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Gall bladder disease

Category: Illness or disabilities

Type

Involuntary

Introduction and description

 
 

The gallbladder (also gall bladder, biliary vesicle or cholecyst) is a small organ where bile (a fluid produced by the liver) is stored and concentrated before it is released into the small intestine.

Anatomically, the gallbladder is divided into three sections: the fundus, body, and neck: The fundus is a rounded end that faces the front of the body. The body is in contact with the liver, lying in the gallbladder fossa, a depression at the bottom of the liver. The neck tapers and is continuous with the cystic duct, part of the biliary tree.

There is little understanding of just how high the instance of disease is in the gall bladder, a much misunderstood organ.

Both gall stones and gall bladder cancer are common in North India. All tertiary care centres in India report high rates of gall bladder cancer (GBC) incidence and poor treatment outcomes in the majority of cases due to advanced stage of presentation. Csendes of Chile has reported very high incidence of gallbladder cancer in Chile and Bolivia …..the incidence rate of gall bladder cancer in Indian males is equal to that of Chile, whereas in females, the rates are almost double the rates of Chile. Indians have also been found to have high concentrations of heavy metals in the gall bladder wall, … In India, gall bladder cancer is the commonest GI cancer in women and fourth commonest cancer overall in the female population. PMID:  27217672

 

In general, Gallbladder and biliary related diseases occurred in about 104 million people (1.6%) in 2013 and they resulted in 106,000 deaths. Women more commonly have stones than men and they occur more commonly after the age of 40.

Functions of the Gall bladder

Regulating the Intestinal flora and immune response

The intestinal flora not only processes our food, extracting nutrients, but is a key part of our immune system.  The management of the microbiota, the garden of bacteria and other organisms in our intestine is regulated by the gall bladder, which secretes bile

Bile, composed primarily of bile salts, promotes digestion. It also provides a barrier between host and bacteria. After bile salts are synthesized in the liver, they are stored in the gallbladder to be released after food intake. The set of host-secreted bile salts is modified by the resident bacteria. Because bile salts are toxic to bacteria, an equilibrium of modified bile salts is reached that allows commensal bacteria to survive, yet rebuffs invading pathogens. In addition to direct toxic effects on cells, bile salts maintain homeostasis as signaling molecules, tuning the immune system. PMID:  27565580

Food digestion

The gallbladder stores bile, also called gall, needed for the digestion of food. The liver produces the bile, which then flows through the hepatic ducts into the gallbladder. When food containing fat enters the digestive tract, it stimulates the secretion of cholecystokinin (CCK) from I cells of the duodenum and jejunum. In response to cholecystokinin, the gallbladder rhythmically contracts and releases its contents into the common bile duct, eventually draining into the duodenum. Bile contains bile salts, which solubilize fats in the digestive tract and aid in the intestinal absorption of fat molecules as well as the fat-soluble vitamins, A, D, E, and K.

The bile that is secreted by the liver and stored in the gallbladder is not the same as the bile that is secreted by the gallbladder. During gallbladder storage of bile, it is concentrated by removal of some water and electrolytes.

Storage for body repair and sexual activity material

 

Cholesterol, is an essential structural component of all animal cell membranes that is required to maintain both membrane structural integrity and fluidity. Cholesterol is not ‘bad’.  Within cells, cholesterol is a precursor molecule for the synthesis of vitamin D and all steroid hormones, including the adrenal gland hormones cortisol and aldosterone, as well as the sex hormones progesterone, estrogens, and testosterone, and their derivatives.  Without cholesterol you would be vitamin deprived, age very quickly and be entirely lacking in any sexual ability – impotent and infertile.

The liver excretes cholesterol into biliary fluids, which is then stored in the gallbladder.

It is then secreted by the gall bladder ‘in a non-esterified form’ (via bile) into the digestive tract. High cholesterol in your blood simply indicates a high level of damaged cells from some pathogen [or high sex drive!].

