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Last Week's Question: S.S. is a 40 year old woman, a bit overweight, who began to develop abdominal pains. She was in good health overall, and was taking no medications apart from birth control pills. She described the pains as an indigestion and gas-like discomfort in her upper abdomen, often occurring after eating. The pains lasted an hour or so, and there was maybe a little heartburn, but antacids didn't seem to help much. The pain never bothered her at night, and did not seem to affect her bowel movements.
This went on for a few months, and she was thinking about getting it checked, but never got around to it. On Thanksgiving, while visiting with her family, she feasted on the usual turkey, gravy, potatoes, stuffing, pie -- the works. She lay down for a nap after the meal, and shortly thereafter awoke with severe abdominal pain on the right side of her abdomen, radiating into her right shoulder. She was nauseated but did not throw up. The pain was so severe that she went to the emergency room.
Questions:
Last Week's Answer:
We received many different answers to this week's puzzler, ranging from gall bladder disease, to ulcers, to hiatus hernia, to appendicitis, and even to bowel perforations. Although it is true that all of these diagnoses need to be considered, the correct answer is "acute cholecystitis," or in other words, a gall bladder attack.
Although many people of all types get gall stones, S.S. had the classic risk factors for gall bladder disease. She was middle-aged, overweight, and fertile. There is an old saying --somewhat crude and simplistic -- that some of our respondents knew about: "fat, fair, female and forty. " Incidentally, birth control pills have also been linked to gall bladder disease.
The patient's pain is classic, too. Contrast it to acid indigestion (something many of us are familiar with) which typically is worse with an empty stomach, and made better by eating. Food, and in particular high fat foods, will trigger gall bladder pains. This is because eating triggers contraction of the gall bladder to pump the stored bile into the intestines. Bile contains enzymes used to digest these foods.
If you happen to have gall stones, pain occurs when a stone blocks the duct draining the gall bladder. Many people who have gall stones know that if they just watch their diet, they can eliminate or reduce the intensity of these pains. However, our troubled patient over-did it on Thanksgiving, and she had severe pain. This can require urgent surgery as the gall bladder can become gangrenous, or infected.
Interestingly, people do just fine without their gall bladders, something S.S. is about to discover for herself.
Bonus question: Anyone know what gall stones are made of?
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