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Gallbladder Disease
Ian Villaneuva, MD, discusses the symptoms and causes of gallbladder disease, as well as treatment options and what patients can expect if their gallbladder has to be removed.
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Learn more about Ian Villaneuva, MD
Ian Villaneuva, MD
Dr. Villanueva is a board-certified general surgeon whose clinical interests include advanced laparoscopic and DaVinci surgical robot-assisted techniques in all areas of gastrointestinal surgery, bariatric weight loss surgery, and minimally invasive hernia surgery.Learn more about Ian Villaneuva, MD
Transcription:
Gallbladder Disease
Bill Klaproth (Host): Gallbladder disease includes inflammation, infection, stones, or blockage of the gallbladder. So how do you know if there’s a problem with your gallbladder and what are the treatment options? Let’s find out with Dr. Ian Villaneuva, a general surgeon specializing in advanced minimally invasive gastrointestinal surgery at WakeMed Health and hospitals. This WakeMed voices, a podcast from WakeMed Health and hospitals. I'm Bill Klaproth. Dr. Villaneuva, thank you for your time. So let’s start here. What is gallbladder disease?
Ian Villaneuva MD (Guest): Gallbladder disease is one of the most common gastrointestinal upper abdominal symptoms and illnesses that’s happening in the United States. It’s estimated that almost 20 to 30 million adults in the United States have some kind of gallstone disease.
Host: So tell me. Who is at risk for this?
Dr. Villaneuva: So interestingly even though 20 to 30 million have gallstone or gallbladder related disease, only a third to about a half of those folks end up having problems with it. The people at highest risk for developing gallbladder related symptoms are usually female, usually of older age, obesity is a risk factor. High cholesterol is a risk factor. There is a strong family history and genetic component to gallbladder or gallstone related disease. People are often surprised when they start experiencing symptoms. Then they start asking family members hey have you ever had this? More often than not there’s usually at least one or two other family members who say yes. That’s exactly what I had. Then once I got my gallbladder taken out I felt so much better.
Host: So for that third to half of the people that do have problems, what are the symptoms and problems that we should be aware of?
Dr. Villaneuva: It’s a very subtle disease. Everyone hears about or has heard the term “oh, I had a gallbladder attack.” It makes it sound very dramatic and some cases it can be. Gallbladder related pain sometimes can duplicate, resemble the pain of an actual heart attack. Very often it’s that severe episode that brings people to the emergency room. But when you question people a little bit further, you’ll find out that the symptoms started much more subtle and much more mild in the very beginning. It’s usually some sort of vague upper abdominal stomachache, stomach cramp. I got a pain in my side. I think I slept funny on my right side the other day and I was just sore for the rest of the morning, the rest of the afternoon. It’s symptoms that are usually mild enough that you can power your way through it. It doesn’t really stop you until it actually stops you. So that’s where it’s tricky to diagnose in the early stage whether you're the average person looking for information on the internet or whether you're a family physician because those symptoms are just very vague.
Host: So if the symptoms are vague, how do you diagnose this?
Dr. Villaneuva: It’s an interesting diagnosis that’s a combination or good old fashioned doctoring in terms of listening to a patient’s symptoms and story, and usually confirmed with some type of radiological study. Most commonly it’s an ultrasound of your gallbladder. That’s probably the best test to look for gallstones. Gallstones is responsible for the majority of gallbladder related symptoms. However, not all gallbladder related symptoms are caused by gallstones. Sometimes it’s a gallbladder function problem. So if your initial ultrasound does not show gallstones that doesn’t necessarily mean that you do not have gallbladder related problem. It just means you need a secondary test called a HIDA scan to check the functioning of your gallbladder because sometimes it’s a malfunctioning gallbladder that duplicates the symptoms of having gallstones.
Host: So if there’s a problem and my gallbladder is malfunctioning; how do you treat this?