Cholesterol & phospholipids, are both electrical insulators, and improve the speed of transmission of electrical impulses along nerve tissue. For many neuron fibres, a myelin sheath, rich in cholesterol, provides insulation for more efficient conduction of impulses.  Lack of cholesterol is implicated in multiple sclerosis.

Bilirubin removal

Bile also acts as a means of eliminating bilirubin, a product of hemoglobin metabolism, from the body.

Types of gall bladder disease

 
  • Cholecystitis is inflammation of the gallbladder. More than 90% of the time acute cholecystitis is from blockage of the bile duct by a gallstone.
  • Gallbladder polyps (GBPs) – Gallbladder polyps are growths, or lesions resembling growths, that form in the gallbladder wall.  Polyps tend to be non malignant “the reported incidence of GBP malignancy is just 0.57%”  [PMID: 27465099], but they may impair function.
  • Gallbladder (GB) perforation – can be a side effect of traumatic abdominal injury. It is potentially life-threatening. A punch in the stomach area for example may cause small defects which are difficult to detect.  “Colour Doppler US and contrast-enhanced US are the examinations of choice to detect the perforation site and show bile movement through the perforation” [PMID:  24151110]
  • Gallbladder (GB) wall thickening  - is defined as a GB wall diameter >3.5 mm on abdominal ultrasound examination or computed tomography. It does not have one cause, but can be caused by many pathogens, for example in one study “Systemic infections were caused by bacteria in 10 patients (41.7%), viruses in 5 patients (20.8%), and fungi in 2 patients (8.3%).”[ PMID:  25061585].  By the time it is detected, the pathogen has often spread all over the body, and the person is often being treated for symptoms which are more obvious, for example “Systemic diseases observed included systemic lupus erythematosus in 2, congestive heart failure in 2, renal disorder in 2”. Hopefully this should bring home the pointlessness of symptom based medicine and organ speciality in medicine.  Pathogens get everywhere and the key is to identify the pathogens
  •  
    Gallstones – are stones formed within the gallbladder out of bile components. The term cholelithiasis may refer to the presence of stones in the gallbladder or to the diseases caused by gallstones. Most people with gallstones (about 80%) never have symptoms.  Gallstones are typically formed from either cholesterol or bilirubin.  In the developed world, 10–15% of adults have gallstones. Rates in many parts of Africa, however, are as low as 3%.  “Brown pigment gallstones form spontaneously in infants who have bacterial infections in the biliary tract. PMID: 2642880”.  Gall stones are caused by gallbladder dysmotility.  In effect, the gall bladder is attacked by pathogens and gradually loses its function.  Initially biliary sludge is formed.  Biliary sludge refers to a viscous mixture of small particles derived from bile. These sediments consist of cholesterol crystals, calcium salts, calcium bilirubinate, mucin, and other materials.  Eventually these solidify to form stones.
  • Ascending cholangitis - also known as acute cholangitis or simply cholangitis, is an infection of the bile duct (cholangitis), usually caused by bacteria ascending from its junction with the duodenum (first part of the small intestine). It tends to occur if the bile duct is already partially obstructed by gallstones.  Cholangitis can be life-threatening, and is regarded as a medical emergency. Characteristic symptoms include yellow discoloration of the skin or whites of the eyes, fever, abdominal pain, and in severe cases, low blood pressure and confusion - shock.
  • Gall bladder cancer - Carcinoma of the gallbladder is the commonest malignancy of the biliary tract in northern India and the link to heavy metals as the cause has been repeatedly shown … “The present study demonstrated a significant decrease in serum, biliary, and tissue levels of selenium and zinc but increased copper, lead, cadmium, chromium, and nickel levels in patients with carcinoma of the gallbladder, indicating a strong relation between the concentrations of these metals and gallbladder cancer.”  [PMID: 23942528] But irritant particles in general can be a cause.
  • Cholestasis is a condition where bile cannot flow from the liver to the duodenum. The two basic distinctions are an obstructive type of cholestasis where there is a mechanical blockage in the duct system that can occur from a gallstone or malignancy, and metabolic types of cholestasis which are disturbances in bile formation.  Drugs such as gold salts, nitrofurantoin, anabolic steroids, chlorpromazine, prochlorperazine, sulindac, cimetidine, erythromycin, estrogen, and statins can cause cholestasis and may result in damage to the liver.
  • Porcelain gallbladder is a calcification of the gallbladder believed to be brought on by excessive gallstones, although the exact cause is not known.
  • Strangulation of the gallbladder  - has rarely occurred.  The lesser omentum (small omentum or gastrohepatic omentum) is the double layer of peritoneum that extends from the liver to the lesser curvature of the stomach (hepatogastric ligament) and the first part of the duodenum (hepatoduodenal ligament).

