Abdominal pain is a major concern when caused by an injury, but chronic disease in internal organs can also be the culprit. The family medic in survival settings needs to know the basics about all conditions that can lead to loss of productivity in group members. One of these is gall bladder disease.
The gall bladder is a hollow sac-like organ that is attached to the liver; it stores a thick liquid substance called “bile” that the liver secretes to help you digest fats. After a meal, the gall bladder contracts and bile passes through to the small intestine through tubes called ducts.
Excess bile cholesterol can cause solid deposits inside the gallbladder that can sometimes grow to the size of a golf ball. These are commonly referred to as “gallstones.” Gallstones are relatively common; they can block liquid bile from passing through the bile duct and cause problems. Perhaps ten to fifteen per cent of the population has them. That means a large enough survival community will likely include someone with the condition.
Luckily, most people won’t have any symptoms. In one or two per cent, however, the stones block the ducts, causing pain as the gall bladder becomes distended from the excess accumulation of bile. The inflammation caused by this condition is called “cholecystitis.”
GALLSTONE TYPES
There are two main types of gallstones:
1) Cholesterol stones: These are the grand majority. Despite the name, they may not be related to actual cholesterol levels in the blood.
2) Bilirubin stones: Sometimes called “pigment stones”, this type may occur in people who have illnesses that destroy red blood cells. The by-products of this destruction release a substance called “bilirubin” into the bile and forms a stone. They may be due to infection or duct blockage.
RISK FACTORS FOR GALL BLADDER DISEASE
In a less politically correct era, risk factors for this condition were described as the 4 “F’s”. For historical purposes, here they are:
Fat: The majority of those with gallstones are overweight.
Female: The majority of sufferers are women.
Forty: Most sufferers are over 40 years old.
Fertile: Most women with gallstones have had children.
Today, more sensitive souls prefer the acronym G.O.L.D.
Genetics: Ethnicity plays a role; Native Americans and Hispanics seem to have more gall bladder issues than Caucasians, Caucasians more than African-Americans.
Obesity: Obesity, especially in women, is associated with at least twice the frequency of gall bladder disease.
Location of Body Fat: Those with obesity concentrated in the torso are more likely to be at risk.
Diabetes: Those with Diabetes are more likely to have gallstones.
DIAGNOSING GALL BLADDER INFLAMMATION
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The pain associated with cholecystitis is known as “biliary colic.” It’s is cramping in nature and is usually seen in the upper right quadrant of the abdomen; it may radiate to the back. If not relieved, inflammation of the liver, gall bladder, and pancreas (“gallstone pancreatitis”) can become life-threatening in some cases.
A serious blockage of the bile duct with corresponding liver/pancreas inflammation can lead to fever, nausea and vomiting, and a yellowing of the skin and eyes known as “jaundice.”
Gallstones are commonly diagnosed by ultrasound, but you won’t have that kind of modern technology off the grid. The classical finding on physical examination is called “Murphy’s Sign.” Press with one hand just below the midline of the lowest rib on the front right. Then, ask your patient to breathe deeply. If the gallbladder is inflamed, the patient should complain of tenderness at the site.
TREATMENT FOR GALLSTONES
The most common treatment for gallstones in normal times, other than pain meds, is to surgically remove the gall bladder (you can live without it and stay healthy). Over 750,000 gall bladder surgeries (called “cholecystectomies”) are performed every year.
New, non-surgical methods are options in some patients. They’re especially effective for those with small cholesterol stones in an otherwise functioning gall bladder or medical conditions that make surgical intervention unsafe.
Methods include:
Shock Wave Lithotripsy – This is a procedure that uses sound wave to break up gallstones in smaller pieces. It has become popular for non-calcified stones as it doesn’t require anesthesia and you can often go home the same day.
Oral Bile Salts – Bile acids such as Ursodiol (Actigall) and chenodiol (Chenix) can, over a period of months or years, break up cholesterol stones.
Endoscopic retrograde cholangiopancreatography (ERCP) – This is a procedure where stones are removed from the gallbladder through a small skin incision, with guidance from ultrasound or other imaging.
Antibiotics may be helpful for cholecystitis due to infection in austere settings. Drugs in the ampicillin class, cephalosporins, and metronidazole are options if modern medicine is not available. It should be noted that gallstones can return when non-surgical treatments are used. This is why surgery is still recommended in many cases.
NATURAL TREATMENTS FOR GALL BLADDER DISEASE
Operating rooms, surgeons, and high technology, however, are likely to be in short supply when the you-know-what hits the fan, so it’s useful to know some alternative remedies. These are mostly taken orally:
- Apple cider vinegar (mixed with apple juice or water)
- Chanca Piedra, (Phyllanthus niruri), a plant native to the Amazon; translated, the name means “Break Stones”.
- Peppermint
- Coffee
- Turmeric
- Alfalfa
- Ginger root
- Psyllium
- Red Yeast Rice
- Dandelion root
- Artichoke leaves
- Beet, Carrot, Grape, Lemon juices
You should know that the hard scientific data proving the effect of the above items is still lacking in many cases. Results tend to vary from person to person. Side effects may also occur; for example, Chanca Piedra crosses the placental barrier in pregnancy and may cause miscarriage.
Unfortunately, it’s difficult to eliminate some of the risk factors for gall bladder disease. You can’t change if you’re forty, female (at least most people say so), or have had children. You may be able to do something about being obese, however. Dietary changes to lower fat intake may help you lose weight and decrease the future risk of gallstones. In survival settings, weight loss may be a matter of course.
Joe Alton, MD
Joe Alton MD
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