cell may have gallstones and not from cholesterol stones but from the breakdown of their hemoglobin and those stones are typically darker, as well, too.
Melanie: How do you know if something is going wrong if someone is experiencing some of those symptoms? Do they rush themselves off to the emergency room? What do you do there?
Dr. Bautista: It depends on the intensity of the symptoms. More often than not, people will have some discomfort, they'll have recurrent episodes, they'll progress, and, at some point, depending on their threshold, they may seek medical attention. That's the typical pattern that we will see. Sometimes, the pain can become so intense that you're not able to wait to make it to your appointment to your primary care physician; you may go to the emergency room. But, obviously, if you're having those symptoms in addition to having fevers and the jaundice, then that would probably require more a urgent evaluation through the emergency department, for sure.
Melanie: Can the gallbladder get cancer?
Dr. Bautista: Yes. It's not a common cancer but when it does occur, it can be potentially very aggressive. Part of the reason for that is, we often don't find these cancers until much later because we don't typically identify symptoms related to gallbladder cancer until they're much larger and they're causing other problems maybe to the bile duct and surrounding structures. Sometimes, when people are evaluated with imaging, CAT scan, or ultrasound, it's not uncommon to find polyps in the gallbladder and the patient may not have any symptoms. If the polyp is typically less than 5-10 millimeters, or about a quarter inch, those can be usually monitored and followed, especially if they're not having any other symptoms or significant risk factors. Larger than 10 millimeters size, which is about 1/3 of an inch, then that's the time you might want to consider having something done about it at that point before it becomes more problematic.
Melanie: So, what are some treatments for gallbladder diseases or some of these things we've been discussing? Is it always to remove the gallbladder, or are there other interventions?
Dr. Bautista: Well, there are always options. Obviously, doing nothing is an option, but depending on their symptoms and their actual pathology what's causing their problems, that might not be reasonable. Usually, the most common thing is an operation to remove the gallbladder. There are some situations where, most commonly, when patients aren't going to be able to tolerate the operation and the anesthesia associated with it, like an older patient with significant heart disease, sometimes, we may do a dissolution therapy, or medication that will help dissolve the stones. But, they have to be a certain type of stone and sometimes you're taking medicines for an extended period of time and you can continue to have problems and even if the medicine works and the gallbladder is still there and it shows that it can make more stones in the future. So, typically, the best option, if you have problematic gallbladder disease, is an operation and this is done laparoscopically, or minimally-invasive, as we say, is the most common technique. It is the standard of doing it surgically that way with the understanding that we may have to convert to an open operation, if there are any issues.
Melanie: What would you like listeners to know about lifestyle behaviors and dietary adjustments that they might have to make if they've had gallbladder surgery or if they're at risk for gallbladder issues?
Dr. Bautista: Well, if they do have problematic gallbladder disease and they want to try to manage it conservatively, the best with regards to diet is maintaining a low-fat diet. Again, it's the fat and the greasy foods that are the ones that are most likely going to release the hormone that stimulates the gallbladder to contract, so if you can minimize that. After an operation for gallbladder, called a “cholecystectomy”, typically patients won't have any significant restrictions with their diet. After they're healed from that operation, there's really no restriction with their activity, as well. There is a small percentage of people that will have chronic loose stools from not having their gallbladder, but that's probably less than 2-3% of people.
Melanie: Some people have heard in the media about gallbladder cleanses. Is there anything to this?
Dr. Bautista: I've had people approach me with that and I really don't feel comfortable to say that I would advocate that. I think it's best maintaining a good, healthful diet, exercise; everything that you would do maintaining your body's health and fitness for the gallbladder, you would do maybe for your colon, for your heart, and all those things. I would think maintaining a healthy lifestyle is the best option.
Melanie: So, in just the last few minutes, Dr. Bautista--it's such great information--give us your best advice about maybe when to call your doctor for symptoms you're not sure of, how to keep a healthy gallbladder, and why they should come to Florida Hospital for their care.
Dr. Bautista: Well, if you should have any symptoms that I've mentioned, I think the first step is going to see your primary care physician, or internist, or family practitioner, and they can help navigate and try to discern what kind of problem are there. Then, based on that, then they may order additional evaluation, typically with lab work or some type of imaging, usually an ultrasound. Sometimes they do a nuclear scan study. If that does confirm gallbladder disease, then the next step may be referrals to a surgeon to discuss that. Sometimes, with complicated cases, you may require a gastroenterologist to help clear the bile duct of any complicated stone. With the need for all these sub-specialties the Florida Hospital Healthcare partners is always a reasonable and good choice because we provide all those specialties to be able to care for the whole patient.
Melanie: Thank you so much for being with us today. You're listening to Health Chat by Florida Hospital. For more information, you can go to fhsurgery.com. That's fhsurgery.com. This is Melanie Cole, thanks so much for listening.