Gall Bladder Attack: Referred Pain
PAIN REFERS TO:
--most common: right side of the neck & shoulder & around the shoulder blade
--second most common: along a thin band from the lateral lower right ribs to the lower pole of the right scapula (could also signal appendicitis)
--sometimes in the middle between the shoulder blades
--pain mid-center beneath the rib cage can be gallbladder or appendicitis
PAIN:
--onset: after a meal
--can come and go or be constant
--may be sharp, excruciating or dull
--may also occur especially at night
--"Referred pain happens when nerve fibers from regions of high sensory input (such as the skin) and nerve fibers from regions of normally low sensory input (such as the internal organs) happen to converge on the same levels of the spinal cord." from http://anatomynotes.blogspot.com/2006/10/referred-pain.html
--referred pain from liver and gall bladder occurs on the neck because the gall bladder problem irritates the diaphragm
Other S/Sx:
--chest pain in the right side (caused by stones in the bile duct or inflammation or swelling of the gallbladder itself)
--Nausea or queasiness
--vomiting and gas
--may or may not be belching or burping
--GB is very tender to touch
--may not be able to walk without bending over
--will typically last for one to four hours
--80% of gallstones are "silent" (without S/Sx)
--10-20% of the population in the west have them
FACTOIDS:
--in developed nations, 80% of gallstones are cholesterol based: crystalline cholesterol monohydrate, appearing white or green with rough edges, very hard on ducts should they attempt to pass through
--20% are pigmented bilirubin stones with calcium in them, brown to black and more like round pebbles
--several microbes can cause stone development
EPIDEMIOLOGY:
--the FIVE F's: female, fat, forty, fertile, fair
--the sixth F: feathers, or fifth nation, as some native American groups are striken
--occurs 3x as often in women as men (due to estrogens)
--overweight individuals
--40% of people in the US over age 40 have gallstones
--1/3 of people who get their stomachs stapled get them
--old age is a risk factor
--diabetic
--natives of North America especially high risk (Pima indians have highest incidence, I think because their reservation is imbedded in the Phoenix metro area.)
DEVELOPMENT OF STONES:
--first, high cholesterol levels either due to diet or sudden weight loss or fasting
--then increased nucleation of cholesterol
--increased mucus in gallbladder (attempt at self defense) thickens fluids and stones form
--one day after a fatty meal the gall bladder attempts to squeeze out its bile and squeezes out a stone which gets lodged in the cystic or common bile duct and causes intense pain, perhaps washes on through, or perhaps causes a rupture (surgical emergency)
DIAGNOSIS:
--Hx
--palpation
--ultrasound
--watch gallbladder fx using radioactive stuff
TREATMENT:
--conventional: cholecystectomy
--other: dietary, flushes, and meds to dissolve stones (terpenes)
--DIET: beets, dandelion greens and all bitters, flax, yam root, milk thistle, turmeric, globe artichoke
--flush: the apple juice and apple fruit and apple vinegar fast, followed by gall squirter concoction: olive oil and lemon juice enough to make you wonder
--most common: right side of the neck & shoulder & around the shoulder blade
--second most common: along a thin band from the lateral lower right ribs to the lower pole of the right scapula (could also signal appendicitis)
--sometimes in the middle between the shoulder blades
--pain mid-center beneath the rib cage can be gallbladder or appendicitis
PAIN:
--onset: after a meal
--can come and go or be constant
--may be sharp, excruciating or dull
--may also occur especially at night
--"Referred pain happens when nerve fibers from regions of high sensory input (such as the skin) and nerve fibers from regions of normally low sensory input (such as the internal organs) happen to converge on the same levels of the spinal cord." from http://anatomynotes.blogspot.com/2006/10/referred-pain.html
--referred pain from liver and gall bladder occurs on the neck because the gall bladder problem irritates the diaphragm
Other S/Sx:
--chest pain in the right side (caused by stones in the bile duct or inflammation or swelling of the gallbladder itself)
--Nausea or queasiness
--vomiting and gas
--may or may not be belching or burping
--GB is very tender to touch
--may not be able to walk without bending over
--will typically last for one to four hours
--80% of gallstones are "silent" (without S/Sx)
--10-20% of the population in the west have them
FACTOIDS:
--in developed nations, 80% of gallstones are cholesterol based: crystalline cholesterol monohydrate, appearing white or green with rough edges, very hard on ducts should they attempt to pass through
--20% are pigmented bilirubin stones with calcium in them, brown to black and more like round pebbles
--several microbes can cause stone development
EPIDEMIOLOGY:
--the FIVE F's: female, fat, forty, fertile, fair
--the sixth F: feathers, or fifth nation, as some native American groups are striken
--occurs 3x as often in women as men (due to estrogens)
--overweight individuals
--40% of people in the US over age 40 have gallstones
--1/3 of people who get their stomachs stapled get them
--old age is a risk factor
--diabetic
--natives of North America especially high risk (Pima indians have highest incidence, I think because their reservation is imbedded in the Phoenix metro area.)
DEVELOPMENT OF STONES:
--first, high cholesterol levels either due to diet or sudden weight loss or fasting
--then increased nucleation of cholesterol
--increased mucus in gallbladder (attempt at self defense) thickens fluids and stones form
--one day after a fatty meal the gall bladder attempts to squeeze out its bile and squeezes out a stone which gets lodged in the cystic or common bile duct and causes intense pain, perhaps washes on through, or perhaps causes a rupture (surgical emergency)
DIAGNOSIS:
--Hx
--palpation
--ultrasound
--watch gallbladder fx using radioactive stuff
TREATMENT:
--conventional: cholecystectomy
--other: dietary, flushes, and meds to dissolve stones (terpenes)
--DIET: beets, dandelion greens and all bitters, flax, yam root, milk thistle, turmeric, globe artichoke
--flush: the apple juice and apple fruit and apple vinegar fast, followed by gall squirter concoction: olive oil and lemon juice enough to make you wonder