A 61-year-old Japanese woman presented to a local hospital after the sudden onset right upper quadrant pain., …. the fundus and body of the gallbladder were markedly swollen … and grossly necrotic.  A narrowed, twisted area was seen between the body and neck of the gallbladder. …. The narrowest part of the gallbladder was tightly strangulated by the lesser omentum, but the gallbladder neck was normal. PMID:  22466106

Symptoms

Nausea and vomiting

A three-year-old male child presented with erythematous maculopapular nonpruritic generalized rash, poor feeding, vomiting, and cramping generalized abdominal pain. He was previously healthy and there was no family history of immunologic or other diseases. On examination he was afebrile, hemodynamically stable, with painful palpation of the right upper quadrant and positive Murphy's sign. Laboratory tests revealed elevated inflammatory markers, elevated aminotransferase activity, and features of cholestasis. PMID: 27200203

 

Fever

Usually indicative of pathogens which the body is able to destroy using heat.

Pain

 Gall bladder problems can cause severe pain in the upper right part of the abdomen. In severe cases of infection, the pain feels like you are being stabbed, and it is possible to go into a state of shock. 

Jaundice

If a gall stone lodges in the biliary system, jaundice may occur; and if the stone blocks the pancreatic duct, then pancreatitis may occur.

Skin problems

– of various sorts, appearing like an allergic reaction.  Rashes, ulcer like spots, and itching may be present.  In the following example, the gall bladder disease is being caused by a parasite:

 Investigators have showed allergic dermatological disorders and others, in patients with giardiasis, that may obey from two mechanisms: first, the parasite or its metabolic products might be antigenic for the host; second, the parasite may act as a hapten, that in successive sensitizations might lead to such manifestations, producing specific antibodies which have been found in patients' sera with giardiasis. … PMID:  7976968

Psoriasis can be a comorbidity of gall bladder disease

Non-alcoholic fatty liver disease and chronic cholecystitis are predictors of psoriatic disease progression.  PMID:  27522710

Causes

Pharmaceuticals

One of the recurrent themes running through the following analyses is the fact that the patient was ‘immunocompromised’ at the time the infection occurred.  We are apt to associate immunocompromised people with AIDS, but let us now take you through a scenario which shows that a person can become immunocompromised by the ill-advised use of pharmaceuticals.

  • Anti-histamines - The person gets a blocked nose.  The nose becomes blocked in order to protect the brain and the lungs from a pathogen.  The person uses anti-histamines, which are immunosuppressants and which serve to unblock the nose, but allow the pathogen to enter.
  • Mouthwash - The person uses a mouthwash, which is anti-bacterial and thus destroys the friendly bacteria in the mouth which are a defense against pathogens entering the body.  Mouthwashes are thus immunosuppressants.  The pathogen enters the throat and from there may travel to the stomach or lungs.
  • Antacids and PPIs - The person gets indigestion.  Not being able to digest food is due to forms of stress, the sympathetic nervous system acts to prevent digestion.  It may also be due to low stomach acid.  The person takes antacids, or Proton pump inhibitors which reduce the acid in the stomach even further.  The acid is a major defensive shield against many pathogens. Antacids and PPIs are thus  immunosuppressants.

