Oh, The Gall!

I thought I’d write about macular degeneration this week since that’s the newest diagnose in my life.  But my daughter’s  Cholecystectomy is taking precedence in my mind, so we can postpone the macular degeneration.  Her what, you ask?  That, my friends, is what the procedure to remove your gall bladder is called. By the way, I asked what it was, too.       photo

This is Nima’s description of how it all started and what the procedure was like:

“At one point or another we’ve all that had that midnight snack of a slice of cold pizza and maybe some juice to wash it down. So when I woke up with severe sharp pain on my right side I didn’t think much of it, except I shouldn’t have eaten that pizza, and where is the Tums?  After two Tums and a hot shower, the sharp pain continued all around the middle of my back to the middle of my front right side. I finally thought to myself, ‘Don’t be stupid. You have a family history of CKD, and one family member who passed stones a few years back. Better to be safe than sorry, get it checked.’

Off to the ER I went. After I described my symptoms to the first year resident, she picked up very quickly on the fact it could be gallstone/gallbladder related due to the side of the pain (right) and asked for a urine sample, as well as ordering blood work, and a sonogram of that area. I was also given an IV, morphine drip for pain (which honestly did nothing – too much pain- all I wanted to do was rock back and forth or keep walking in circles to help me be in motion so I didn’t have to think about the pain), and eventually antibiotics.

The doctor came back with the results of the blood work to tell me that my white blood count was elevated to 12, an indication the gallbladder was infected. I was finally taken to sonogram. A bariatric first year resident explained I had an impassable 2.7 in. diameter gallstone that was causing blockage in the duct in the front and a bunch of pain. There’d be no way to take it out other than surgery. After meeting with the attending physician, he concurred. He also mentioned that, because the gallbladder was infected, it’d be smart to remove it.

So, I did. I’ll now have to learn an entirely new way to eat (low-fat) as the gallbladder is what processes fat. I’ve learned quickly if I consume the slightest bit of fat, my body’s response is “Um, what the hell are we supposed to do with that?!” and to reject it in a not so nice way. I’ll have to play it smart and step up the exercise and water intake as well to make up for the missing organ and amount of bile that could now possibly be floating in my body because it has nowhere to go. As for pizza at midnight? Well unless, I want another episode like the one I just had, those days are now in my rearview mirror.”

But what do gall stones have to do with chronic kidney disease?  Searching the web only garnered this one article from January, 2009 – that’s four and a half years ago – http://www.ncbi.nlm.nih.gov/pubmed/19352299. The relevant quote is this:

“The prevalence of gallbladder stones in patients with chronic kidney disease is significantly higher than in those without chronic kidney disease. Our findings suggest that increasing age, chronic kidney disease, body mass index > or =27 kg/m {greater than 59 pounds}, metabolic syndrome, and cirrhosis are the related factors for gallbladder stone formation.”

Now think about it another way: you already have a compromised immune system because you have ckd.  Gall stones can cause infection of the gall bladder. As in Nima’s experience, infection causes white blood cell elevation. So you know you have an infection, you might even realize it could be in the bile ducts, too.  But did you check to see if there’s infection in other areas of your body? That would mean you can read your own test results or have the kind of relationship with your doctors – especially your nephrologist – to freely ask questions.

Let’s back track a little since I’m so good at that.  Here’s a picture of the location of the gall bladder. gall_bladder

As for what it does, I went to http://www.nlm.nih.gov/medlineplus/gallbladderdiseases.html.

“The gallbladder is a pear-shaped organ under your liver. It stores bile, a fluid made by your liver to digest fat. As your stomach and intestines digest food, your gallbladder releases bile through a tube called the common bile duct. The duct connects your gallbladder and liver to your small intestine.”

Keep in mind that your liver, the largest organ in your body {the skin is actually the largest organ, but it’s external} is the other organ that filters your blood.  Since your ckd has been diagnosed, your liver is already working harder. Add losing your gall bladder and you’ve got one very hard working – possibly overworked? – liver.

What about the surgery, you ask?  There are two kinds: open which is surgery as we understood it before laparoscopic surgery and laparoscopic surgery.  In the latter kind:

image-07Under general anesthesia, so the patient is asleep throughout the procedure.

  • Using  a cannula (a narrow tube-like instrument), the surgeon enters the abdomen in the area of the belly-button.
  • A  laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient’s internal organs on a television screen.
  • Other  cannulas are inserted which allow your surgeon to delicately separate the gallbladder from its attachments and then remove it through one of the openings.
  • Many  surgeons perform an X-ray, called a cholangiogram, to identify stones, which may be located in the bile channels, or to insure that structures  have been identified.
  • If the surgeon finds one or more stones in the common bile duct, (s)he may remove them with a special scope, may choose to have them removed later through a second minimally invasive procedure, or may convert to an open operation in order to remove all the stones during the operation.

After the surgeon removes the gallbladder, the small incisions are closed with a stitch or two or with surgical tape.

Thank you for this information Society of American Gastrointestinal and Endoscopic Surgeons at: http://www.sages.org/publications/patient-information/patient-information-for-laparoscopic-gallbladder-removal-cholecystectomy-from-sages/

And that, ladies and gentlemen, is all I know about the gall bladder and gall stones.

Until next week,

Keep living your life!