Sometimes symptoms of a sluggish liver and/or sluggish bile flow can be interpreted incorrectly as gall bladder disease and the solution is to improve liver function. There may be excessive pressure inside the bile ducts within the liver and this occurs before the bile ducts get to the gall bladder. This increased pressure inside the bile ducts can be caused by thick toxic bile or an inflamed liver.
A fatty liver is swollen and congested with fat; this can cause bile flow to be sluggish, resulting in increased pressure and discomfort over the liver.
If the increased pressure remains in the bile ducts this can result in back pressure in the bile ducts; this can cause liver cysts. These cysts are small to begin with, but if nothing is done, these cysts can grow in size and become painful.
The following symptoms are typical of a gallbladder attack.
- Moderate to severe pain under the right side of the rib cage
- Pain may radiate through to the back or to the right shoulder
- Severe upper abdominal pain (biliary colic)
- Nausea and upset stomach
- Burping or belching
- Attacks are often at night
- Attacks often occur after overeating
- Pain will often but not always follow a meal with fats or grease
- Pain may be worse with deep inhalation
- Attacks can last from 15 minutes to 15 hours
Other problems can masquerade as gallbladder problems and the diagnosis may not be made correctly.
Problems that can masquerade as gall bladder problems include:
- Stomach inflammation known as gastritis – this may be caused by infection with bacteria known as helicobacter pylori; these bacteria live in the stomach lining and flare up if you eat excess sugar or excess carbohydrates
- Reflux of acid from the stomach back into the oesophagus
- Ulcers in the stomach or duodenum
- Food allergies
- Gluten intolerance
- Liver cysts caused by sluggish bile flow (these are often small)
- Fatty liver with liver congestion
- Severe emotional stress causing spasm in the smooth muscle in the gut
- Adverse drug reactions from anti-inflammatory drugs which can upset the liver and stomach
If a patient presents with symptoms that could be due to gall bladder disease, the doctor will order various tests such as:
- Blood tests for liver function
- Imaging tests of the upper abdomen to visualise the liver, gallbladder, bile ducts and pancreas such as an ultrasound scan, CT scan, MRI scan or a HIDA scan.
- A HIDA scan (Hepatobiliary Imino-Diacetic Acid scan),) or cholescintigraphy is a nuclear imaging procedure to evaluate the health and function of the gallbladder. A radioactive tracer, usually technetium-99m, is injected through a vein, then allowed to circulate to the liver, where it is excreted into the biliary system and stored by the gallbladder.
- Normally the gallbladder is visualized clearly within 1 hour of the injection. If the gallbladder is not visualized within 4 hours after the injection, this indicates either gallbladder inflammation or cystic duct obstruction.
- An MRI scan of the liver and gallbladder is very accurate but can be expensive- still its worth it, if it can help you avoid uneccessary surgery.
It is not uncommon to find gallstones using these various imaging techniques, even in people with no symptoms, and these gall stones may or may not be the cause of the symptoms. However once the gallstones are detected, they are usually blamed for the patient’s symptoms.
Beware – your gallbladder is precious!
You may be talked into having your gallbladder out at the earliest convenience. The surgeon may tell you, “Why not get it removed; it’s not important and it’s making you sick?” Another common thing that doctors will say is “After your gallbladder is removed, you can eat whatever you like without any more pain”
Dr Cabot disagrees with both of these concepts for several reasons –
- The gallbladder concentrates the bile and supplies a quick shot of bile into the small intestine during a meal – this facilitates the digestion and absorption of fats.
- The gall bladder may not be the cause of any of your symptoms and may not be making you sick.
- The gall bladder may be the cause of only a few of your symptoms and having it out may not relieve all your symptoms
- After your surgery, if you eat whatever you like, you will probably get a fatty liver and gain a lot of weight
- Any operation carries significant risks and if you get complications, you may end up worse off
- You do not need to panic if you have a grumbling gallbladder – why not try to treat the cause first – namely improve your liver function so your liver can make healthy bile allowing your gallbladder to heal