In the authors' previous study of gallbladder function …. 58% of the patients demonstrated preoperative gallbladder motor dysfunction, and 86% of those retested after .. cessation of proton pump inhibitors (PPIs) normalized. … For 15 of 19 subjects [in this study], PPI therapy was associated with reduced gallbladder motility. … Short-term PPI therapy reduces gallbladder motility in healthy volunteers. Chronic PPI therapy may pose a risk for long-term gallbladder dysfunction and biliary complications.  PMID:  16858534

  • Antibiotics - A person goes to the emergency department of their hospital ill.  The first thing the medical staff may do is give them antibiotics, even when they have no idea of the cause of the illness.  Antibiotics destroy the intestinal flora, which are an absolutely key part of the immune system.  Antibiotics are thus immunosuppressants.
  • Immunosuppressants - The person has one or more of a host of illnesses classified by the medical fraternity as auto-immune diseases.  None of these diseases are, but because the medical profession practises symptom based and not cause based medicine, they do not know the true cause of the illness.  In order to treat the symptoms but not the cause the doctor hands out immunosuppressants.
  • Hormonal contraceptives - Whilst estrogens increase cholesterol secretion and diminish bile salt secretion, progestins act by reducing bile salt secretion and impairing gallbladder emptying. Cholesterol is used to repair the body as such progestins  are a form of immunosuppressant andheighten the risk of gallstone disease as many gallstones are formed from cholesterol.
 

The eHealthme site collect the Adverse drug reports submitted by doctors to the FDA and SEDA.  They have two categories for gall bladder disease worth exploring.  If you follow the links, and then scroll down for each symptom you will find a section entitled “Drugs causing xxx” by pressing this link you are provided with a list of all the pharmaceuticals that have caused gall bladder disease along with the number of cases:

  • Gallbladder disorder – follow this LINK.  There are about 900 plus pharmaceuticals in this list that have caused gallbladder disorder
  • Gallstones – follow this LINK.  There are about 1,550 plus pharmaceuticals in this list that have caused gallbladder disorder

Pharmaceuticals are a MAJOR cause of gall bladder disease.

Polysorbate 80 – Vaccines and Food additives

 

Polysorbate 80 is a nonionic surfactant and emulsifier often used in foods, medicines and cosmetics. This synthetic compound is a viscous, water-soluble yellow liquid.  Other names include - E number: E433; Brand names: Alkest TW 80, Scattics, Canarcel, Poegasorb 80, Tween 80 – Tween is a registered trademark of ICI Americas, Inc.

In foods - Polysorbate 80 is used as an emulsifier in foods.  For example, in ice cream, polysorbate is added up to 0.5% (v/v) concentration to make the ice cream smoother and easier to handle, as well as increasing its resistance to melting. Adding this substance prevents milk proteins from completely coating the fat droplets. This allows them to join together in chains and nets, which hold air in the mixture, and provide a firmer texture that holds its shape as the ice cream melts.

Vaccines and injected medicines - Polysorbate 80 is an excipient that is used to stabilize aqueous formulations of medications for parenteral administration. A parental administration may include:

  • intravenous  - into a vein
  • intra-arterial - into an artery
  • intraosseous infusion - into the bone marrow
  • intra-muscular

It is used as an excipient in some European and Canadian influenza vaccines, for example. Influenza vaccines contain 25 μg of polysorbate 80 per dose.

It is used as an emulsifier in the manufacture of the antiarrhythmic amiodarone.  It is used in the culture of Mycobacterium tuberculosis in Middlebrook 7H9 broth. It is also used as an emulsifier in the estrogen-regulating drug Estrasorb.

