Ask the Doctors: Best solution for gallstones? Surgery

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Q: Our granddad is 86 and wound up in the ER with extreme abdominal pain, which turned out to be gallstones. The doctors say he should have his gallbladder removed. Why? Isn't that a big operation just to take care of gallstones?

A: The gallbladder is a small, pear-shaped pouch that sits on the right side of the abdomen, just beneath the liver. It's part of the biliary tract, which is a system of organs, ducts and vessels. The structures of the biliary tract — sometimes referred to as the biliary tree — secrete, store and guide a bitter greenish-yellow liquid called bile, which aids in the breakdown of dietary fat. Bile is secreted by the liver and is stored in the gallbladder. It's a complex liquid with dissolved substances that aid in the digestion of fat and play a role in the elimination of certain waste products. When bile isn't being used for digestion, it is stored in the gallbladder.

In some people, small hardened deposits known as gallstones may form. This often happens because of too much cholesterol, or when the gallbladder is unable to empty properly. People who are overweight or obese are at an increased risk of gallstones, as are those who live with diabetes. This is due to the higher level of triglycerides, a type of lipid, in the blood. Rapid weight loss has been known to trigger the formation of gallstones. So can fasting, which is one of the things that can prevent a gallbladder from adequately emptying. A tendency to form gallstones can also run in families.

Gallstones can irritate the lining of the gallbladder and lead to inflammation or infection. Because the gallbladder stretches and squeezes as it fills and empties, gallstones can also shift and move into the bile ducts. Although small stones can pass unimpeded, larger stones can become lodged and cause a blockage. This prevents the gallbladder from emptying into the small intestine.

Sudden and severe pain in the upper right section of the abdomen may be a symptom of a gallbladder attack. The pain can last just a few moments, or it can go on for hours. Pain in the upper back and the area of the right shoulder can also occur during a gallbladder attack. Urine may turn a dark yellow color, and the attack may be accompanied by nausea, vomiting and profuse sweating.

The most common treatment for a gallbladder attack is surgery. That's because — even when symptoms recede — the stones are still there. This raises the risk of another blockage, infection and even rupture. The good news is that most gallbladder surgeries are now done laparoscopically, meaning that instead of an abdominal incision and an "open" surgery that can result in a weeklong hospital stay, the procedure is done with instruments and a camera that are introduced into the abdomen via small incisions. Patients typically leave the hospital in 24 to 48 hours, and are fully recovered in about two weeks.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.

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