Last November, the liver was featured as an organ "of the month." This month we take a look at the liver's close friend and neighbor as well as co-worker - the gall bladder.
Some of you may no longer have a gall bladder, some of you may occasionally
wish you no longer had a gall bladder, and the rest of you are probably blissfully unaware of this 4 inch, musculo-membranous sac nestled in a nook in the under side of the right lobe of your liver. It's the green, pear-shaped thing in the picture. While you're looking at the picture, notice the 2 green ducts and the duodenum which is the sweet potato-looking thing on the right.
Function. The gall bladder has one primary function -- it is a storage vessel for bile that is made in the liver. That seems pretty straight forward but, of course, it's a little more complicated than it sounds. Over the course of a day, the liver continually secretes bile, amounting to between 600 and 1000 milliliters (2.5-4 cups). The gall bladder's maximum volume is 30-60-milliliters (2-4 tablespoons). Even the mathematically-challenged (such as myself) will notice a significant discrepancy here. It would seem doomed to failing at its primary function! But the mucosal layer of epithelial cells that line the inside of the gall bladder are constantly absorbing water, sodium, chloride and many other small electrolytes, thereby concentrating the bile 5-15 times its original strength. Then, on cue from various inputs but primarily from the hormone cholecystokinin, the gall bladder empties the concentrated bile into the duodenum where it plays an important role in the digestion of fat among other things. (I think I'll have to have bile as a "Body Fluid of the Month" sometime to continue this story and give you the whole picture!)
Dys-Function. It's almost unfair to say that the problems we blame on the gall bladder are a dysfunction of the gall bladder. Except for rare malformations, auto-immune problems or other complicating diagnoses, nearly all "gall bladder problems" are the result of the Western diet and lifestyle, not an actual dysfunction of the gall bladder itself. But here's a short list of gall bladder diagnoses.
Cholecystitis - Inflammation of the gall bladder can be acute or chronic. This is usually associated with gall stones.
Cholelithiasis - AKA gall stones are likely your first thought when you think of gall bladder problems. While nearly one million Americans are diagnosed with gall stones each year, many more millions actually have gall stones -- most are found inadvertently when scanning for other problems. That means that most gall stones are without symptoms which is a good thing, as symptomatic gall stones can be very painful!
Choledocholithiasis - gallstone(s) that have lodged in the common bile duct (one of the green tubes you noted in the picture above). This blocks the flow of bile, can be very painful and cause a multitude of other problems including serious issues with the liver and/or pancreas.
Cholecystectomy - removal of the gall bladder - a common result of the two previous "chole" words. About 600,000 such surgeries are done in the U.S. each year.
Biliary dykinesia, which is a little easier to say than cholecystodyskinesia, is less often discussed, but can be a source of pain without inflammation. It is more of a functional disturbance with uncoordinated, decreased or absent motility of the gall bladder.
Gallstones. As the most common gall bladder issue, let's talk about these a little more. How about that picture, eh?
It is, obviously, very extreme! About 90% of gallstones are made primarily of cholesterol. Other kinds are called pigment stones, are much less common and we aren't going to address those here.
Cholesterol gallstones are about 90% cholesterol with the remaining portion being some sort of calcium compound. Bile is high in cholesterol. Once in the gall bladder, under certain circumstances, the cholesterol can crystallize out of the bile and form into stones. These circumstances include excess absorption of water and bile acids, too much cholesterol and/or inflammation of the gall bladder itself. Gallstones may be microscopic -- when the gall bladder is filled with microscopic stones it is called biliary sludge. Sludge is reversible or may precipitate further into bigger stones up to an inch or more.
Risk factors include being female (2x higher incidence than males), Native or Latin American or overweight. Diet plays a significant role as does diet-ing. Sudden, dramatic weight loss is a common trigger for gallstone attacks. Some medications contribute as well, including birth control pills, proton pump inhibitors (your common heartburn drugs) and possibly statin drugs.
Miscellaneous Trivia. Back in Hippocrates time, it was thought that the body was ruled by 4 "humours" - one of which was yellow bile. An excess or imbalance of this bile was said to make you "choleric" - or bitter & angry. That's where all those "chole" words related to the gall bladder come from! The dictionary defines gall as something bitter to tolerate. It is also interesting that in Traditional Chinese Medicine (which pre-dates Hippocrates by a few thousand years), the gall bladder is very affected by anger and bottled-up resentment. While today if we say someone has a lot of gall, we tend to mean that in a more negative way, in TCM, the gall bladder affects courage and initiative in a very positive way.
Care and Feeding of your Gall Bladder. I mentioned earlier that a typical Western diet and lifestyle is the primary cause of gall bladder problems. This means that moving AWAY from these typical habits can prevent or reverse the same problems! Avoid simple sugars, high calories and high (bad) fat diets. The good fats - Omega 3s from fish for instance - actually decrease precipitation of cholesterol into stones. These and other healthy plant oils are necessary for the actual working of the gall bladder. Beets are one of the best foods for gall bladder health. High fiber - wheat bran in particular - helps prevent stones. Exercise is important, as are anti-oxidants, maintaining a healthy weight and maintaining good bowel health. There are some herbs and other compounds that can be helpful with known gall bladder problems. AND perhaps you should consider letting go of an old grudge, learning to diffuse anger and summon courage!
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