Gallbladder problems: Symptoms and treatments - MedTalk by Medical Tourism S7 – EP11
It can make me nauseous, yes, it can make me vomit too, it can even make me diarrhea. These are medical emergencies that occur. Or is it something progressive? There are patients who arrive with their gallbladder already completely ruptured. Hi how are things? Welcome to today's segment, where I feature Dr. Adrián Rivas, a general surgeon specializing in laparoscopy who has over seven years of experience practicing in the city of Puebla.
And our topic is going to be the gallbladder. Hello, how are you, doctor? How are you feeling? Thanks a lot. I feel very well, I hope you are too Kurt. Thank you so much for the invitation and to everyone watching. I hope you enjoy this chapter and, above all, that it is informative for you.
So first of all, where is it? What is the gallbladder for? Okay, what is the gallbladder? If we give a definition of the book, it is a pear-shaped organ. It is located in the lower part of the liver, which is in the upper right part of the abdomen. And what is the function of the gallbladder? It's to store bile, and when we eat foods high in fat or fatty, the bile leaves the gallbladder and reaches our intestine, so it can begin to break down these fats, that's what the gallbladder does. It's a reservoir. What is bile used for? I've only heard what the grandmothers say.
You're going to spill your bile, don't get angry. So what is it for or what? Okay, the function of bile itself is to begin to break down fats so that we can better absorb them in the intestine. It works at different levels of the small intestine and what it does is allow our body to take advantage of a lot of nutrients and not consume or absorb all the fats we have. Okay, so it kind of helps you stay healthy. I think it's the fat thing. Yeah, that's right. Healthy bile helps with better breakdown and absorption of nutrients in the intestine.
And why does it get sick? Okay. Why does our gallbladder or bile get sick? Bile is made up of cholesterol and bile salts and something called lecithin. When one of these three components increases or decreases, bile loses its essence and stones can form.
There are other pathologies in which the gallbladder no longer performs its function. It is called vesicular CNS. It can get sick from bacteria, it can get sick from parasites. Suddenly there are cases where the parasites arrived, went up, entered the gallbladder and stayed there. But the most common thing is that stones form in the gallbladder, blocking the tube that carries bile in and out. What causes these stones to form in the gallbladder? Okay.
What causes stones to form is this alteration between these three components that I mentioned. So, for example, patients who gain weight very quickly, who lose weight very quickly, too. Pregnant patients are at greater risk due to the hormonal increase that occurs. All of this causes the bile to flow more slowly instead of normally, but it flows improperly, it begins to stick together, and stones begin to form.
Regarding the gallbladder, there are some signs or ways in which I can know that I have gallbladder problems. Yes, it can happen that we suddenly have a sudden pain, I am normal and suddenly I start with a cramp on the right side of the abdomen. But the most common thing is that we go to eat tacos, which I make fried, something with a lot of fat and after 30 to 60 minutes we start to feel a colic-type pain. It can be in the pit of the stomach or in the upper right part of the abdomen 30-60 minutes after we ate. It's colic. It can be intense, it can last for a few hours, it may not go away, but that's the most common.
We eat fats and after 30-60 minutes we start to feel pain. It may be a suspicion. The most common thing is that when they eat fat again they have another bout of pain, or after a month they have another bout or they have more and more recurring bouts. But it is usually after eating high-fat foods. Ugh, this whole thing with food.
How can I tell if I should see a doctor? How do I know if it could be my gallbladder or if I'm not having digestive problems from eating a super fatty meal? I don't know how you could help me tell. Is it the gallbladder or something I ate? Okay, first of all, you have to understand that no one should have pain after eating. I mean, if something causes pain after eating, we shouldn't have any pain at all. Even if you eat that. ike, if you eat, I don’t know, 12 super greasy tripe tacos. I mean, no, we shouldn't feel pain. No.
No, we shouldn't feel the pain. It's not. It's not normal. I mean yes, if I eat 12 tacos, I tell you I'm going to feel full and not like this, but the pain shouldn't be there.