Dr. Villaneuva: Unfortunately gallbladder symptoms—whether they're related to gallstones or whether they're related to gallbladder malfunctioning—unfortunately we really don’t have any good medical therapies. We don’t have good medicines to make the gallbladder either function better or to make gallstones go away. We’ve had no luck with those medications. First line treatment that most folks try is dietary modification. Since diet—especially greasy, fatty fried foods—is the most common trigger, most folks will actually start on their own. They start picking up on the pattern. “Oh, I had a cheeseburger last night. That made me feel ill. So I'm not going to have any more fried food the next day.” Sometimes that might be good enough to control the symptoms in the short term. In the long run, the success rate of just dietary modifications to control gallbladder symptoms, it’s probably less than 10% successful. So unfortunately if you're having gallbladder related disease—especially if you have risk factors we referenced earlier—most people wind up needing a surgery to remove the gallbladder to ultimately take care of the problem.
Host: So if someone does have to have their gallbladder removed, what do we lose? You can live without a gallbladder? What happens without the gallbladder?
Dr. Villaneuva: So the gallbladder is a storage bag for bile. Your liver makes the bile and stores it in the gallbladder. Once we eat food with any kind of microscopic fat in, which whether it’s healthy or not, most of our diet needs microscopic fat. The gallbladder squeezes the bile. The liver delivers it through a ductal system into the intestines, and the intestines use that bile to digest the fats out of the foods that we eat. So when we lose the gallbladder, we lose a storage bag for bile. Thankfully the human body’s still smarter than all of us. There’s certain amount of internal adjustments and remodeling that our liver and that our main bile duct delivery system can actually do a little bit of remodeling, a little bit of stretching so that it can take on a storage function in addition to the delivery function that it already does. So the end result of all that, most people when you lose your gallbladder you actually have a very long, normal, healthy life without any kind of lifestyle or dietary modifications to be done in the long term.
Host: That is amazing. You're right about the human body. So you said earlier greasy, fatty, fried meals, etcetera. Is there anything else for anyone listening going, “Gosh, you know, that kind of sounds like me.” So you were mentioning dietary modifications. How else should we change our diet to help avoid these gallbladder pains, if you will?
Dr. Villaneuva: Eating a healthy well balanced diet that’s high in fiber will always be the go to diet to try to control gallbladder related symptoms. So anything that’s baked, grilled, not fried, fresh fruits and vegetables. Those are the best things to try to limit the stimulation of the gallbladder. However, the gallbladder after a certain point whether you’ve had too many small gallbladder attack episodes that pile up on each other or whether your gallbladder misfunction worsens, most of the time it gets to the point where even healthy foods will trigger gallbladder related pains. Because, again, even healthy foods have small microscopic levels of fat. So at some point the gallbladder kind of just gets burnt out for lack of a better term. At that point, usually there’s no dietary lifestyle modification that helps.
Host: So when it’s had enough, it’s had enough I guess. So any final thoughts as we wrap up for somebody concerned about gallbladder disease?
Dr. Villaneuva: Well most courses of gallbladder disease is relatively benign. However, there are some consequences to having gallstones that in the rare but unfortunate circumstances can proceed to life threatening conditions. Gallstones can also not only just cause gallbladder pain, but it could also cause an obstruction to your pancreas. Pancreatitis in the wrong circumstances can definitely be life threatening. Other negative consequences of passing gallstones that gets stuck. If those gallstones plug up your main bile system, you can get a very life threatening liver infection where bile starts overflowing to your blood stream. Those folks can be critically ill for sure.
So it’s one of those things where if you're starting to have symptoms, you want to seek medical evaluation early on in the process. When we get to the gallbladder diseases early on in the process, that’s when we’re most likely able to remove your gallbladder on an outpatient basis. It can be done as a same day surgery, usually with four small incisions. You go home the same day as long as everything went according to plan. Removing a gallbladder is probably the most common abdominal surgery that we do today. However, if you get to the fever stage, the nausea/vomiting stage, other associated conditions like the pancreatitis or the liver infection, those are the folks that wind up in the hospital. They stay for three to five days, and they may wind up with the classic surgery where there’s a bigger incision that’s across the abdominal wall and much longer recovery. So definitely discuss those subtler symptoms with your physician as soon as you can.
Host: Well, this has been very informative. I think the message is loud and clear. If you feel something and it doesn’t feel right, go get it checked out. Better safe than sorry. Don’t wait.
Dr. Villaneuva: Absolutely right.
Host: Dr. Villaneuva, thank you so much. This has been very interesting. I appreciate your time today.
Dr. Villaneuva: Thanks for having me.
