A Holiday Warning about Pregnancy, Fatty Foods and Gallstones

Dec. 9, 2009 - PRLog -- With the holiday season upon us, pregnant women have to be especially vigilant about not eating large, fatty meals. Pregnancy predisposes women to gallstones. Approximately 2.5 to 4.5% of pregnant women have gallstones. Approximately 81% of women that develop signs of gallbladder disease had their initial attack within the first year of pregnancy. Most gallbladder attacks occur during the second or third trimester of pregnancy. The risk of developing gallstones increases with the number of pregnancies. Pregnant patients with symptomatic cholelithiasis have a high rate of relapse of symptoms during their pregnancy.

What causes gallbladder disease in pregnancy?

The combination of increasing volume of the gallbladder during the second and third trimester, along with decreased motility due to elevated progesterone levels, and increased cholesterol and bile acids can lead to the development of gallstones. Women that have obesity or diabetes with a hereditary tendency to gallstones are especially susceptible.

What are the symptoms of gallbladder disease in pregnancy?

About 50% of women with cholelithiasis, (gallstones alone) have no symptoms at all. Symptoms, if present, can include right upper quadrant colicky pain or mid-epigastric pain which can radiate to the back or the right shoulder. The pain often occurs after consuming a large fatty meal. The pain can be accompanied by nausea and vomiting, fever and/or chills. Laboratory values of leukocytes, hepatic functions, amylase, lipase, and alkaline phosphatase may also be elevated.

What causes the symptoms of gallbladder disease?

The gallstones, or sludge (precursor to gallstones) induces a chemical inflammation. This can cause obstruction and swelling in the gallbladder with decreased blood flow. This allows bacteria to enter with resultant infection. The most common bacteria is Escherichia coli, a common bowel bacteria. Other bacteria can include Klebsiella, Proteus, Enterococci, and Streptococci, Bactericides, and Clostridia.

How do you make the diagnoses?
History of symptoms along with increase in pain in the right upper quadrant when taking a deep breath (Murphy’s sign) helps make the diagnoses. Ultrasound is the one diagnostic test that is safe, and 93% accurate in diagnosing gallbladder disease. Visualizing a stone in the gallbladder duct can be impossible to see. Seeing thickening of the gallbladder wall, swelling of the gallbladder, and experiencing pain when pressing the gallbladder are also helpful in making the diagnoses.

What are the treatment options for gallbladder disease?

   * Antibiotics
     A penicillin and an aminoglycoside are generally first line medical therapies for women who develop pain and symptoms during first, second , or third trimester.
   * Resting the bowel
     Not eating and giving hydration
   * Correcting any abnormal lab values
   * Pain medication
   * Surgery

Unfortunately there is a high rate of recurrence of symptoms throughout the pregnancy. Generally if a woman is known to have gallbladder disease, she should have surgery for removal of the gallbladder prior to becoming pregnant.

For recurrent episodes, or refractory pain in the first trimester, surgery should be delayed, if possible, to the second trimester. Recurrent episodes in third trimester should be delayed till postpartum but if patients have deteriorating status or refractory pain, surgery should be done. Laparoscopic cholecystectomy is preferred method in pregnancy because of reduced morbidity and mortality and decreased hospitalization costs.

Laparoscopy if preferred because

   * Patients return to normal activity quicker
   * Bowel function resumes faster
   * Less requirement for pain medication in pregnancy
   * Lower risk of spontaneous abortion, preterm labor, and premature delivery.

If this is not possible, traditional laparotomy can also be done.

In summary

Pregnancy is a risk factor for the formation of biliary sludge or gallstones which can lead to cholecystitis, or gallbladder inflammation. Eating a large, heavy fatty meal can precipitate symptoms. Ultrasound is the best way to make a diagnoses. Relapse rates of disease are high in pregnancy. Surgical management by laparoscopy is warranted if conservative medical management fails.

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