How do I identify that it could be a gallbladder that is, for example, food poisoning? When we have problems with the gallbladder we generally start with pain, can the pain make me nauseous? Yes, it can make me vomit. It can also even cause diarrhea. When it's the other way around, I usually start with nausea, I start with vomiting, I start with dizziness, I start with diarrhea, and pain follows.
That is the most characteristic thing, when it is the gallbladder it is I ate something greasy. I have elements, I started with colic and then nausea and the rest. And when we eat something bad, too much, I get nauseous, I want to vomit and then the pain starts. It's like the difference between thinking about one or the other. Ok, yes, I think so.
When you were saying it like it made sense to me,then don't fall for it, even if you eat fatty foods you shouldn't feel pain, you should feel full. Maybe you want to vomit whatever you want, but not pain, and if you feel pain, then you should see the doctor to have your gallbladder checked. How do you check the gallbladder? So, how do you know it's the gallbladder? Okay, clinically we obviously question the patient and generally hear what they tell us.
I went to eat some tacos and after a while I started to feel pain. This is the third 4th time he has come to me for a physical examination. We can hear slightly increased peristalsis on auscultation, but the characteristic is when we palpate the abdomen. They have pain in the lower part of their ribs, that is, below the ribs on the right side. There is a point there where the gallbladder is that is causing pain.
We ask the patient to take a deep breath, and when they are inhaling, we press that point and the patient stops breathing. So that's the morphine cycle and it's when inspiration is cut off, that's already very suggestive that it's the gallbladder and so we generally ask for imaging studies, which is an ultrasound which is the best study and that's where the vast majority tell us it's inflamed, has stones or is inflamed and has stones. You see, there are about 10,000 diets and 10,000 home remedies for everything.
Is there anything currently being done that could cause stones or inflammation in the gallbladder that would make you say, stop doing it, take care of your gallbladder, and don't do this? If the diet we can follow is to eat healthy, eat fruits, eat vegetables, eat meat, avoid processed foods, avoid soft drinks. However, it is important to mention that eating these will not cause stones to form, and not eating them will not prevent stones from forming. We have had patients who are the healthiest people in the world.
Eat the best in the world, exercise every day, and because of your own genetics, you developed gallstones. But how can we help ourselves reduce the risk? Well, it's with a healthy diet. And all these gallbladder problems are usually medical emergencies that occur, that is, people eat their tacos, they eat their very fatty food and there comes a point where you have to go to the hospital or it's something that goes, it's progressive.
What I want to take is and that's where the appendix bursts or not suddenly it's, it's fine and the peace and the emergency hospital. So with the gallbladder, it's something progressive that we have the opportunity to go and get treated, or if it's something that can happen emergently. Okay, usually, uh, the picture is not so urgent, so to speak.
Because? Because the first thing patients do is take painkillers and it is quite common for the pain to subside, unlike the appendix when it becomes inflamed, these stones in the gallbladder can become unclogged from the ducts in the legs with. When we walk, move, or lie down, the stones also dance around inside the gallbladder. Suddenly the duct is unclogged, the pain is felt and the patient no longer comes to the doctor. This does not excuse the fact that many patients who get a stone stuck experience pain that doesn't go away at all and end up in the emergency room. Yes, it's very common for people with this pain to go to a doctor and what happens is they give them painkillers.
It is often confused with gastritis, so to speak. So the patient's pain is gone and he's not going to be treated anymore, but the symptoms keep recurring, and the more the symptoms keep recurring, the more aggressive they become. This pain, the gallbladder becomes increasingly inflamed and yes, patients arrive literally from the emergency room. I've had this pain for five years. I've had about 15 episodes of pain, but I haven't wanted to get treatment.
But they arrive with a ruptured gallbladder, for example. Well, they already have peritonitis and everything is already infected. That is, generally, what is indicated when you have a condition of this type is to go to a consultation and if a gallbladder disease is diagnosed, it is at that moment or as soon as possible, then a procedure is performed to treat the patient. The more times you have this condition, the worse it will get for you, each time it will get worse. If a gallstone gets stuck in the duct, the pressure will immediately increase. There will be a lot of pain and that can cause the gallbladder to become infected, or even rupture.