The increasing prevalence of obesity has emerged as one of the most important global public health issue. The change to the human microbiome as a result of changes in the quality and quantity of food intake over the past several decades has been implicated in the development of obesity and metabolic syndrome. We administered polysorbate-80 to mice via gavage. ….. Compared with control mice, those receiving emulsifier, showed impaired glycemic tolerance, hyperinsulinemia, altered liver enzymes, larger mitochondria and increased gall bladder size. Additionally, mice in the experimental group showed higher levels of DCA, reduced Muc2 RNA expression, reduced mucus thickness in the intestinal epithelium and increased gut permeability. Intestinal bacteria of mice receiving P-80 were found deeper in the mucus and closer to the intestinal epithelium and had increased level of bioactive LPS, flagellin and LCN2 expression. The result of the study are supportive of evidence that emulsifier agents such as polysorbate-80, may be contributing to obesity related intestinal inflammation and progression of liver dysfunction and alteration of gut microbiota.  PMID:  27430014

If the liver doesn’t work, neither will the gall bladder.

Viruses

 

A number of different viruses have been implicated in various forms of gall bladder disease.  The hepatitis family of viruses, all appear to be implicated:

Although hepatitis A in adults is typically a benign, self-limited disease, it can occasionally have a fatal course. In a significant proportion of patients with an evident risk factor for hepatitis A, the possibility of active prophylaxis was not used. Hepatitis A should be regarded as a sexually transmitted infection. Acalculous cholecystitis is a frequent finding among adults with symptomatic hepatitis A.  PMID: 26768634

And

Hepatitis E virus (HEV) causes an acute viral hepatitis that is transmitted enterically. It is epidemic in Africa, Asia, the Middle East, and Central America. It is known that HEV can cause extrahepatic manifestations. Here, we report a case of acalculous cholecystitis as an extrahepatic symptom of HEV.  PMID:  27433137

The herpes family are also implicated:

Abdominal ultrasound showed gallbladder wall thickening of 8 mm with a positive sonographic Murphy's sign, without gallstones or pericholecystic fluid. Acute Alithiasic Cholecystitis (AAC) was diagnosed. Tests for underlying infectious causes were negative except positive blood specimen for Human Herpes Virus Type-6 (HHV-6) by polymerase chain reaction. PMID: 27200203

 

Bacterial infection

This paper is a good summary of just how many bacteria could be implicated.  But, a warning note needs to be sounded here, as we have found in other sections that some bacteria are actually on our side, fighting viruses and pathogens:

Bacterial infection is considered a predisposing factor for disorders of the biliary tract. This study aimed to determine the diversity of bacterial communities in bile samples and their involvement in the occurrence of biliary tract diseases. A total of 102 bile samples were collected during endoscopic retrograde cholangiopancreatography (ERCP). …. In total, 41.2 % (42/102) of the patients showed bacterial infection in their bile samples. This infection was detected in 21 % (4/19), 45.4 % (5/11), 53.5 % (15/28), and 54.5 % (24/44) of patients with common bile duct stone, microlithiasis, malignancy, and gallbladder stone, respectively. Escherichia coli showed a significant association with gallstones. Polymicrobial infection was detected in 48 % of the patients. While results of the culture method established coexistence of biofilm-forming bacteria (Pseudomonas aeruginosa, E. coli, Klebsiella pneumoniae, Enterococcus spp., and Acinetobacter spp.) in different combinations, the presence of Capnocytophaga spp., Lactococcus spp., Bacillus spp., Staphylococcus haemolyticus, Enterobacter or Citrobacter spp., Morganella spp., Salmonella spp., and Helicobacter pylori was also characterized in these samples by the PCR-DGGE method. Multidrug resistance phenotypes (87.5 %) and resistance to third- and fourth-generation cephalosporins and quinolones were common in these strains, which could evolve through their selection by bile components.  PMID: 27193890

