Support groups

Frankly, I am not sure why anyone would need to go to a support group after having their gallbladder removed. I had mine removed and I felt no urge to get up and share how my altered digestion function affects my life. But, I am not everyone.

So the best I could find was a forum. http://www.mdjunction.com/gallstones
Unfortunately or not, there are no physical meetings that occur on a regular basis that I could find. If there were, well... that would be interesting.

Apps recommended for patients with cholelithiasis

Some apps that a nurse may recommend to a patient with cholelithiasis are...

Medscape
WebMD

•  to help understand signs and symptoms

iColeLAP

• a mobile medical app which explains the surgical procedure of laparoscopic cholecystectomy. 

Low-Fat Recipes by SHMEDIA

• for ideas on how to eat right and still enjoy great foods

Nursing care of individuals with the disease – web sites to recommend to patients

Nursing care for a client who has undergone a cholecystectomy is general postoperative care. This consists of use of analgesics, incentive spirometry, monitoring urine output and splinting the incision. This surgery is generally an outpatient procedure, where the patient will be held a few hours. If the patient is elderly or pediatric they may be held overnight for observation. A patient may also be held overnight if there were any complications.

A few websites a nurse might provide for patient education are the following:

http://www.nursingcenter.com/journalarticle?Article_ID=1079103

• this one is very easy to read and helps inform the patient on what will happen so that they are prepared and possibly not so scared

http://www.healthline.com/health/gallstones#RiskFactors3

• this one helps describe the signs and symptoms one might experience with gallstones and who is susceptible 

Dietary considerations for patients with cholelithiasis

Diet control is one of the major interventions used to control gallstones. I will attempt to highlight some of the major factors contributing to cholelithiasis, some dietary methods of control and what can be done about it

Dietary factors

• Obesity and Weight Loss
• Being overweight or obese has been linked to an increased risk of gallstones. However, while weight loss is often a means to control this disease, excessive weight loss has also been linked to formation of gallstones due to an increased cholesterol to bile salts ratio. Excessive weight loss also may cause asymptomatic gallstones to suddenly become symptomatic 
• Food Allergy
• Failure to recognize and act accordingly to allergies has been linked to symptomatic gallstones and thus preventable cholecystectomies. This is because an inflammatory response from a food allergy or intolerance inhibits and delays gallbladder emptying, a major cause of gallstone formation. There is a strong correlation between untreated celiac disease and cholelithiasis due to stagnant bile 
• Dietary Cholesterol and Fat
• Excessive cholesterol intake causes an increase in biliary cholesterol saturation which would presumable increase the risk of gallstone formation or cause symptoms in asymptomatic gallstones. Observational studies indicate a positive correlation between saturated and trans fat intake and increased incidence of gallstones. Conversely, higher intake of polyunsaturated or monounsaturated fatty acids indicated a negative correlation, yielding a decreased risk of gallstones. Studies have been conducted where patients with gallstones are supplemented with 11.3 g/day of fish oil and their cholesterol saturation of bile decreased 25%
• Refined Sugar
• Through observational studies we see a correlation between high intake of sucrose and fructose and high gallstone incidence. This correlation, however, may be as simple as the link between excessive sugar intake and obesity, which in turn is linked to gallstones. However, some studies suggest that refined sugars in a and of themselves are lithogenic
• Vegetarian Diet
• Cross-sectional studies noting the prevalence of gallbladder disease in vegetarians vs omnivores notes that increased consumption of vegetable protein (as opposed to animal) is associated with a decreased risk of developing gallstones. A separate study in the same cohort indicated that high intake of fruits and vegetables is linked with a decreased prevalence of gallbladder disease
• Dietary Fiber
• Observational studies indicate high fiber intake is associated with lower prevalence of gallstones. Supplementation of 10-50 g of bran per day for 4-6 weeks yielded low cholesterol saturation of bile in participants. Fiber works primarily on the colon, decreasing the formation of deoxycholic acid which is a lithogenic agent of bile. Fiber also increases the synthesis of chenodeoxycholic acid which is used in gallstone dissolution therapy. 

Based on these recommendations, patients can change their diet to help control symptoms of gallstones.

 Gaby M.D., A. (2009). Nutritional Approaches to Prevention and Treatment of Gallstones. Alternative Medicine Review, 258-267. 