Host: That’s Dr. Ian Villaneuva, a general surgeon with WakeMed Health and hospitals. To learn more or to request an appointment with WakeMed general surgery or to get connected with Dr. Villaneuva or another provider, please visit wakemed.org. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Bill Klaproth with WakeMed Voices brought to you by WakeMed Health and hospitals in Raleigh, North Carolina. Thanks for listening.
Gallbladder Disease
Bill Klaproth (Host): Gallbladder disease includes inflammation, infection, stones, or blockage of the gallbladder. So how do you know if there’s a problem with your gallbladder and what are the treatment options? Let’s find out with Dr. Ian Villaneuva, a general surgeon specializing in advanced minimally invasive gastrointestinal surgery at WakeMed Health and hospitals. This WakeMed voices, a podcast from WakeMed Health and hospitals. I'm Bill Klaproth. Dr. Villaneuva, thank you for your time. So let’s start here. What is gallbladder disease?
Ian Villaneuva MD (Guest): Gallbladder disease is one of the most common gastrointestinal upper abdominal symptoms and illnesses that’s happening in the United States. It’s estimated that almost 20 to 30 million adults in the United States have some kind of gallstone disease.
Host: So tell me. Who is at risk for this?
Dr. Villaneuva: So interestingly even though 20 to 30 million have gallstone or gallbladder related disease, only a third to about a half of those folks end up having problems with it. The people at highest risk for developing gallbladder related symptoms are usually female, usually of older age, obesity is a risk factor. High cholesterol is a risk factor. There is a strong family history and genetic component to gallbladder or gallstone related disease. People are often surprised when they start experiencing symptoms. Then they start asking family members hey have you ever had this? More often than not there’s usually at least one or two other family members who say yes. That’s exactly what I had. Then once I got my gallbladder taken out I felt so much better.
Host: So for that third to half of the people that do have problems, what are the symptoms and problems that we should be aware of?
Dr. Villaneuva: It’s a very subtle disease. Everyone hears about or has heard the term “oh, I had a gallbladder attack.” It makes it sound very dramatic and some cases it can be. Gallbladder related pain sometimes can duplicate, resemble the pain of an actual heart attack. Very often it’s that severe episode that brings people to the emergency room. But when you question people a little bit further, you’ll find out that the symptoms started much more subtle and much more mild in the very beginning. It’s usually some sort of vague upper abdominal stomachache, stomach cramp. I got a pain in my side. I think I slept funny on my right side the other day and I was just sore for the rest of the morning, the rest of the afternoon. It’s symptoms that are usually mild enough that you can power your way through it. It doesn’t really stop you until it actually stops you. So that’s where it’s tricky to diagnose in the early stage whether you're the average person looking for information on the internet or whether you're a family physician because those symptoms are just very vague.
Host: So if the symptoms are vague, how do you diagnose this?
Dr. Villaneuva: It’s an interesting diagnosis that’s a combination or good old fashioned doctoring in terms of listening to a patient’s symptoms and story, and usually confirmed with some type of radiological study. Most commonly it’s an ultrasound of your gallbladder. That’s probably the best test to look for gallstones. Gallstones is responsible for the majority of gallbladder related symptoms. However, not all gallbladder related symptoms are caused by gallstones. Sometimes it’s a gallbladder function problem. So if your initial ultrasound does not show gallstones that doesn’t necessarily mean that you do not have gallbladder related problem. It just means you need a secondary test called a HIDA scan to check the functioning of your gallbladder because sometimes it’s a malfunctioning gallbladder that duplicates the symptoms of having gallstones.
Host: So if there’s a problem and my gallbladder is malfunctioning; how do you treat this?
Dr. Villaneuva: Unfortunately gallbladder symptoms—whether they're related to gallstones or whether they're related to gallbladder malfunctioning—unfortunately we really don’t have any good medical therapies. We don’t have good medicines to make the gallbladder either function better or to make gallstones go away. We’ve had no luck with those medications. First line treatment that most folks try is dietary modification. Since diet—especially greasy, fatty fried foods—is the most common trigger, most folks will actually start on their own. They start picking up on the pattern. “Oh, I had a cheeseburger last night. That made me feel ill. So I'm not going to have any more fried food the next day.” Sometimes that might be good enough to control the symptoms in the short term. In the long run, the success rate of just dietary modifications to control gallbladder symptoms, it’s probably less than 10% successful. So unfortunately if you're having gallbladder related disease—especially if you have risk factors we referenced earlier—most people wind up needing a surgery to remove the gallbladder to ultimately take care of the problem.
