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Body works…

Body works…

While the tonsils and appendix can be removed with little effect on the body, other organs commonly removed can make a difference in how the body functions. Unlike the tonsils, the gallbladder has a very active and understood function.

brenard burgess, m.d.“The gallbladder stores, concentrates and releases bile, which is produced in the liver and is used to help the body digest fats,” says general surgeon Bernard Burgess, M.D., of Franklin Surgical Specialists.

Surgery to remove the gallbladder is called cholecystectomy, and often is performed when the gallbladder becomes inflamed, obstructed or, most commonly, when symptomatic gallstones are detected.

Normally three to four inches long and two to three inches wide, the gallbladder resembles a small sack of marbles when gallstones are present, Burgess says.

Gallstones are made up of cholesterol and the pigment bilirubin. When cholesterol or bilirubin levels are not normal, small stones begin to form. The gallstones obstruct the opening to where the gallbladder empties, causing pressure and pain in the right upper quadrant. Warning signs of a serious problem are fever, jaundice and persistent pain.

ed leichner, m.d.Franklin family practice physician Edward Leichner Jr., D.O., says that while medications sometimes can dissolve larger stones, the most definitive treatment is removal of the gallbladder.

“Rarely is removal of the gallbladder an emergency situation,” Leichner says. “Many patients experience pain and intolerance to certain foods for a while before seeing a doctor.”

Surgery typically is performed laparoscopically, requiring only four small incisions, and can be done as an outpatient procedure or require an overnight hospital stay. The patient is under general anesthesia, unconscious and pain-free.

As soon as the gallbladder is removed, the body begins to compensate for its absence.

“Once it’s gone, the liver and bowel adjust to the loss of the bile storage facility,” Burgess says.

Unlike the gallbladder, the removal of two other organs — the pancreas and the spleen — can result in considerably more serious health consequences.

“The spleen plays an important role in the body’s immune system by removing bad red and white blood cells,” Burgess says. “When there are too many cells the spleen can become enlarged and start to destroy healthy platelets as well.”

Splenectomy typically is performed after abdominal trauma or blunt injury, when certain blood disorders have been diagnosed or when tumors or recurrent cysts are found. Leichner says an enlarged spleen, like any lymphoid type organ, sometimes can return to normal size on its own without medical treatment, but that the condition greatly limits a person’s activity level.

“Any time the spleen is enlarged it’s in danger of rupturing, especially if the person is involved in physical activity or contact sports,” he says.
Splenectomy can be performed laparoscopically, though some patients require traditional open surgery. Hospitalization can be as short as two days, and patients return to normal activities within four to six weeks.

“The main concern following surgery is that the patient is more prone to bacterial infections caused by pneumococcus. That’s why splenectomy patients receive additional vaccinations every few years,” Burgess says. “Losing the spleen is a pretty big deal.”

A less frequent operation is removal of the pancreas, or pancreatectomy, typically performed following a diagnosis of cancer or chronic pancreatitis.

The pancreas is a large, long gland located behind the stomach that secretes digestive enzymes and the hormones insulin and glucagon. Burgess says the surgery typically follows a diagnosis of pancreatic cancer or, more commonly, acute pancreatitis. The chief causes of acute pancreatitis in adults are gallstones, gallbladder disease and drug and alcohol use. Symptoms include a swollen and tender abdomen, nausea, vomiting, fever and a rapid pulse.

Severity of the situation determines whether pancreatectomy will be total or partial. In cases where the entire pancreas is removed, decreased insulin production causes diabetes and a lifetime reliance on medications. The most serious situation involving the pancreas involves partial removal of the stomach as well.

What causes gallstones?
It is believed that the mere presence of gallstones may cause more gallstones to develop. However, other factors that contribute to gallstones have been identified, especially for cholesterol stones.

 * Obesity. Obesity is a major risk factor for gallstones, especially in women. A large clinical study showed that being even moderately overweight increases the risk for developing gallstones. The most likely reason is that obesity tends to reduce the amount of bile salts, resulting in more cholesterol. Obesity also decreases gallbladder emptying.

* Estrogen. Excess estrogen from pregnancy, hormone replacement therapy or birth control pills appears to increase cholesterol levels in bile and decrease gallbladder movement, both of which can lead to gallstones.

* Ethnicity. Native Americans have a genetic predisposition to secrete high levels of cholesterol in bile. In fact, they have the highest rate of gallstones in the United States. A majority of Native American men have gallstones by age 60.

* Gender. Women between 20 and 60 years of age are twice as likely to develop gallstones as men.

* Age. People over age 60 are more likely to develop gallstones than younger people.

* Cholesterol-lowering drugs. Drugs that lower cholesterol levels in blood actually increase the amount of cholesterol secreted in bile. This in turn can increase the risk of gallstones.

* Diabetes. People with diabetes generally have high levels of fatty acids called triglycerides. These fatty acids increase the risk of gallstones.

* Rapid weight loss. As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones.

* Fasting. Fasting decreases gallbladder movement, causing the bile to become overconcentrated with cholesterol, which can lead to gallstones.

Source: National Digestive Disease Information Clearinghouse (NDDIC), a service of the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), NIH