Transcription:
Gallbladder Diseases: Causes, Treatment, and Prevention

Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand.

This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.

Melanie Cole (Host): Welcome to Say Yes to Good Health with Memorial Hospital. I'm Melanie Cole and today we're discussing gallbladder diseases and general surgery. Joining me is Dr. Peter Perll. He's a General Surgeon at Memorial Hospital. Dr. Perll, thank you so much for being with us today. So, we're talking today about the gallbladder and not a lot of people know what that is. Can you tell us what is the gallbladder? What does it do for a living.

Peter Perll, MD (Guest): The gallbladder's a small organ that sits up underneath the right side in the liver bed. Its function is really to take bile, concentrate it, and when you eat, usually inject that concentrated bile to help you digest your foods, particularly fats. It kind of acts like soap. It gets in there and breaks up fats and lipids to help you digest your food better.

Host: Well, that was an excellent explanation. Very understandable. So what are some of the most common gallbladder diseases that you see on a regular basis?

Dr. Perll: Well, there'd really be two major ones. One is people with, we call cholelithiasis, meaning that you have gallstones that could be giving you symptoms. A second one, it's called biliary dyskinesia, where the gallbladder doesn't have stones, but just isn't functioning properly. But the most common are having gallstones that are giving you trouble.

Host: We've all heard about gallstones and not really knowing what they are. So tell us a little bit about gallstones. How does somebody develop one of those? What, are there risk factors that would put us at risk? Tell us a little bit about those.

Dr. Perll: Well, there, there's mainly two types of gallstones. The majority of them are called cholesterol stones and then the other minority are just pigmented stones. And everyone's heard of kidney stones, you can get an x-ray and a lot of times they'll see those on the plain x-ray. Gallstones are different.

It used to be an 80 20 for kidney stones would show up it's 80 20 for gallstones, except they're mostly cholesterol, which you don't see on a regular x-ray, but you see well with an ultrasound. And that's the main way that we diagnose. Sometimes you'll see them on CT, but mainly when people have symptoms, we do an ultrasound to see if you have gallstones. Gallstones in and of themselves, don't need to be taken care of unless you're having symptoms. The main symptom is pain, especially when you eat. It can cause nausea and vomiting. Those are usually symptoms that bring patients in to be looked after. Gallstones can also cause other issues that are more serious, but the main one people come in with we call symptomatic cholelithisasis is when their gallstones are causing them pain or inability to tolerate foods very well.

Host: So as long as we're talking about symptoms and you just gave us some really good ones to be aware of and red flags for gallstones, you mentioned cholecystitis. Why don't you give us some symptoms of that too? Because that's a little bit more severe, yes?

Dr. Perll: Right. When you get a cholecystitis, any itis is usually an inflammation of the organ. So the gallbladder is getting inflamed, may have caused an appearance of an infection that needs to be treated. People all know what appendicitis is. We usually treat that with antibiotics and some surgery. It's similar with acute cholelithiasis, symptomatic cholelithiasis, where it's an acute episode causing pain, may need to be treated faster than someone that has we call it biliarycolic where their gallstones are causing intermittent symptoms, but they're not getting so ill that they have an inflamed gallbladder. The reason that we treat people really with gallstones, when you're having symptoms, we want to treat that sooner rather than later, because we don't want you to have the next stage are those stones that, that organ is connected to the main duct from the liver. We don't want those stones to go down and number one block and get an acute episode where that gallbladder gets so inflamed, it becomes necrotic and becomes an emergency that way.

But we also don't want the stones to block the bile. You don't want them turning yellow, docholithiais where there's stones in the common duct. But the worst thing is if one of those stones goes and blocks the pancreatic duct, people can get gallstone pancreatitis and get very ill from the pancreatitis. So, when you start having symptoms, as a surgeon, I usually recommend trying to get the gallbladder out before it gives you trouble.

Host: And we're going to talk about that as well, and the surgical procedures that you do at Memorial Hospital, but how does one develop these diseases? Dr. Perll, is this something that is hereditary for gallstones and cholelithiasis? Are these something that are, puts you at risk for other problems like bile duct cancer? Does obesity contribute? Lifestyle? Tell us a little bit about risk factors here.

