Gall Bladder Disease
Dr. Weyrich's Naturopathic Functional Medicine Notebook
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Overview
Gallstones will affect about 10% of the population, resulting in billiary colic that appears as pain in upper abdomen, particularly center to right sided, and radiating to the back, espcially in the region of the shoulder blade. The pain may come and go, and may be worse after eating fatty foods.Causes include elevated cholesterol, rapid weight loss, liver dysfunction, and hemolytic diseases.
Standard allopathic treatment for gallstones is removal of the gallbladder.
Naturopathic treatment options include dissolving cholesterol stones and correcting the underlying cause. Non-cholesterol stones require surgical intervention.
Etiology
Cholesterol stone formation may be due to production of bile supersaturated in cholesterol, possibly secondary to decreased bile acid or phospholipid production in the liver.Billiary stasis or impaired gall bladder motility, possibly secondary to spinal misalignment imparing innervation of gall bladder or to disruption of the vagus nerve [Domino2008, pg 264].
Predisposing factors include:
- Obesity [Domino2008, pg 264].
- Rapid Weight Loss [Domino2008, pg 264].
- Hyperlipidemia [Domino2008, pg 264].
- Blood dyscrasia and hemolytic disorders [Domino2008, pg 264].
- Inflammatory Bowel Disease [Domino2008, pg 264].
- Cirrhosis (pigment stones) [Domino2008, pg 264].
Differential Diagnosis
- Colesterol stones: visible in ultrasound but not in x-ray.
- Calcium stones: visible in x-ray.
- A small percentage of hypothyroid patients develop pain in the upper right quadrant that mimics gallstones, but no gallstones are evident. This condition resolves upon treatment of hypothyroidism [Barnes; Starr2005, pg 142].
Treatment
Cholesterol Stones
Ursodiol 300mg (ursodeoxycholic acid, Actigall) dosed at 8-10 mg/day/Kg body weight in 2 or 3 divided doses often slowly disolves cholesterol gall stones over a period of several months. However, if the underlying cause of stone formation is not addressed, often stones recur within five years.Pathophysiology
Hypothyroidism is associated with a thinning of the endothelial lining of the gall bladder, resulting in irritation of the bladder by its contents [Hertoghe1914; Starr2005, pg 142].ICD-9 Codes
| ICD9-Code | Description | Comments |
|---|---|---|
| 574.00 | Gallstone (calculus) + acute cholecystitis | |
| 574.01 | Gallstone (calculus) + acute cholecystitis + obstruction | |
| 574.10 | Gallstone (calculus) + cholecystitis, NOS | |
| 574.20 | Gallstone (calculus) | |
| 575.0 | Cholecystitis, acute | |
| 575.10 | Cholecystitis, NOS |
References
Unless specifically noted above, references used in the construction of this web page include the following:[FDM] Lecture notes from Functional Medicine University.
[SCNM] Lecture notes from Southwest College of Naturopathic Medicine.
[UT] Lecture notes from the University of Tennessee graduate programs in Chemistry and Biochemistry.
[Barnes1999] B.O. Barnes & C.W. Barnes. Hope for Hypoglycemia, Revised Edition. America Book Company (1999). Cited by [Starr2005].
[Domino2008] Domino Frank J. The 5-Minute Clinical Consult, 2008. Lippincott Williams &Wilkins (2008).
[Hertoghe1914] E. Hertoghe. Thyroid Deficiency. Lecture presented to the International Surgical Congress at the New York Polyclinic School and Hospital (April 1914). Copy availaible from Broda O. Barnes M.D. Research Foundation at http://www.brodaobarnes.org [Cited by Starr2005].
[Starr2005] Mark Starr. Hypothyroidism Type 2: The Epidemic. Columbia, MO: Mark Starr Trust (2005).
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