DISEASES OF THE GALLBLADDER
Function
The gallbladder concentrates the bile and stores it. Upon entering the duodenum, fat stimulates the secretion of a hormone, cholecystokinin. This hormone is carried by the blood stream to the gallbladder and forces contraction, so that the bile is released into the common duct and then into the duodenum. Bile emulsifies fats so that they can be hydrolyzed by the fat-splitting enzymes, the lipases. If there is any interference with the flow of bile, fat digestion is impaired.
Inflammation of the gallbladder is known as cholecystitis, and formation of gallstones is cholelithiasis. Stones are often present without symptoms. If the gallbladder is inflamed or if there are stones blocking the flow of bile, there is pain when the gallbladder contracts.
Dietary modification
The aim of diet therapy is to reduce the discomfort by minimizing the contraction of the gallbladder. In acute cholecystitis no food is given for the first 12 to 24 hours. A clear-fluid diet is followed by a soft very low-fat diet, allowing only 20 to 30 gm fat per day. This allows skim milk, 5 to 6 ounces of very lean meat, fish, or poultry, not over 3 eggs per week, and customary amounts of breads, cereals, fruits, and vegetables. This food allowance is low in cholesterol, but it is not known whether cholesterol restriction reduces the formation of stones or not.
Once the acute attack subsides, the patient is progressed gradually to a diet that includes 50 to 60 gm fat daily. Such an allowance permits the use of whole milk (2 cups) and 2 to 3 teaspoons butter or margarine in addition to foods allowed on the very low-fat diet. Obesity is frequent in patients with gallbladder disease, and a low-calorie low-fat diet should be used.
Many patients with gallbladder disease complain of abdominal discomfort when they eat certain foods such as eggs, legumes, melons, berries, and strongly flavored vegetables. Although these foods need not be omitted for all patients, the individual tolerances should be respected.
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GENERAL HEALTH
