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One of the vexing realities of gallbladder diseases is that it is possible to have new gallstones (cholelithiasis) even after you have your gallbladder surgically removed (cholecystectomy). Even if you have been successfully treated for gallbladder inflammation (cholecystitis) by surgical removal of your gallbladder, you can still have gallstones in your bile duct (choledocholithiasis). Surgical removal of your gallbladder won't remove stones that are in your bile duct, and it also won't correct problems with the sphincter of Oddi.

How do all of these problems come about?

One of the functions of your liver is to make a substance called bile. A greenish-yellow liquid, bile functions to dissolve fats. One of the fats bile dissolves is cholesterol. Your liver flushes cholesterol out of your body with the bile, which eventually finds its way into the bowel. Bile salts also stabilize fat in digested food, so your body can absorb it. Some fat, it's important to understand, is a good thing.

When cholesterol is dissolved in bile, the liquid becomes "slushy." When you go on a low-fat diet, your liver sends more of the cholesterol it manufactures into your bloodstream and less into bile. Your liver makes less bile, so any cholesterol already in the liver has more time to form salts that form "gravel" that form "stones." Usually it's deprivation of dietary fat that triggers a gallbladder attack. You try to lose a little weight, and you lose a lot more when you have to have surgery.

The function of the sphincter of Oddi isn't to regulate the release of bile. It's a ring of muscles that regulate the flow of digestive juices from the pancreas into the bile duct. These digestive juices travel down the same channel to the gut, where they are used to release nutrients from food. These muscles can go into spasm and block the flow of bile, causing just as much pain as gallstones.

When this sphincter is in spasm, you can have two sets of symptoms:

  • Abdominal pain, and
  • Jaundice.

The abdominal pain caused by this kind of muscle spasm, it's most intense in the middle or right side of the abdomen. The pain may radiate to the shoulders and back. It can last a few minutes, or a few hours, but it usually goes away. It's especially common about an hour after you eat, especially if you exercise after you eat, and if you eat a fatty meal. The pain can be mildly throbbing, or it can be so intense you want to pick up the phone and call for an ambulance.

Jaundice is a yellowing of the skin and eyes. It occurs when bile backs up into the liver and the bile goes into the bloodstream. Jaundice can result from gallstones that block the bile duct, or it can occur as a result of obstruction at the sphincter of Oddi.

What can you do about this?

  • First of all, don't eat large meals. Just don't. Any problems you have will be aggravated if your gut is full of half-digested food.
  • Secondly, avoid inappropriate natural therapies. While there are some natural remedies that help, don't do liver flushes or take herbs that increase production of bile, such as silymarin (milk thistle). If the underlying problem is an obstruction of the bile duct, you don't want to put more fluid into the bile duct.
  • You'll probably get more relief from anti-spasmodic medicines. These are tricky to manage, since many of them are addictive, and many of them cause constipation. However, they usually offer relief.
  • Sometimes the solution for a surgical problem is more surgery. It's best, however, to try anti-spasmodic medications first, this isn't a situation you can handle on your own.

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