“The pain cuts like a knife,” is a common description of the intense pain that often comes with a gallbladder attack. WakeMed Physician Practices general surgeon Dr. Ian Villanueva says the most classic symptoms he sees are ‘sharp or crampy pain under the right ribs and/or the breastbone that occurs 20 minutes or more after a meal.’
This painful condition occurs when tiny, stone-like masses that are most often made of cholesterol get lodged in the gallbladder or bile duct (the tube that carries bile from the liver and gallbladder through the pancreas to the small intestine).
The pain is often severe enough be mistaken for a heart attack. In most cases, the intensity of the pain makes it hard to sit still, and it doesn’t change or get worse when you move. Sometimes it will spread from the abdomen to your right shoulder and/or your back between the shoulder blades. Other symptoms may include nausea, vomiting, fever, chills, dark-colored urine, light-colored bowel movements or yellowing of the skins and/or eyes.
Treating a Gallbladder Attack
Patients having a severe gallbladder attack often wind up in the emergency department. While there’s nothing that can be done to stop a gallbladder attack once it starts, medications can help ease the pain. It’s also important to get evaluated to rule out other potentially dangerous conditions such as appendicitis, heart attack, or a perforated ulcer.
Much like kidney stones, gallstones can sometimes pass on their own. However, when they don’t, they can lead to complications such as infection or inflammation. Dr. Villanueva says that gallstones that are very small (less than 0.5 cm) can be observed if they are not causing symptoms, but patients experiencing even mild to moderate pain or those with larger stones should strongly consider elective surgery.
Surgical Treatment for Gallstones
For patients with severe inflammation or infection, or those with reoccurring gallbladder attacks, surgery is typically indicated. The gallbladder can be removed by a general surgeon through a common surgery known as a cholecystectomy. This procedure is most often performed laparoscopically where a fiber optic camera helps guide the surgeon in removing the gallbladder through very small incisions. This minimally-invasive approach leads to faster recovery, shorter hospital stay and less need for pain medications. Even still, most patients who have their gallbladder removed will take 3-5 days off of work, but are back to full activity in two weeks or less. However, Dr. Villanueva says these ranges will vary based on the amount of inflammation present. “Oftentimes, patients who are admitted through the emergency department will have a longer recovery due to severe inflammation, which can lead to longer, more difficult surgery.”
Wait! Don’t I Need My Gallbladder?
Believe it or not, you can live a healthy life and digest food normally even without your gallbladder. Once it’s removed, bile will move directly from your liver to your intestines. It’s important to note, however, that some patients will experience some short term side effects such as indigestion or diarrhea as your body adjusts after surgery. Dr. Villanueva tells his patients to avoid greasy/fatty foods in the first month because these foods may cause diarrhea while the body adjusts to life without the gallbladder. After a brief adjustment phase, most patients will be able to eat normally without restrictions.
Treatment for Gallstones Obstructing the Bile Duct
Patients with an obstructing gallstone within the main bile duct will need an additional endoscopic procedure to clear the blockage. Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure most often performed by a gastroenterologist that uses endoscopy and x-ray technology to open blocked ducts and either break up or remove gallstones. The procedure can also be used to perform a biopsy, remove tumors in the ducts, to insert stents to hold the narrowed ducts open or to stop bile leaks that can occur after gallbladder surgery. In most cases, this procedure takes less than 2 hours and patients are sent home after a brief observation period.