And

We examined the whole exomes of 26 primary gall bladder tumour and paired normal samples for presence of 143 HPV (Human papilloma virus) types along with 6 common Salmonella serotypes (S. typhi Ty2, S. typhi CT18, S. typhimurium LT2, S. choleraesuis SCB67, S. paratyphi TCC, and S. paratyphi SPB7) …. typhoidal Salmonella species were found in 11 of 26 gallbladder cancer samples, and non-typhoidal Salmonella species in 12 of 26 gallbladder cancer, with 6 samples were found co-infected with both.  PMID:  26941832

And

A 69-year-old man with a history of pulmonary tuberculosis presented with fever. He tested positive for the QuantiFERON TB-2G and human T-cell lymphotropic virus type 1 antibodies. Imaging revealed a mass in the neck of the gallbladder, with periportal lymph node enlargement and penetration into the duodenum. .. the patient was diagnosed with abdominal tuberculosis lymphadenitis extending into the gallbladder and duodenum.   PMID: 27264431

 
 

Parasites

Gall bladder cysts, growths, tumours and cancers have been found to be associated with parasites, especially in the immunocompromised [see above, pharmaceuticals].  Some of the parasites that have been commonly associated with these disorders are Cryptosporidium species, Cystoisospora belli/Isospora belli, Cyclospora cayetanensis and Enterocytozoon bieneusi [common Name: Microsporidia].

Herein we describe two cases of Cystoisospora belli infection of the gallbladder in patients with chronic abdominal pain ….. Neither of the patients at our institution was found to be immunocompromised, HIV-1/2 antibody testing was non-reactive in both.  PMID: 27526491

Researchers have been able to make these findings, as so many people are now dying of AIDS and thus providing a ready source of organs for study.  But any immunocompromised person may suffer the same problems:

The authors performed a parasitological survey on the gallbladder tissue sections of patients who underwent cholecystectomy due to chronic acalculous cholecystitis at the Shiraz University of Medical Sciences, Iran. Light microscopic investigation in more than three hundred archived histopathological slides revealed the presence of sexual stages (i.e., mature sporocysts) of a coccidial protozoan in a patient with AIDS who developed acalculous cholecystitis as confirmed by histological, parasitological and molecular tests, in which Sarcocystis species was the only identifiable pathogen in gallbladder sections. PMID: 24827104

Coccidia can infect all mammals, some birds, some fish, some reptiles, and some amphibians. Most species of coccidia are species-specific in their choice of host. An exception is Toxoplasma gondii, which can infect all mammals, although it can only undergo sexual reproduction in cats.  Thus being with cats is a cause.  There are other parasites:

Giardia lamblia is a protozoa that invades the high portions of human small bowel, as well the gall bladder and biliary passages. The absorption from the gut of extrinsic particles which have all properties occurs at full scale in the small bowel. Infections by this protozoa may lead to different clinical symptoms: departing free-symptom, urticarial manifestations of variable intensity and malabsorption syndromes, as well. In Cuba, Giardia lamblia parasitism constitutes a health problem because of its high incidence and prevalence.  PMID:  7976968

And

Chagas disease is an infectious disease caused by the protozoan Trypanosoma cruzi. The disease mainly affects the nervous system, digestive system and heart. The objective of this review is to revise the literature and summarize the main chronic gastrointestinal manifestations of Chagas disease. .. The anatomical locations most commonly described to be affected by Chagas disease are salivary glands, esophagus, lower esophageal sphincter, stomach, small intestine, colon, gallbladder and biliary tree.  PMID:  20037711

 

Toxins including heavy metals

Heavy metals are a well-known cause of gall bladder cancer and inflammation, but other toxins have also been implicated

