DRHOOK- Stoned: Overeating has the gall to cause trouble

the handsome doctor John Hong

Have you ever had a stone thrown your way? A friend of mine said, "Humans make plans. God laughs at them."

During these holidays, most people just want to pig out on turkey, stuffing, cookies, eggnog, and the next day another round of the same! But what happens to a holiday dinner if your gallbladder throws a stone?

Supper's over! 

I still remember a surgery professor of mine said, "If you suspect someone is having an acute gallbladder issue, just ask them if they would like to eat their favorite food. If they turn green like The Hulk, you should suspect gallbladder."

The gallbladder is located off the liver and stores bile. Like an oyster can make a pearl, the gallbladder can develop stones– though you'd never buy one at Tiffany's (well, maybe Fred Flintstone would for Wilma). These stones aren't natural, and if they enter the ducts, they can block the conduit from the liver and gallbladder to the small intestine. The end result? (Insert groans and retching sounds.)

Abdominal pain in the right upper quadrant (RUQ) usually increases quickly and lasts for at least four to six hours. The RUQ is the area of the belly under the right rib cage. In fact, gallbladder tenderness is located a finger's breadth under the rib cage at the vertical level of the right clavicle middle point– in particular when taking a deep breath. 

The pain radiates, meaning it travels, around the right side of the abdomen to the back. It's like someone slapped duct tape coated with barbed wire around the side of the abdomen from the RUQ to the back. It can be confused with an ulcer, though, because the pain can occur just south of the breastbone. Also if a gallstone blocks the pancreatic duct, inflammation of the pancreas can cause pain located around the navel.

The symptoms tend to occur about an hour after eating a fatty meal. Nausea and vomiting can occur, and, as mentioned above, even the thought of eating a Five Guys Burger will make the most gluttonous people feel like they just rode an hour on the Tilt-A-Whirl.

If the gallbladder becomes inflamed or infected, fever can mount. On labs, an elevated white blood-cell count can indicate an infection. The person will usually receive antibiotics to "cool down" the gallbladder before having surgery to remove it. Gangrene or perforation of the gallbladder can be deadly, so fast treatment is important.

An ultrasound of the gallbladder can reveal gallstones, but timing is everything (as in most of life, it seems). Gallstones in the ducts towards the small intestine are often not seen, but the aftermath of the "road trip" can be insinuated if the ducts are stretched. If the gallbladder is swollen with those (Flint) stones inside, it's pretty suggestive of gallbladder inflammation. 

Surgeons are consulted to make the decision for surgery. A doctor specializing in gastrointestinal problems is usually consulted as well, in case surgery is not indicated. For most, a lap-chole (pronounced Lap-Coal-E) for laparoscopic-cholecystectomy is done to remove the gallbladder. In the lap-chole, because the whole RUQ of the abdomen doesn't need to be cut open, risk of infection is minimal, increasing healing time and creating a much smaller scar.

If someone suspects she is passing a gallstone or has a gallbladder infection, she needs to go to the ER— it's an emergency! Yes, it might ruin the dinner party before dessert, but trust me. Passing a gallstone will make any dessert turn from Yabba-Dabba-Do to Yabba-Dabba-Yuck!


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.