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Gallstones an issue for many seniors: acute pain attacks from gallstones may require surgical treatment.

If you tend to suffer from sharp pain in your upper right abdomen after eating, and the pain radiates to your shoulder blade and back, you may have a gallbladder problem. Older adults are at particular risk, with gallbladder disease one of the most common causes of acute abdominal pain in people age 65 and older.

What Does the Gallbladder Do? The gallbladder essentially bridges the gap between the liver (which produces the bile your body uses to digest fats and absorb nutrients) and the small intestine. Bile produced by the liver is stored in the gallbladder until you eat. When you eat, the gallbladder releases bile into the small intestine, where it breaks down fats. If bile is prevented from exiting the gallbladder, you won't properly digest fats, and also won't absorb adequate amounts of fat-soluble vitamins like A, D, E, and K. Plus, as Brian Jacob, MD, associate clinical professor of surgery at Mount Sinai points out, bile that isn't released backs up in the gallbladder, which may cause inflammation and pain.

Gallstones Common in Seniors Gallstones are the most common form of gallbladder disease. Formed from bile and cholesterol, they range in diameter from a few millimeters to several centimeters. In about 80 percent of people, the stones do not cause symptoms, but if they block the bile ducts (the tiny tubes that carry bile to and from the gallbladder) they can cause acute pain. "The pain that people experience from a gallstone attack can be debilitating," Dr. Jacob confirms. "Unfortunately, medications are not very effective at breaking up gallstones, so multiple attacks of pain are an indication to have the gallbladder removed." Depending on where they lodge, gallstones also can cause pancreatitis (inflammation of the pancreas). "Pancreatitis can be very dangerous, and is another reason why somebody with gallstones should consider surgery to remove the gallbladder," Dr. Jacob explains.

Your risk for gallstones increases as you age. Women are more vulnerable, as are people with a family history of gallstones. Diabetes, obesity, rapid weight loss (for example, after gastric bypass surgery), and Crohn's disease (an inflammatory condition of the intestine) also raise the risk, as does a diet that is low in fiber, and certain medications (for example, diuretics).

Cholecystitis a Risk Gallstone blockages can resolve themselves, with stones spontaneously moving out of the bile duct and into the intestine. But prolonged blockages can cause cholecystitis (inflammation of the gallbladder). Acute cholecystitis symptoms include severe pain that persists for four or more hours, nausea and vomiting, and fever. However, elderly adults don't always have these symptoms--instead they may feel tired and lisdess, with no appetite.

Cholecystitis can result in serious complications, including infections, permanent scarring, and rupture of the gallbladder, so if you experience symptoms, Dr. Jacob recommends you alert your doctor immediately. "It's more risky to operate on an inflamed gallbladder than a non-inflamed gallbladder," he says, "so many surgeons will recommend gallbladder removal surgery after repeated attacks of pain, in order to reduce the risk for cholecysitis."

Gallbladder Removal Gallbladder removal is typically performed with "keyhole surgery" through a tiny incision in the belly button. "You should be able to go home the same day, and recovery is generally fast, though you'll be advised to avoid heavy lifting for a few weeks," says Dr. Jacob. "Your body will function perfectly well without a gallbladder, since bile can drain into the intestine through other ducts in the liver."

If you have had repeated episodes of cholecystitis, or previous abdominal surgery, you may have internal scarring that makes open surgery necessary to remove your gallbladder. You'll need to stay in the hospital for up to a week afterwards. For people who are in poor health and cannot undergo surgery, accumulated bile can be drained using a catheter which is inserted through the abdominal wall direcdy into the gallbladder. This approach is effective at resolving cholecystitis, but the external drainage tubes can affect your quality of life.

Protecting Your Gallbladder Health Getting plenty of exercise, maintaining a normal weight, and eating a healthful diet that is high in fiber and low in fat can help you avoid gallstones. You also should pay attention to your heart health--a large 2016 study (.Arteriosclerosis, Thrombosis and Vascular Biology, Aug. 18) suggested that people with a history of gallstones were 17 percent more likely to develop heart disease as they aged. Dr. Jacob emphasizes the importance of following your doctor's advice for controlling any heart disease risk factors you have, such as high blood pressure and high cholesterol. "Poor nutrition and obesity are risk factors for heart disease as well as gallbladder problems, so eating better and getting plenty of exercise will help protect your heart as well as your gallbladder," he adds.


Cholecystitis symptoms include:

* Upper right abdominal pain that develops after eating, is not relieved by changing position, and may radiate to the right shoulder and upper back area.

* Nausea and vomiting due to fats not being broken down in the intestine.

* Fever About half of people with cholecystitis develop a mild fever, but this is less typical in seniors.

* Jaundice (a yellowing of the skin and white of the eyes)--again, this symptom may not develop in older adults.

* General malaise A feeling of discomfort and uneasiness--this is especially common in seniors, for whom other gallbladder symptoms may be vague.
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Publication:Focus on Healthy Aging
Date:Feb 1, 2017
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