Question: My parents both had gall stones. I am worried that I might too. Who gets gall stones and how are they treated?
Fair, fat, female, forty and flatulent. These are the people who, according to traditional medical textbooks, are more likely to suffer from gall stones. Of course the problem can occur in many people outside this group, but I find it quite surprising just how many do belong to this ’5F’ group. Problems occur when the bile in the gall bladder becomes too concentrated and precipitates out as a crystal or stone. Small stones can pass out along the ducts, but larger stones block up the bile ducts, and when the gall bladder contracts, the movement of the stone in the duct causes severe pain.
The only effective treatment is surgery to remove the gall bladder and the stones it contains. If there are no acute problems, it can be carried out routinely at the patient’s convenience. Some patients can have stones very low in the common bile duct removed by an instrument that is passed through the mouth and stomach into the intestine. Patients who are too old or ill for an operation may use an expensive drug that slowly dissolves some gall stones over many months.
A newer technique to disintegrate gall stones by ultrasound waves is being trialed in some hospitals, but this is not routinely available yet.

Question: Following an extensive liver resection for metastatic cancer my husband developed intense itching all over but there is no sign of a rash. What could cause this?
The liver is an extraordinarily complex organ that is responsible for the production of many of the body’s essential chemicals and enzymes, and for removing waste products from the blood stream. Any surgery to the liver may interfere with these processes, and metastatic deposits of cancer may also have an effect. If any one of the hundreds of substances produced in the liver is being manufactured in excess, or in insufficient quantities, there may be a minor imbalance in the body’s metabolism. The same applies if one particular waste product is not being removed efficiently. Either problem can lead to a wide variety of symptoms, one of which could easily be an itch.
Identifying the chemical imbalance can be very difficult or impossible, as it may be an interaction between two or more different substances. If nothing obvious is found on routine investigation, it is often just a matter of time while your husband waits for the liver to repair itself (which it usually does).
In the meantime, there are medications that can be prescribed by your general practitioner to ease the itch and discomfort. You should discuss the various options further with him/her.

Question: What is the gall bladder? What does it do? I’m told that it is essential for digestion, but I have to have mined taken out because of stones, even though they only give occasional pains.
The liver, which sits behind the lower ribs on the right side of the body, produces bile at a more or less constant rate. This bile moves through a series of collecting ducts, which join up to form the common bile duct. This duct leads to the small intestine. There is a side duct to the common bile duct that leads to the gall bladder.
Bile is required to help in the digestion of food, but as we do not eat constantly, it is not needed in the gut all the time. There is a valve at the lower end of the common bile duct where it opens into the intestine. This valve opens when food passes to allow bile to be added to the food in the gut. When the valve is closed, the bile must be stored, and this is where the gall bladder fits in to the picture. The gall bladder is a storage area for bile not immediately required, and the bile from the liver is directed into it when the valve is closed. When extra bile is required in the gut to digest food, the gall bladder contracts to squeeze the bile out through the open valve onto the food.
If your gall bladder is removed, the bile trickles into the gut constantly, and although not an ideal situation, the bile and food will eventually mix together, and digestion will occur, with minimal consequences to you or your gut.

Question: I had my gall bladder removed recently, a cholestomy (sic) it is called, and I would like to know what parts are missing. I am frightened about what foods I can eat. Can you advise me?
In a cholecystectomy, the only part of you removed is the gall bladder. Bile is produced constantly in the liver, but is only required in the gut when food is present. As a result, the bile is stored in the gall bladder, and when food is eaten, the gall bladder contracts to squirt bile onto the food, and help its digestion (see diagram on page 242).
If the bile becomes too concentrated, stones may form, and cause pain and discomfort. The only way to remove these is to remove the entire gall bladder. After the operation, you will still produce bile, but it will trickle into the gut constantly. Some patients find they get a bit bloated after a cholecystectomy, and have intermittent indigestion, but generally there are minimal symptoms.
There are no general rules on foods to avoid, but some people find that fried and fatty foods upset them. By trial and error, you will find those foods that cause problems, and learn to avoid them.
The vast majorities of people who have their gall bladder removed have no problems afterwards and lead a totally normal life.