A high incidence of gallbladder cancer (GBC) is reported from North India, with elevated concentrations of heavy metals in water and soil. This Indo-Japan collaborative study compared presence of heavy metals in gallbladder tissues.  RESULTS: Chromium, lead, arsenic and zinc were significantly high in Indian GBC compared with Japanese GBC. Chromium, lead and arsenic were significantly high in the Indian cholecystitis tissues compared to the Japanese. TEM of Indian tissues demonstrated electron dense deposits in GBC.  PMID:  22502665

Fungal infection

Candida albicans is an important fungal pathogen that can cause life-threatening disseminated infections. …. we aimed to develop real-time non-invasive imaging to monitor infection in vivo……We confirmed the kidney as the main target organ but additionally observed the translocation of C. albicans to the urinary bladder. The treatment of infected mice with caspofungin and fluconazole significantly improved the clinical outcome and clearance of C. albicans from the kidneys; however, unexpectedly, viable fungal cells persisted in the gall bladder. Fungi were secreted with bile and detected in the faeces, implicating the gall bladder as a reservoir for colonization by C. albicans after antifungal therapy. PMID:  24951534

Treatment

 

 

 FIND THE CAUSE – TREAT THE CAUSE. 

The current medical approach

Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that is used primarily to diagnose and treat conditions of the bile ducts and main pancreatic duct, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP is now rarely performed without therapeutic intent.  It does not involve the removal of the gall bladder.
Stone recurrence is a common late adverse event after ERCP in patients with common bile duct stones (CBDS) [PMID:  25952091].  In other words, treating the symptoms gets you nowhere long term, one has to understand the cause to stop the problem recurring.

Lithotripsy is a medical procedure involving the physical destruction of hardened masses like kidney stones, or gallstones. The term is derived from the Greek words meaning "breaking (or pulverizing) stones.

Cholecystectomy - Where significant damage to the gall bladder exists, such that it has ceased to function, or it is severely cancerous, the standard procedure used by the medical profession is the CholecystectomyCholecystectomy is the surgical removal of the gallbladder.

It is, however, used almost as a standard procedure in some countries and hospitals for any problems of the gall bladder.  The cause of the problem is rarely investigated, as such a surgical procedure may be being used for something which is actually treatable.   Surgical options include the standard procedure, called laparoscopic cholecystectomy, and an older, more invasive procedure, called open cholecystectomy.

Given the absolutely key function of the gall bladder, one would have thought that this procedure was a treatment of truly last resort. 

Surgical removal of the gallbladder can lead to what is called “postcholecystectomy syndrome”.  Postcholecystectomy syndrome means you suffer from the following for the rest of your life

  • Dyspepsia, nausea, and vomiting.
  • Flatulence, bloating, and diarrhoea.
  • Persistent pain in the upper right abdomen.

And cholecystectomy is a risk factor for nonalcoholic fatty liver disease  [PMID:  26566061]. 

These symptoms do not affect just a small number of people.  Depending on who is collecting the statistics, around 40 percent of patients who undergo cholecystectomy have them, and in 10% of the cases the symptoms are described as ‘chronic’.

The pain associated with postcholecystectomy syndrome is usually ascribed to either sphincter of Oddi dysfunction or to post-surgical adhesions”.

Gall bladder disease is caused by something, as we have seen, and the problem of removing the gall bladder is that the pathogen is still there, so you just die of something else that it attacks, for example:

Controlling for multiple factors associated with increase in liver fibrosis, analyses confirmed that there was an increase in the proportion of patients who developed cirrhosis … and ascites … as well as in the incidence of death …. 5 years after cohort entry among HCV-positive patients with cholecystectomy compared with HCV-positive controls. The HCV-positive patient group with previous cholecystectomy showed an increased incidence of cirrhosis, hepatocellular carcinoma…., and death ….5 years after cohort entry compared with HCV-positive controls with GBD who had not undergone cholecystectomy.  PMID:  26566061

Why would a doctor recommend surgery this drastic with such appalling side effects, for an illness which may actually be treatable with plant based medicines or even less invasive surgery?  The answer, in some cases, appears to be money:

