By Christine Cardellino

Maintaining an appropriate weight provides more health benefits than reducing your risk of Type 2 diabetes, cancer and cardiovascular disease.

People who stay at their recommended weight are also less likely to develop buildups of hardened bile in the gallbladder or small intestine—the unglamorous, inglorious gallstone.

According to the American Liver Foundation, obesity is a major risk factor for gallstones, which afflict 20 million Americans, or 10 percent of all adults. But there’s a catch-22 for people who shed extra pounds too fast: Gallstones can form after rapid weight reduction.

The gallbladder, a small organ located under the liver, has a role in the digestion of fats. The pear-shaped gallbladder stores bile, a fluid made by the liver. During digestion, the gallbladder releases bile into a tube (the common bile duct), which transports the fluid to the small intestine. Sometimes, substances in the bile form crystals that can harden over time into stone-like masses. These gallstones can block the bile duct or small intestine.

In addition to obesity and rapid weight loss, gender and age are risk factors for gallstones. They occur more often in women than men, although all adults face increased risk as they age. In addition to post-menopausal women, expectant mothers and women who use oral contraceptives or hormone-replacement therapy are more likely to develop gallstones.

The majority of gallstones are composed of cholesterol, a fatty substance made by the liver. About 20 percent of all gallstones are known as pigment stones, which are believed to develop in people with cirrhosis of the liver, biliary tract infections and sickle cell anemia.

You can develop gallstones and not know it for many years, until the gallbladder becomes inflamed and symptoms erupt unexpectedly one day. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) calls this sudden onset of symptoms a gallbladder “attack.” Common warning signs of a gallbladder attack include chronic indigestion, nausea, and intense pain in the upper right abdomen, in the back between the shoulder blades or under the right shoulder. Sometimes this pain mimics the feel of a heart attack.

Because our bodies can function without a gallbladder, surgical removal of the gallbladder is the most common treatment for gallstones.

Appendicitis: another sudden attack
Severe abdominal pain is a symptom of inflammation in another obsolete organ: the appendix. This small, finger-shaped organ is attached to the colon and is considered nonessential to the body’s functioning.

Jill Roberson, M.D.

“We’re not really certain why the appendix gets inflamed,” says Jill Roberson, M.D., a pediatrician with Premier Pediatrics in Southern Pines. “In both children and adults, we believe, appendicitis may be caused by a blockage from a piece of food that was swallowed or, less often, by a fecolith, a piece of petrified stool. As a result of the obstruction, the appendix can swell and become infected.”

According to the NIDDK, appendicitis most commonly occurs between ages 10 and 30. People with appendicitis may experience severe pain, swelling, and/or tenderness in the abdomen around the navel or lower right side. Fever, loss of appetite, nausea and vomiting may be experienced. Some people may have a sensation to empty their bowel, a condition called tenesmus.

According to Dr. Roberson, children with appendicitis may complain of cramps or pain on their right side or around the belly button.

“They may double over in pain, which is far worse than an ordinary bellyache,” she says. “If your child has right-sided pain and gets lethargic, pale and sweaty, the appendix might be perforated. In both children and adults, a perforated appendix is a life-threatening medical emergency requiring immediate attention.”

People with sudden, severe abdominal pain often turn to the nearest emergency department for expert evaluation and care. Each of the FirstHealth hospitals—Moore Regional, Montgomery Memorial and Richmond Memorial—are fully equipped to treat people experiencing gallstone attacks and signs of appendicitis.

“Advances in medical technology allow us to diagnose these conditions with greater accuracy and speed than ever before,” says James O. Lewis, M.D., of Sandhills Emergency Physicians and medical director of the Emergency Department at Moore Regional Hospital. “This has shortened the time spent evaluating and treating patients, and also reduces the need for overnight observation or hospitalization in many cases.

“When patients come in with abdominal pain, we perform a physical examination, blood tests and radiology studies such as CT scan or ultrasound as needed. If the diagnosis of gallstones or appendicitis is confirmed, we consult with the surgeon on call. If the diagnosis is a virus or something else and surgery is not necessary, we may prescribe anti-nausea and pain medications and send the patient home.”

Surgical advances such as laparoscopy also have enhanced the quality of care at FirstHealth hospitals. The NIDDK reports that more than 500,000 Americans have cholecystectomy, or
gallbladder-removal surgery each year. One in 2,000 people will have an appendectomy, surgical
removal of the appendix, according to the American College of Surgeons.

Ranvir Achreja, M.D.

“Surgery is the most widely used treatment for both appendicitis and gallstones, and most of these procedures are now done laparoscopically,” says Ranvir Achreja, M.D., a surgeon affiliated with Montgomery Memorial Hospital. “Laparoscopy is a minimally invasive technique that uses smaller incisions, smaller instruments and a tiny camera to guide the surgeon.”

Traditional, open appendectomies or cholecystectomies usually required a three- to four-day hospital stay and weeks of recuperation and recovery, but the minimally invasive approach offers several advantages, according to Dr. Achreja.

“First, the cosmetic result is almost always superior to that achieved with open surgery,” he says. “In addition, post-operative discomfort is significantly reduced, often leading to earlier discharge from the
hospital and quicker return to normal activity.”

FirstHealth surgeons collaborate with physicians in the Emergency Department to treat people with gallstones and appendicitis.

“We see abdominal pain every day,” Dr. Lewis says. “In the past, a lot of these patients were admitted for overnight evaluation or emergency surgery. Emergency surgery often still is required for appendicitis, but for gallstones, unless an acute infectious process is found, the patient is usually sent home, thereby allowing an elective procedure to be done, which is safer for the patient.”

“Advances in medical technology allow us to diagnose these conditions with greater accuracy and speed than ever before.”

—James O. Lewis, M.D.