Medical Treatment Options for Cholelithiasis

If you have gallstones, some non-pharmacological interventions to consider are the following:

• Before eating a meal (especially a fatty one) consider taking a supplement of bile salts derived from an ox to help supplement your possible bile deficiency 
• If you are a vegetarian and cannot take ox bile, consider taking concentrated beet powder before a meal to enhance natural bile production
• Stone root supplements have anecdotally been recommended to help dissolve the stones. It is available in pills, tinctures and tea
• Eat a small amount of saturated fat to prompt the liver to produce bile. Some excellent sources are eggs, some meets, fatty fish and coconut oil
• Eat lots of vegetables and a low fat diet. 
• Consider switching to a vegetarian or vegan diet

Ox and calf

Some pharmacological/medical interventions also to be considered if you have symptomatic gall stones are: 

• Surgical Treatments
• Laparoscopic cholecystectomy
• simple removal of whole gallbladder 
• Open cholecystectomy
• necessary if there is an infection
• Medications
• Over the counter pain medication
• Bile salt tablets
• Other
• Lithotripsy procedure
• use of ultra sound waves to break up gallstones 

Signs and Symptoms of Cholelithiasis

Signs and symptoms of insufficient bile production include:

• Craving fatty/fried food 
• Not feeling fully satisfied after eating
• Immense sugar cravings 
• Itchy skin and dry eyes
• Hives, sneezing
• Bloating, indigestion, burping, belching, flatulence  

While many people may have gallstones and be asymptomatic, typical signs, symptoms and clinical presentations of acute symptomatic cholelithiasis are:

• Pain in upper abdomen, sometimes radiating to just below the right axilla
• Frequent"attacks" or sudden sharp pain after eating a fatty meal that may last moments to several hours
• Intermittent pain on the right, below the ribcage
• Bloating
• Nausea
• Vomiting 
• Belching
• Gas
• Indigestion
• Sweating, chills, low grade fever
• Jaundice 
• Clay-colored stools 

Typical signs and symptoms of Bouveret Syndrome are:

• Nausea
• Uncontrollable vomiting and/or hematemesis
• Upper abdominal pain and distention
• Dehydration 
• Fever
• Weight loss
• Melena (tarry, black, blood filled stools)

"Bouveret Syndrome." Cinahl Information Systems, Glendale, CA, 5 Dec. 2014. Web. 13 Oct. 2015.

Gallstones (Cholelithiasis). (2015, January 20). Retrieved October 13, 2015.

 Savitsky, D. (14). Gallstones (M. Chwistek, Ed.). 20070420. Retrieved September 9, 15, from Nursing Reference Center.

Tweed, V. (n.d.). Gallstones: HEALING FOODS & REMEDIES. Better Nutrition. Retrieved September 9, 15 from Nursing Reference Center.

Diagnosis of Cholelithiasis

How is cholelithiasis diagnosed?

Once asked about medical history, family history and current symptoms, the healthcare provider may conduct a physical exam by palpating the upper right quadrant of the patient's abdomen and looking for a positive Murphy Sign. The provider may then order blood tests and imaging to be done. Some ways physicians can get images of potential gallstones are:

• Abdominal ultrasound
• Magnetic resonance cholangiopancreatography (MRCP)
• Hepatobiliary scintigraphy (HIDA) scan
• Abdominal CT scan
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Cholecystogram

This image is an ultrasound depicting a large gallstone. 

These tests are important in the diagnosis of cholelithiasis because they tell the provider if a gallstone is present, where it is, and if it is in a dangerous spot or not. The provider can then decide the best course of action. 

"Bouveret Syndrome." Cinahl Information Systems, Glendale, CA, 5 Dec. 2014. Web. 13 Oct. 2015.

Gallstones (Cholelithiasis). (2015, January 20). Retrieved October 13, 2015.

 Savitsky, D. (14). Gallstones (M. Chwistek, Ed.). 20070420. Retrieved September 9, 15, from Nursing Reference Center.

Etiology and Pathophysiology of Gallstones

Gallstones arrise when there is a buildup of calcium, cholesterol salts and bilirubin salts in a crystalline structure. Another reported cause is when the gallbladder does not void itself completely of bile often enough, likely leading to a buildup of these substances.

There are 3 categories of gallstones;

Cholesterol-

• 80% of gallstones in the United States are primarily composed of cholesterol, lending to evidence of our high cholesterol diets compromising our health. The bile becomes too thick and concentrated and can buildup in the bladder. 

Calcium, bilirubin and pigment gallstones-

• Also called "black pigment gallstones" due to their jet black hue
• These stones make up 10-20% of gallstone occurrences in the United States.
• Bilirubin is secreted into gallbladder by liver cells, form precipitates with calcium that are insoluble ("calcium bilirubinate"), which form stones.

Mixed Stones-

• These are gallstones that are made of cholesterol, but have calcium participates in the mix. 

One complication that may arise from the presence of gallstones is Bouveret Syndrome. Bouveret Syndrome, in short, is when a large gallstone obstructs the pyloric sphincter (or any length of the duodenum), making it impossible for gastric contents to move on through the duodenum and then to the rest of the small intestine.