…. the assessment of new technologies must include the surgical value (SV) of the procedure. ….The average DVSC for TLC was $929 and was significantly lower than NTLC at $2,344 and ROBOSILS at $2,608. There were no differences observed in secondary outcomes in 30-day emergency department visits …Nontraditional, minimally invasive gallbladder removal (SILS and ROBOSILS) offers significantly less surgical value for elective, outpatient gallbladder removal.  PMID:  26922602

 

References and further reading

  • Acta Parasitol. 2014 Jun;59(2):310-5. doi: 10.2478/s11686-014-0243-1. Epub 2014 May 15. First detection of acalculous cholecystitis associated with Sarcocystis infection in a patient with AIDS.  Agholi M1, Heidarian HR, Moghadami M, Hatam GR.
  • Adv Clin Exp Med. 2015 Sep-Oct;24(5):829-36. doi: 10.17219/acem/27566.  Viral Hepatitis A in 108 Adult Patients During an Eight-Year Observation at a Single Center in Poland.  Bura M1, Michalak M2, Chojnicki MK3, Kowala-Piaskowska A1, Mozer-Lisewska I1.
  • Allergol Immunopathol (Madr). 1994 Jul-Aug;22(4):155-60.  [Giardia lamblia extract (giardine): its immunologic mechanism].  [Article in Spanish]  Alvarez Guevara T1, Alfonso Fernández LA, Gómez Echevarría AH.
  • Asian Pac J Cancer Prev. 2012;13(1):187-90. Chronic heavy metal exposure and gallbladder cancer risk in India, a comparative study with Japan. Chhabra D1, Oda K, Jagannath P, Utsunomiya H, Takekoshi S, Nimura Y.- 1Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India.
  • Case Rep Pediatr. 2016;2016:9130673. doi: 10.1155/2016/9130673. Epub 2016 Apr 20.  Acute Alithiasic Cholecystitis and Human Herpes Virus Type-6 Infection.  Gomes MM1, Antunes H2, Lobo AL3, Branca F4, Correia-Pinto J5, Moreira-Pinto J5.
  • Clinics (Sao Paulo). 2009;64(12):1219-24. doi: 10.1590/S1807-59322009001200013.  The chronic gastrointestinal manifestations of Chagas disease.  Matsuda NM1, Miller SM, Evora PR.
  • Eur J Clin Microbiol Infect Dis. 2016 Aug;35(8):1331-9. doi: 10.1007/s10096-016-2669-x. Epub 2016 May 18.  Association of diverse bacterial communities in human bile samples with biliary tract disorders: a survey using culture and polymerase chain reaction-denaturing gradient gel electrophoresis methods.  Tajeddin E1,2, Sherafat SJ1,2, Majidi MR2,3, Alebouyeh M4,5, Alizadeh AH2, Zali MR2.
  • Eur J Gastroenterol Hepatol. 2016 Feb;28(2):181-6. doi: 10.1097/MEG.0000000000000512.  Relationship of hepatic fibrosis, cirrhosis, and mortality with cholecystectomy in patients with hepatitis C virus infection.  Martin DJ1, Weideman R, Crook T, Brown G.
  • Adv Appl Microbiol. 2016;96:43-64. doi: 10.1016/bs.aambs.2016.07.019. Epub 2016 Aug 5.  In Sickness and in Health: The Relationships Between Bacteria and Bile in the Human Gut.  Hay AJ1, Zhu J1. - 1University of Pennsylvania, Philadelphia, PA, United States.
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  • Infect Agent Cancer. 2016 Mar 3;11:12. doi: 10.1186/s13027-016-0057-x. eCollection 2016.  Non-typhoidal Salmonella DNA traces in gallbladder cancer.  Iyer P1, Barreto SG2, Sahoo B1, Chandrani P1, Ramadwar MR3, Shrikhande SV4, Dutt A1.
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