If there are patients who arrive with their gallbladder already completely ruptured, something that also happened suddenly, we don't know that we have stones, I don't have any pain symptoms. Well, I have pain there, I'm seeing my eyes yellow, my face, my hands, my tongue are turning yellow. And that can tell us that one of the stones got stuck in the main bile duct and so we have those symptoms. They never have pain symptoms, they eat well, everything is normal, and suddenly, doctor, I'm yellow and when we examine them, they have stones in their gallbladder and they have stones in their bile duct. What should be done? When the patient reaches the point where we know the gallbladder is bad, are there ways to fix it medically or do you have to undergo surgery and remove more of it? What is the treatment for gallbladder? If the gallbladder is inflamed, nothing more, there is no evidence of infection. Are the patient's labs normal or do we just have an inflamed gallbladder? We can manage this anti-inflammatory, see if that corrects it. In
many patients, if their gallbladder improves, they are checked after five days and it is back to normal, and we can stay with that. However, if we have a study, we see that if we have stones, we usually have to remove that gallbladder. Because? Because the only thing stones are going to do is make our existence more complicated. If they do come out of the gallbladder, but worse because they get stuck in the main bile duct or they get stuck in the pancreatic duct and well, they can get pancreatitis or something called cholangitis, which is a much more serious disease and well, it makes the patient worse. So when it is only inflamed without stones, we can give it a chance for medical treatment.
If we know that the patient has stones, we know that it will become increasingly complicated and the patient will need to be operated on. There is no way to just get in and remove the stones. No, I mean, we could open the gallbladder and remove the stones and close the gallbladder, but that gallbladder will continue to form stones, that gallbladder will become inflamed again. This is something that is not really indicated unless it is so inflamed that we cannot identify the important structures to remove the gallbladder. We do something
called a subtotal cholecystectomy, which is removing 80% of the gallbladder, removing the stones, and closing the remaining remainder. There are other options that involve opening the gallbladder, inserting a drain, and having the patient have the drain for several weeks so the bile can drain out. These are just rescue procedures. When we don't have a safety vision to perform the entire surgery. What should be done? I'm already a candidate for surgery. I'm going to have surgery, I'm going to have my gallbladder removed. What should I do beforehand?
That's what I was seeing coming out of a lot of things, so be careful not to throw some tacos at that, not before. Come on. Well before the surgeries we already know that you are going to have surgery. First, you don't have to force your gallbladder, you have to change your diet.
What is the ideal? A fat-free diet, you should avoid dairy products, milk, yogurt, cheeses, creams. You have to avoid avocado, cooking with oil, fried things, adding too much salsa to tacos, too many condiments, all of that has to be avoided. Because? Because that will put a lot of strain on the gallbladder and could cause further pain, and as such, before surgery, you should arrive fasting and have your labs ready, and that's it.
How long does the operation last? It leaves a super scar. It is done laparoscopically. Please tell us your recovery time as well.
Recovery depends greatly on the type of surgery. In some places, open surgery is still performed, a 15-20 centimeter incision below the rib. You have to cut with a lot of layers, you have to burn muscles, if it's a fairly large surgery, I'd say it's not complex, but if it's a very large wound, recovery takes two to three weeks.
The patient will be in a lot of pain, but basically what we do is laparoscopic surgery, or mini-laparoscopy, or robotic surgery, so we make 3 to 4 very small incisions, even 3-millimeter incisions. A gallbladder surgery takes approximately 40 minutes. It depends a lot on the severity of the patient as well, of course. Within 40 minutes of surgery and seven days after surgery, the patient is returning to completely normal activities.
The pain is much less compared to open surgery and after 7 to 14 days the patient is as if nothing had happened. And how does your life impact you once your gallbladder is removed? Because I suppose that if before I was failing I was struggling to process fats, now that I have no gallbladder, this either gets worse or it doesn't. Uh, no, in fact the bile, the way, the liver and the bile goes down the main bile duct to the small intestine. The gallbladder is what functions to store the bile produced by the liver in the gallbladder.