Dr. Perll: Well, just like almost anything we have, there is genetic relationship. If you have family members that have symptomatic gallstones or trouble, you're, you are at higher risk of it, but you know, the prevalence is increased with as you get older, it's also tends to be more prevalent in females.

Other situations like being pregnant when you have a different composition of the bile and you have trouble emptying your gallbladder can cause trouble. Diabetes is also another one that increased because of the, of the troubles with diabetes. Those are the main things. But how do you develop stones?

It's kind of interesting. It would be like, developing a little pearl, you get a seed inside that gall, gallbladder, the fluid, and maybe there's a little cholesterol in there and it just starts to layer like a pearl. That's the kind of the way I envision it. Why does it happen? Probably there's too much cholesterol in there, or the gallbladder is not emptying as well, but they develop them and they're not going to go away.

Unlike kidney stones where people can have had the shock treatment to treat them. You just can't do that with the gallbladder stones, because it's just not effective. If even if you were able to get them to go away, they're going to come back likely because you're not going to be able to clear all that material.

Host: So there really is no non-surgical treatment or a watch and wait situation. None of that with gallstones.

Dr. Perll: That's correct. If you're having symptoms and you have stones, if you're a good candidate, and obviously there are people that aren't great surgical candidates, but if you're a normal healthy person with not a lot of risk factors, then I think that a cholecystectomy is the routine. Now, is there other things you can do?

Sure. There are some medicines that may help dissolve that, but again, they're likely to come back. For really sick individuals, we may not necessarily take out the whole gallbladder that's probably going to be a surgical procedure, but in the normal person walking around, you develop symptomatic gallstones, we usually recommend getting your gallbladder out. Now, can you do things to slow down if you don't want to do it right away? Yes. You know, eating a lower fat diet, trying to limit those intakes of foods. We know that high-fat foods and greasy foods, and dairy products also have a lot of fat can cause more symptoms than diets that are high in fiber, or, you know, just not trying to take things that are gonna stimulate the gallbladder is as effectively as the fats do.

Host: What about lifestyle? You know, we always hear about the lifestyle things that contribute to everything like smoking and drinking too much or obesity, you know, being dehydrated. Can any of these things? Do they all contribute to this or is this kind of standalone in that way?

Dr. Perll: Well, obesity obviously is again, is a risk factor with this process. People that go through a rapid weight loss can also develop gallstones. So exercise is helpful. Those are the things that you can try to do to prevent it from happening from the beginning. But as you said, I think people's diet and the genetic susceptibility and just being unfortunately for females have a more prevalent or have a more risk, have a higher risk of getting it, especially as they get older, in this disease process.

Host: So interesting. And before we wrap up this portion of our show today, Dr. Perll, what would you like to tell listeners about being a General Surgeon at Memorial Hospital and the different procedures that you perform? We're going to get into the gallstone thing in our next portion of the show, but tell us a little bit about being a General Surgeon.

Dr. Perll: Well, I love being a General Surgeon. I've been one for over 25 years. I like being in this small community hospital. It's a wonderful place. It's got all the attributes of a big hospital, except I think we get a lot more personal service here. We know the patients. They're all usually family or friends of the staff. You know, we're trying to offer things close to home. You don't have to travel to the big city. We can do everything here at Memorial Hospital that they can do at other hospitals. And I think you'll notice a difference with your care. That's taking care of you here.

Host: And it's really a comprehensive multidisciplinary approach with patients, isn't it?

Dr. Perll: Yes. I mean, we, as a General Surgeon, I've seen this disease process for years. We have great anesthesia. You know, we need imaging with radiology. We have that. We have the pathology to take the specimens and look at them. And typically there's not a problem, but every once in a while we'll see something and we're gonna, we're gonna take great care of you here.