Host: So if someone does have to have their gallbladder removed, what do we lose? You can live without a gallbladder? What happens without the gallbladder?
Dr. Villaneuva: So the gallbladder is a storage bag for bile. Your liver makes the bile and stores it in the gallbladder. Once we eat food with any kind of microscopic fat in, which whether it’s healthy or not, most of our diet needs microscopic fat. The gallbladder squeezes the bile. The liver delivers it through a ductal system into the intestines, and the intestines use that bile to digest the fats out of the foods that we eat. So when we lose the gallbladder, we lose a storage bag for bile. Thankfully the human body’s still smarter than all of us. There’s certain amount of internal adjustments and remodeling that our liver and that our main bile duct delivery system can actually do a little bit of remodeling, a little bit of stretching so that it can take on a storage function in addition to the delivery function that it already does. So the end result of all that, most people when you lose your gallbladder you actually have a very long, normal, healthy life without any kind of lifestyle or dietary modifications to be done in the long term.
Host: That is amazing. You're right about the human body. So you said earlier greasy, fatty, fried meals, etcetera. Is there anything else for anyone listening going, “Gosh, you know, that kind of sounds like me.” So you were mentioning dietary modifications. How else should we change our diet to help avoid these gallbladder pains, if you will?
Dr. Villaneuva: Eating a healthy well balanced diet that’s high in fiber will always be the go to diet to try to control gallbladder related symptoms. So anything that’s baked, grilled, not fried, fresh fruits and vegetables. Those are the best things to try to limit the stimulation of the gallbladder. However, the gallbladder after a certain point whether you’ve had too many small gallbladder attack episodes that pile up on each other or whether your gallbladder misfunction worsens, most of the time it gets to the point where even healthy foods will trigger gallbladder related pains. Because, again, even healthy foods have small microscopic levels of fat. So at some point the gallbladder kind of just gets burnt out for lack of a better term. At that point, usually there’s no dietary lifestyle modification that helps.
Host: So when it’s had enough, it’s had enough I guess. So any final thoughts as we wrap up for somebody concerned about gallbladder disease?
Dr. Villaneuva: Well most courses of gallbladder disease is relatively benign. However, there are some consequences to having gallstones that in the rare but unfortunate circumstances can proceed to life threatening conditions. Gallstones can also not only just cause gallbladder pain, but it could also cause an obstruction to your pancreas. Pancreatitis in the wrong circumstances can definitely be life threatening. Other negative consequences of passing gallstones that gets stuck. If those gallstones plug up your main bile system, you can get a very life threatening liver infection where bile starts overflowing to your blood stream. Those folks can be critically ill for sure.
So it’s one of those things where if you're starting to have symptoms, you want to seek medical evaluation early on in the process. When we get to the gallbladder diseases early on in the process, that’s when we’re most likely able to remove your gallbladder on an outpatient basis. It can be done as a same day surgery, usually with four small incisions. You go home the same day as long as everything went according to plan. Removing a gallbladder is probably the most common abdominal surgery that we do today. However, if you get to the fever stage, the nausea/vomiting stage, other associated conditions like the pancreatitis or the liver infection, those are the folks that wind up in the hospital. They stay for three to five days, and they may wind up with the classic surgery where there’s a bigger incision that’s across the abdominal wall and much longer recovery. So definitely discuss those subtler symptoms with your physician as soon as you can.
Host: Well, this has been very informative. I think the message is loud and clear. If you feel something and it doesn’t feel right, go get it checked out. Better safe than sorry. Don’t wait.
Dr. Villaneuva: Absolutely right.
Host: Dr. Villaneuva, thank you so much. This has been very interesting. I appreciate your time today.
Dr. Villaneuva: Thanks for having me.
Host: That’s Dr. Ian Villaneuva, a general surgeon with WakeMed Health and hospitals. To learn more or to request an appointment with WakeMed general surgery or to get connected with Dr. Villaneuva or another provider, please visit wakemed.org. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Bill Klaproth with WakeMed Voices brought to you by WakeMed Health and hospitals in Raleigh, North Carolina. Thanks for listening.