When we eat, the gallbladder releases bile as if the gallbladder is not working properly, or has stones or is blocked, causing us pain. But what is life like after having my gallbladder removed? Completely normal. Why? Because bile continues to be produced. The bile will reach your small intestine, but your body will understand that it doesn't have a gallbladder.
So it will release bile in a different percentage than it did when you had a gallbladder. So it's a period like the one you're used to, like two or three weeks, during which it's suggested you follow the same diet, fat-free, and then your life will be completely normal, eating whatever you want to eat, as if you hadn't done anything at all. That is, business as usual, business continues, everything is the same. Correct, everything is the same. But now without pain. Exactly no pain.
Hey, I have a friend who had her gallbladder removed and they told her she could never eat fatty foods and I don't know what. So that may happen in some cases or it was just something to take care of. I think it was just so he would take care of himself. Obviously, if a patient has diabetes, hypertension, or other problems, and they are on a diet for other illnesses. You have to take those illnesses into account, but I mean, for example, in the case you're telling me about, well, I think they just told him so he'd eat well, but no, go ahead.
If you want to eat some carnitas tacos later, absolutely nothing will happen to you and you can go. And you don't need to be taking any kind of medication to help you control the amount of bile that comes out to be processed or that you're going to start producing more or in excess. No. Nothing, no, you don't have to take any kind of medication. Your body will function as if nothing has ever been done to it.
So she can go and eat, there's no need for extra vitamins, or medications, or what many patients are prescribed, they prescribe bile formers or something like that, they start selling it to people and the truth is that they don't need it, but she can't go and eat whatever she wants and nothing will happen to her normal life. Please enjoy your meal. I'm going to tell Miriam not to watch this episode so she can continue taking care of herself and avoid eating fats. Well, thank you very much, Doctor, for your time. I don't know if there's anything you'd like to add or something you see that I missed.
Just take good care of yourself. Remember, the trick is not to arrive when it's already an emergency. If you already have symptoms or have had one or two episodes of pain, go to the doctor. Operating on a scheduled patient is not the same as operating on a patient who arrives urgently.
The surgery takes longer, the complications are greater. So, if you are in pain, go to your trusted surgeon. If you're here in Puebla, I'd be happy to welcome you. Thank you so much, Kurt, for your time and for this conversation. No thanks to you. And remember that a timely diagnosis is always the best way to stay healthy.
So don't self-diagnose if you feel pain, go to this doctor, the one in your city, but go to the doctor so he can give you a good diagnosis and see that he can do this. If that happens, what else could it be that would not cause having to remove the gallbladder? Ok differential diagnosis could be pancreatitis. Yes, it could be gastritis, it could be peptic acid disease. There are some cases of appendicitis in which the appendix is upwards, so the patient has pain below the rib, but it is due to appendicitis, which if it happens, but generally, it is the most common thing that is confused with gallbladder problems. Well, thank you very much for your time and thank you very much for listening to this. I'll leave the camera with the doctor so he can say goodbye. Take care of
yourselves, then. Thank you so much for the invitation again, and everyone knows, we need to talk about it, take good care of yourselves, exercise, and we'll see you another time. After my conversation with Dr. Adrián, I can conclude that if
you experience any type of pain after eating a very fatty food, you may have gallbladder problems. And it's very important that you go to a general surgeon for a check-up. Nowadays, completely open surgeries are no longer common, so you have nothing to worry about. Here's the link to our episode where I spoke with another general surgeon so you can learn everything a general surgeon can do for your health. Don't forget to like and share. This helps us continue generating content like this.
Thanks for listening. See you next time! Before choosing your doctor, investigate their years of experience, the number of procedures they have performed, and whether they are members of the institutions that regulate and certify that they have the necessary training and knowledge to perform the procedures and surgeries they offer. In the description, you'll find a link to more information on the topic discussed, as well as the specialists within Mexico who meet the requirements to do so. The information mentioned here represents a point of view and should not be taken as a medical assessment. And remember, investing in health so as not to spend on illness is an excellent philosophy.
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2025-05-02 16:05