Host: So Dr. Perll, we were talking about gallbladder disease, gallstones specifically for the most part. And you told us about lifestyle and you talked to us about risk factors and you talked to us about really kind of how these things, these little pearls as you described them really do develop. So now, surgical procedures. Once you've determined that somebody has a gallstone based on those symptoms. Well, first of all, you mentioned symptoms, vomiting and things like that, hurting when we eat, how do you determine that someone has a gallstone, is there imaging involved?

Dr. Perll: Yes. Actually, like I said earlier, because most of these are cholesterol stones, they don't show up on plain x-ray. So, we typically will do an ultrasound which shows us the gallbladder itself and we'll see shadowing from those stones or can see some movement within there. That's the primary way that we, we see gallstones. We have also found them in other ways with a CT. Someone may have CT scan, a CAT scan, say several years ago, and it was for another reason, but they saw that there were gallstones. So, you know, once the diagnosis is established, then we kind of know if they start having the symptoms, primarily pain, nausea, vomiting when you eat. A lot of times, the pain will go from your right upper abdomen, straight through to your back or even up to your shoulder. Cause that's kind of where the pain is referred to. Then we know you're having symptoms. So, ultrasound is the primary way that we're we're detecting it. Didn't mention, we did talk about a little bit earlier about biliary dyskinesia, and again, that's typically diagnosed with radiology as well. We find out number one, that you don't have gallstones, but we feel like your gallbladder is not functioning right. It's dyskinetic. If you think of a gallbladder and it's, it has a rhythmic flow to try to push things out. If you have one that just sits up there and kind of gets full, but it fibrillates, it doesn't have the strength to push things through, then that could also cause similar symptoms. And those are the two diseases that we see with the gallbladder. Most common either cholelithiasis or biliary dyskinesia dysfunction.

Host: So tell us a little bit about the surgical procedures that you perform for gallstones. What does that mean for the patient? Is this something that requires an overnight stay? Is it minimally invasive? Tell us a little bit about it.

Dr. Perll: Typically it should not be an overnight stay. It's an outpatient procedure. We try to do everyone laparoscopically or minimally invasive surgery, meaning that there's an incision at your belly button, another one up in the upper abdomen and then two smaller ones that we're using to work on the gallbladder. We have a camera that we put in your abdomen. We're able to get good visualization. It's a safe procedure. It is under general anesthesia. Typically, we'll also do an x-ray during the procedure to confirm that everything is okay in your liver duct system, that there's no stones involved.

And the surgery itself, depending, you know, it's maybe an hour or so to do it. You recover and you go home for as an outpatient surgical procedure. Would do the same procedure, whether gallstones or dyskinetic or malfunctioning gallbladder. Good, typically good relief of symptoms. People have this done. And they feel much better. I don't know, after a little bit of recovery, obviously you had an operation, but it's very gratifying to, to do the procedure because they typically have a lot of relief of their symptoms.

Host: What are some examples, Dr. Perll of the positive patient outcomes that you have experienced?

Dr. Perll: Well, people that come in with that pain and they can't eat anything that they like afterwards they're able to get back to eating typically without any, any of the pain. And that's the, that's what we're trying to do. We're trying to take care of those symptoms. We still encourage them to have a healthy lifestyle, but, everyone every once in a while, wants to go have a piece of pizza or have something that's fried. And, you know, being able to enjoy that again is gratifying to the patients. They're appreciative. And that's what I like to do. I like to take care of patients, get them better as fast as we can.

Host: Well, that's really excellent to hear that you have such positive outcomes. And do you have any advice? I mean, we still have a lot of questions, but really preventing gallbladder issues. Obviously, you've mentioned healthy lifestyle. I'm an exercise physiologist. So I love that you mentioned exercise and diet. Does lowering our cholesterol help to prevent this risk? Are there things that we haven't talked about that we can try?

Dr. Perll: Well, you know, low fat diet is obviously better for your overall health and also lowers your risk of developing gallstones. Also keeping away from being obese, keeping your weight down is good. Those are really the main things. There's other medicines that, that there that give you some risks, but then some things you know, if you're on hormone replacements or you're on contraceptives, those are things that you may not be able to get rid of.

