Why the gall bladder is a luxury, not a necessity

by Ruth Nichol / 08 September, 2018
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The gall bladder lies below the liver and is used to store bile. Photo/Getty Images

For a “nice to have” organ, the gall bladder can cause a lot of problems – and pain.

Hilary Stace thought she had food poisoning when she experienced severe pain in the right-hand side of her abdomen and into her back, as well as nausea and vomiting, after eating dinner at a conference in July last year.

But when she suffered the same symptoms a few months later, a friend suggested she might have gallstones.

“The pain was worse than childbirth. I couldn’t move it was so intense,” says Stace, a Wellington historian.

Although the pain eventually subsided, she went to see her GP, who sent her for an ultrasound scan that confirmed she had gallstones and needed to have her gall bladder removed – a procedure known as cholecystectomy, and one of the most-common surgeries performed on adults.

She was told it could take up to four months to have the surgery at Wellington Hospital but that she should contact her GP if the pain came back. A week later, she had another attack so severe her GP sent her straight to the emergency department.

Soon, Stace was recuperating after having her inflamed gall bladder removed using keyhole surgery. She had to return to hospital a few days later to check whether any remaining gallstones were lodged in her bile ducts. These can lead to complications, but can be removed by inserting a flexible tube through the mouth into the small bowel and pushing them out – known as endoscopic retrograde cholangiopancreatography or ERCP.

The gall bladder is a small pear-shaped organ that lies below the liver and is used to store bile until the body needs it to help digest fatty food. “When we eat, the gall bladder contracts and squeezes out bile, which acts like detergent – it breaks up what we’ve eaten so it can be dissolved and absorbed,” says Christchurch surgeon Ross Roberts.

Luckily, it’s easy to survive without a gall bladder. In most cases our livers produce enough bile to deal with even the fattiest meal, and any extra can be stored in the bile ducts. “If you don’t have a gall bladder you can digest food perfectly well. It’s a luxury, not a necessity,” Roberts says.

But for a “nice to have” organ, the gall bladder can cause a lot of problems, mostly because of gallstones, which are crystal-like deposits that can be as small as a grain of sand or as large as a golf ball. About 70% of gallstones are cholesterol stones that form when the liver produces too much cholesterol.

Ross Roberts.

As many as 20% of people produce gallstones, though not all of them develop symptoms. Gallstones run in families, and being older, female and overweight increases your risk of producing them. Pregnant women are also at higher risk because pregnancy hormones relax the gall bladder, so it’s less likely to empty properly. Weight-loss surgery can also cause gallstones and there’s some evidence that yo-yo dieting may be a predisposing factor.

Some gallstones cause problems only occasionally, when they get lodged against the narrow neck of the gall bladder once it starts contracting to release bile after a large or fatty meal. The pain, known as biliary colic, subsides once the gall bladder relaxes again.

These gallstones may eventually become permanently lodged against the neck of the gall bladder, which causes inflammation and severe pain that takes longer to go away.

Other gallstones get forced out of the gall bladder and into the ducts that carry bile from the liver to the small intestine, where they can cause inflammation, infection and pain, as well as complications such as jaundice and pancreatitis.

In some cases, gallstones pass through the liver and into the digestive system and eventually out of the body altogether. However, they can cause a lot of pain and damage along the way, and even if your body gets rid of one gallstone, that’s unlikely to be the end of the matter.

“In most people, gallstones are not just singular – there are usually more gallstones left in the gall bladder,” Roberts says.

In most cases removing the gall bladder is a straightforward operation that requires a one-night hospital stay and takes about two weeks to recover from. It also provides a complete cure for gallstones.

“I say to people that there’s no point in picking up the eggs – you have to get rid of the chicken,” Roberts says. “The gall bladder here is laying the gallstones.”

This article was first published in the August 25, 2018 issue of the New Zealand Listener.

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