What changes after gallbladder removal?
The gallbladder serves as a reservoir: it stores bile and releases it into the intestine in response to food intake. After its removal, bile enters the duodenum continuously and in small portions. This is enough to digest regular food, but if you eat a lot of fatty foods, there may not be enough bile, hence the heaviness and looseness of stools in the first months. Over time, the ducts adapt and most people return to a normal diet. If complaints persist for more than several months or appear for the first time after surgery, you need to look for a specific cause.
- Bile enters the intestine constantly, and not in portions
- Possible intolerance to rich fatty foods
- The body gradually adapts
- Complaints longer than several months require examination
- New symptoms after surgery cannot be attributed to its consequences
Common causes of complaints
The first group is problems of the bile ducts themselves: remaining or newly formed stone in the duct, cicatricial narrowing, a long stump of the cystic duct, disruption of the sphincter that regulates the release of bile. The second group includes diseases that a person had before surgery, but remained unrecognized: gastritis, ulcers, reflux disease, chronic pancreatitis, irritable bowel syndrome, celiac disease. The third is excess bile acids in the colon, causing watery stools, especially in the morning and after meals. Adhesions and hernias in the area of postoperative scars are less common.
- Stone in the common bile duct
- Duct stricture
- Sphincter of Oddi dysfunction
- Gastritis, ulcer, reflux disease
- Chronic pancreatitis
- Diarrhea associated with bile acids
- Irritable bowel syndrome
- Adhesions and postoperative hernias
How to examine
They begin by clarifying the nature of the complaints: when did they appear, are they related to food, is there jaundice, temperature, change in stool. Basic tests include liver function tests, GGT, alkaline phosphatase, amylase and lipase, and complete blood count. An abdominal ultrasound evaluates the condition of the ducts, pancreas and liver. Gastroscopy is almost always needed, because a significant part of the complaints are related to the stomach and duodenum. If a stone or narrowing is suspected, magnetic resonance cholangiography is performed. If there is persistent diarrhea, its connection with bile acids and the functioning of the pancreas is assessed.
- Liver tests, GGT, alkaline phosphatase
- Amylase and lipase
- Abdominal ultrasound
- Gastroscopy
- Magnetic resonance cholangiography
- Pancreatic function assessment
- Computed tomography with an unclear picture
Treatment
Therapy is aimed at the found cause. The stone is removed from the duct endoscopically, and the narrowing is widened or stented. For stomach diseases, proton pump inhibitors and H. pylori treatment are prescribed. For diarrhea associated with bile acids, drugs are used that bind them in the intestines. For pain caused by dysfunction of the sphincter, antispasmodics are used, and the decision on endoscopic intervention is made strictly according to indications. Enzyme preparations help with pancreatic insufficiency. There is no universal treatment, so the selection is always individual.
- Endoscopic removal of stone from the duct
- Dilatation or stenting of narrowings
- Proton pump inhibitors and H. pylori treatment
- Bile acid binders for diarrhea
- Antispasmodics for pain syndrome
- Enzyme preparations for pancreatic insufficiency
- Observation by a gastroenterologist
Nutrition and lifestyle
In the first months after surgery, it is more convenient to eat fractionally, four to five times a day in small portions, limiting very fatty, fried and spicy foods, as well as large amounts of food at one time. Then the diet is gradually expanded, focusing on tolerance: a lifelong strict diet is not necessary and only leads to nutritional deficiencies. A sufficient amount of fiber and water, regular meals, giving up alcohol and smoking, moderate physical activity and weight control are useful. If a certain product consistently causes complaints, it is limited individually.
- Fractional meals in the first months
- Limiting fatty and fried foods during the adaptation period
- Gradual expansion of the diet
- Enough fiber and water
- Quitting alcohol and smoking
- Weight control and moderate activity
- A lifelong strict diet is not required