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TREATMENTS

Treatment of this disorder usually involves surgical removal of the gallbladder, cholecystectomy. However, surgery may have to be withheld till the acute infection subsides. Till then the patient is kept in the bed and suitable analgesics and antibiotics are administered

Foods to Avoid

Foods which precipitate or aggravate symptoms should be avoided. The most likely foods to produce intolerance are 

• Fried foods, fats and butter 
• Fatty meats (brain, liver, kidney, duck and bacon)
• Eggs
• Milk and milk products with cream
• Legumes
• Dried fruits and nuts
• Sweets or sweet meat
• Condiments and spices
• Papar, chutney or pickles

RECOMMENDATION
If you are having gallstone then avoid having large meals. Try to take plenty of fluids early in the morning, late at night and in between meals. 

Gallstone disease

Gallstone disease Gallbladder concentrates bile formed in the liver and stores it until needed for digestion of fat. The entrance of fat in the duodenum stimulates the secretion of the hormone cholecystokinin by the intestinal mucosa. This hormone reaches the gall bladder via the blood and causes it to contract releasing bile. Interference with the flow of bile may cause impaired fat digestion. 

Cholecystitis involves the inflammation of the gallbladder usually due to a low grade chronic infection. Such a infection affects the absorptive powers of the gall bladder mucosa, in turn affecting the solubility ratios of the bile ingredients. Thus, cholesterol may precipitate out causing gall stones to form. Gallstone formation or cholethiasis may occur when along with cholesterol bipigments, bile salts, calcium and other substances precipitate out of the bile.

DIETETIC MANAGEMENT

The main aim of dietary treatment is to reduce discomfort by providing a diet restricted in fat. In acute cases, it is advisable to keep the gall bladder at rest and minimize contractions. Thus fat is excluded from the diet. 

A liquid diet, given as hourly or two hourly feeds daily for a few days, would be beneficial. When the condition settles down, clear soups. weak tea milk, refined cereals may be added

Calories
The gallbladder disease is more prevalent in communities consuming significantly more calories. The minimum amount of calories to maintain normal bodyweight is therefore advised. 

Proteins
Higher protein intake also increases biliary cholesterol concentration. A normal 60 to 80 grams of protein intake is permitted.

Fats
Since the fat is the major cause of pain, the energy needs should mainly be met from carbohydrates and not fat sources. The fat intake may be limited to 20 to 30 g per day and later increased to 40 to 45 g per day, thus increasing the palatability of the diet. Control of fat also contributes to fatloss.
For patients in whom fats do not produce symptoms, administration of vegetable oils like olive oil and unhydrogenated ground nut or till oil is recommended

Carbohydrates
Increased intake of simple sugars in drinks and sweets is associated with gallstone formation. 

Fibre
Deficient fiber intake is also considered as a cause of gallstone formation, but fiber has been shown to have very little effect on cholesterol metabolism

Vitamins 
If a low fat diet is prescribed, fat soluble vitamins A, D, E and K should be given as supplements

Fluids
A high fluid intake should be encouraged

The presence of gallstone do not always produce symptoms. However when accompanied by inflammation of the gallbladder, there may be severe pain. Generally, pain is felt after ingestion of fat due to the contractions stimulated by cholecystokinin. 

Factors leading to gallstone formation

• Stasis 
• Infection
• High dietary fat intake over a long period of time predisposes to gallstone formation because of constant stimulus to produce more cholesterol as a bile ingredient to metabolize fat

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