They may be a source of the gallstones, but they're going to be something that, that you're really not going to know until after the fact. Having other conditions, medical conditions, such as a spinal cord injury or having liver failure because of alcohol abuse, having disease processes, inflammatory bowel disease, such as Crohn's or having your bilirubin that's high. Those are things that can cause the gallstones. Some of those are not preventable. Something, some of those are, if you are diagnosed, you need to know that there's a chance that you may develop these symptoms and try to get treated as soon as possible before you have those complicating issues like blockage of the liver or having the pancreatitis.

Host: It's really such an interesting issue. And I suppose that it's important. We're really working with our primary care physicians. And if someone does have diabetes or high cholesterol that they're working with their physicians to really keep those kinds of things under control, and that will reduce our risk. Yes?

Dr. Perll: Yes. I mean, your primary care doctor is your go-to person. They're gonna, they're going to help encourage you to have a healthy lifestyle with you know, physical activity. Limit the fats in your diet and try to increase the fiber with fruits and vegetables, keeping your weight in check. They're also the ones that, that when you start mentioning these symptoms are probably going to encourage you to get the ultrasound, to get tested so that we can intervene as fast as possible.

Host: And as a general surgeon, Dr. Perll, what other surgical procedures do you perform at Memorial Hospital? What else do you do?

Dr. Perll: Well, the great thing is I was trained, meaning general surgery takes care of a lot of things. And being at this hospital, I'm not limited to a subspecialty. So, I do a lot of minimally invasive surgery, both gallbladder, appendix, hernia surgery. We also do open hernia surgery. We take care of breast cancers. We take care of skin lesions. We try to be kind of broad-based in what we're going to take care of. So, just try to head to toe, you know, we're not doing vascular procedures, but pretty much almost anything else that you can think of at least we can get you treated or if we can't treat you, we're going to get you somewhere where you're going to get the care that you need.

Host: One of the things that I think, you know, people don't know about surgeons because when we're visiting our primary care physician, we get to know them just a little bit, Dr. Perll, you know, maybe we see them every year, but a surgeon and hopefully we don't need to see one, but if we do, we don't really get to know you that well. Tell us a little bit about your philosophy of care and how you work with patients, and even give us a little bit of background on yourself. What you like to do for fun outside of work?

Dr. Perll: Oh I love general surgery because of the breadth of the things that we get to take care of, especially at Memorial Hospital. I've been doing it a long time. I was kind of raised in a medical family, both my physician, both my parents were physicians way back in the day. I went to school in the Midwest at Creighton, and then I trained surgery down at University of Kentucky.

That's, I had a very rigorous training. I feel very comfortable with taking care of the patients. I like to get to know them. I do sit down with, when you come in to see me, we're going to go over. I'm going to give you an exam. We're going to go over what I think is going on and give you my best opinion of what we should do.

I'm going to explain things. You're going to be comfortable. You know, the surgery itself is obviously, you're going to be under anesthetic. You're not going to feel anything, but we want the patients to feel comfortable in what's going on, understand what's going on, you know, involve them as much as they want to, get their family lives involved.

And we want to take care of them until we, we see them after the surgery, get your staples out and get you on your way back to a normal life. What I like to do. I have a family and most of my children are now grown up,five children. I love the outdoors. I love to hunt and fish. I like being with family. Those are the things that, that I do in my free time. Sometimes I don't have a lot of it, but when I do, those are the things I enjoy the most.

Host: That's great. Dr. Perll, thank you for sharing that with us today. What an informative show this was. Thank you so much for joining us and to schedule a consultation with Dr. Perll, you can call 217-357-2173 that's 217-357-2173. That concludes this episode of Say Yes to Good Health with Memorial Hospital.

For more health tips, like you heard here, visit our website at mhtlc.org to get connected with one of our providers. We'd like to thank our audience and invite you to download, subscribe, rate, and review this podcast on Apple podcast, Spotify and Google podcast. And if you found it informative and I'm sure you found it as informative as I did, please share it with your friends and family, on your social channels, because we are really learning from the experts at Memorial Hospital together.

I'm Melanie Cole. Thanks so much for joining us today.

Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand.

This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.