According to Cinahl Information Systems, fewer than 1% of individuals with gallstones develop Bouveret syndrome, but can be quite deadly if let untreated. Mortality in patients with Bouveret syndrome has been reported to be as high as 20% of confirmed cases. 

"Bouveret Syndrome." Cinahl Information Systems, Glendale, CA, 5 Dec. 2014. Web. 13 Oct. 2015.

Gallstones (Cholelithiasis). (2015, January 20). Retrieved October 13, 2015.

 Savitsky, D. (14). Gallstones (M. Chwistek, Ed.). 20070420. Retrieved September 9, 15, from Nursing Reference Center.

Photo can be traced back to this weird little website: http://www.foamem.com/2014/05/29/emu-monthly-may-2014/ (if you scroll pretty far down)

Epidemiology of Cholelithiasis

Epidemiology- the branch of medicine that deals with the incidence, distribution and possible control of diseases and other factors related to health.

According to the National Institutes of Health, as many as 20 million Americans have gallstones. One may hear the incidence of cholelithiasis in terms of the 3 F's: Female, Fat, and Forty. The reason for this alliteration can be linked to the various onset symptoms of gallstones. It should be noted, however, that while many americans have gallstones, a high percentage of them may not even be aware of them. These are called asymptomatic gallstones, and people can live their entire lives without them causing any problems.

Female:
       Obviously men can get gallstones as well, but studies have shown that women with high estrogen levels are at an increased risk for gallstones.

Fat:
      While this 'F' may not be the most politically correct, it is true that individuals who struggle with obesity is associated with an increased risk of gallstones.

Forty:
      Forty years of age tends to be the average time people who are at risk for gallstones develop them. However, according to Savitsky, a more accurate age range is between 20 and 60 years of age. Even this, however is a stretch. My surgeon discovered I had gallstones when I was 10 years old and I got my gallbladder removed when I was 14.

Other factors that are associated with an increased risk for gallbladder disease include:

• People of Native American, Mexican American and Northern European descent. 
• Inflammation of the organ
• Rapid weight loss and fasting
• High fat diets

Thankfully, treatment for cholelithiasis is relatively easy. The details of this will be elaborated on in a later blog post. Essentially, some symptoms can be controlled with diet. If the Gallbladder must come out, however, the procedure is very safe and very straight forward. The diagram below from the CDC represents this; 

Center for Disease Control Health, United States. In Brief- Medical Technology 2009. (n.d.). Retrieved September 28, 2015, from http://www.cdc.gov/nchs/data/hus/hus09_InBrief_MedicalTech.pdf

 Savitsky, D. (14). Gallstones (M. Chwistek, Ed.). 20070420. Retrieved September 9, 15, from Nursing Reference Center.

Tweed, V. (n.d.). Gallstones: HEALING FOODS & REMEDIES. Better Nutrition. Retrieved September 9, 15 from Nursing Reference Center. 

So, what is the catch with Cholelithiasis?

cho-le-li-thi-a-sis

Cholelithiasis is a disease in which concentrations of crystalized cholesterol and bilirubin salts are found in the gallbladder creating "stones." These stones vary in size and number and can either be asymptomatic or contribute to extreme discomfort in the patient.

To understand gallstones and their dietary implications, we first need to understand the anatomy and physiology of the gallbladder.

The gallbladder is tucked up under the right lobe of the liver close to the stomach, where it serves as a holding sac for bile made by the liver. Fully distended it's length is about 8 cm with about a 4 cm diameter. Recognizable by its greenish hue, the gallbladder empties (and fills) via the cystic duct, where it meets up with the common bile duct and travels to the Sphincter of Oddi, releasing its contents into the duodenum. The liver releases bile via the left and right hepatic ducts, down through the common hepatic duct, where it too joins the common bile duct to eventually empty into the duodenum. Bile is secreted and released from the liver to help emulsify fats in the small intestine. When there is excess, the bile will travel back up the hepatic duct and be stored in the gallbladder. Cholecystokinin (CCK) is the hormone that tells the gallbladder to contract, releasing its contents into the digestive system.

Medically, the gallbladder is considered non-essential, which means humans can live without it. However, patients lacking a gallbladder tend to struggle with indigestion as a result of an inability to properly digest fats.




References

 Savitsky, D. (14). Gallstones (M. Chwistek, Ed.). 20070420. Retrieved September 9, 15, from Nursing Reference Center.

Tweed, V. (n.d.). Gallstones: HEALING FOODS & REMEDIES. Better Nutrition. Retrieved September 9, 15 from Nursing Reference Center.