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Gall Bladder Attack: Referred Pain

moon
PAIN REFERS TO:
--most common: right side of the neck & shoulder & around the shoulder blade
--second most common: along a thin band from the lateral lower right ribs to the lower pole of the right scapula (could also signal appendicitis)
--sometimes in the middle between the shoulder blades
--pain mid-center beneath the rib cage can be gallbladder or appendicitis

PAIN:
--onset: after a meal
--can come and go or be constant
--may be sharp, excruciating or dull
--may also occur especially at night

--"Referred pain happens when nerve fibers from regions of high sensory input (such as the skin) and nerve fibers from regions of normally low sensory input (such as the internal organs) happen to converge on the same levels of the spinal cord." from http://anatomynotes.blogspot.com/2006/10/referred-pain.html
--referred pain from liver and gall bladder occurs on the neck because the gall bladder problem irritates the diaphragm

Other S/Sx:
--chest pain in the right side (caused by stones in the bile duct or inflammation or swelling of the gallbladder itself)
--Nausea or queasiness
--vomiting and gas
--may or may not be belching or burping
--GB is very tender to touch
--may not be able to walk without bending over
--will typically last for one to four hours
--80% of gallstones are "silent" (without S/Sx)
--10-20% of the population in the west have them

FACTOIDS:
--in developed nations, 80% of gallstones are cholesterol based: crystalline cholesterol monohydrate, appearing white or green with rough edges, very hard on ducts should they attempt to pass through
--20% are pigmented bilirubin stones with calcium in them, brown to black and more like round pebbles
--several microbes can cause stone development

EPIDEMIOLOGY:
--the FIVE F's: female, fat, forty, fertile, fair
--the sixth F: feathers, or fifth nation, as some native American groups are striken
--occurs 3x as often in women as men (due to estrogens)
--overweight individuals
--40% of people in the US over age 40 have gallstones
--1/3 of people who get their stomachs stapled get them
--old age is a risk factor
--diabetic
--natives of North America especially high risk (Pima indians have highest incidence, I think because their reservation is imbedded in the Phoenix metro area.)

DEVELOPMENT OF STONES:
--first, high cholesterol levels either due to diet or sudden weight loss or fasting
--then increased nucleation of cholesterol
--increased mucus in gallbladder (attempt at self defense) thickens fluids and stones form
--one day after a fatty meal the gall bladder attempts to squeeze out its bile and squeezes out a stone which gets lodged in the cystic or common bile duct and causes intense pain, perhaps washes on through, or perhaps causes a rupture (surgical emergency)

DIAGNOSIS:
--Hx
--palpation
--ultrasound
--watch gallbladder fx using radioactive stuff

TREATMENT:
--conventional: cholecystectomy
--other: dietary, flushes, and meds to dissolve stones (terpenes)
--DIET: beets, dandelion greens and all bitters, flax, yam root, milk thistle, turmeric, globe artichoke
--flush: the apple juice and apple fruit and apple vinegar fast, followed by gall squirter concoction: olive oil and lemon juice enough to make you wonder

Comments

( 6 comments — Leave a comment )
hausfrauatu
Mar. 10th, 2008 07:34 pm (UTC)
I had mine out on Tuesday. Good riddance. I don't think it had worked right ever. I remember being uncomfortable since my teens.

I had all of the classic symptoms, but I had to get a test that cost me $810 before they could take it out. Hyatascan or something like that. I had no stones, but it was only ejecting 21% of its bile. I had no stones.

I have realized that I had been mildly nauseated after most meals for a long time. I had to wait until my kids were more sufficient and GONE for most of the day. It went tits up over the holidays. I had my last bad attack in late January. I just decided to get it over with now.
liveonearth
Mar. 10th, 2008 07:37 pm (UTC)
Well. I hope your liver is still workin' good! You need that bile. Did they put you on a low fat diet for the rest of your life?
hausfrauatu
Mar. 10th, 2008 08:04 pm (UTC)
Yeah. It works fine. The gall bladder didn't empty itself properly. So I think it would get overfull and cause the pain. I will be interested to see what the Surgeon will say. Maybe the exit was too narrow or the sphincter muscles didn't work right.

Nope. No low fat diet. Actually raw dark greens set me off, too. The WORST attack I had was from a big salad with lots of dressing. It was the combo of the two. Is a low fat diet usually recommended? They told me to stay away from raw food for a couple of days, so I wouldn't get gas. Once I got off of the painkillers, everything was smooth sailing, so to speak...My mom isn't on a low fat diet. Actually I think it was her insistence when she visited in December that bacon and eggs=protein is part of the reason I started having attacks. That with holiday eating was just too much.
liveonearth
Mar. 10th, 2008 09:43 pm (UTC)
I'm glad to hear you've had a smooth recovery. What the gall bladder does is store up bile so that you can dump a bunch of it into the small intestine when you eat a fatty meal. So if you only have as much bile as the liver can produce at the time (no storage) then you can't emulsify and absorb as much fat from your intestine at one time, which will cause you to poop out more fat. Fatty poop will float and smell bad. Not absorbing as much isn't all bad, as you can imagine, but it isn't all good either. You need certain fats: make sure that you take in some good omega 3's and limit your omega 6's and you should be fine. Next time you see your doctor, ASK. Just because your mom's not on a low fat diet doesn't mean that there might be some dietary considerations that regular doctors aren't talking about. Consult a naturopathic physician or a dietician and they will tell you lots more than a surgeon will about how to maintain your health without your gall bladder.
liveonearth
Mar. 11th, 2008 05:08 pm (UTC)
I just ran across this factoid: we need bile to absorb vitamins A, D, E and K. So if you have less bile available on demand, you might need to supplement those.
hausfrauatu
Mar. 10th, 2008 07:35 pm (UTC)
Supposedly in Traditional Chinese medicine, it's the seat of emotion, heard anything about that?
( 6 comments — Leave a comment )

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