Q: I have been diagnosed with fatty liver grade one and gallstone of 3.5mm. My doctor is suggesting I undergo surgery, but I don’t want to go for removal of gallbladder. Sometimes I feel pain in upper abdomen.

 

Before I answer your question, a brief on what the gallbladder is and what gallstones are. The gallbladder is a small pouch that sits just under the liver. It stores bile (fluid for digestion) produced by the liver. Before a meal, the gallbladder may be full of bile and about the size of a small pear. After a meal, the gallbladder empties itself as the fluid is used for digestion, and becomes flat, like a deflated balloon. Gallstones are stones formed inside this bladder.

Diabetes mellitus, glucose intolerance and insulin resistance are risk factors for the formation of gallstones. Obesity is a risk factor for gallstones in women. Elevated triglycerides levels may promote gallstone formation. The prevalence of gallbladder disease is increased in men (but not women) with cirrhosis (fibrosis of the liver) and hepatitis C (liver infection) virus infection.

Gallstones are more common in women than in men and increase in incidence in both with age. Rapid weight loss, as occurs after bariatric surgery (weight loss surgery), also increases the risk of symptomatic gallstone formation.

Gallstones attributable to haemolysis (rupture of red blood cells) occurs in over a third of individuals with sickle cell disease and the incidence is high in individuals with Crohn’s disease (inflammatory bowel disease).

Prolonged fasting (over 5-10 days) can lead to formation of biliary "sludge", which usually resolves with refeeding but can lead to gallstones. Pregnancy, particularly in obese women and those with insulin resistance, is associated with an increased risk of gallstones and of symptomatic gallbladder disease.

Aspirin and some nonsteroidal anti-inflammatory drugs have been found to protect against gallstones.

A low-carbohydrate diet, physical activity, and cardiorespiratory fitness may help prevent gallstones. Consumption of caffeinated coffee appears to protect against gallstones in women, and a high intake of magnesium and of polyunsaturated and monounsaturated fats reduces the risk of gallstones in men.

Gallstones are frequently asymptomatic and are discovered in the course of routine radiographic study or operation. The symptoms of "episodic gallbladder" pain develop in 10-25 per cent of patients and acute cholecystitis (inflammation of gallbladder) develops in 20 per cent of these symptomatic persons over time.

Nonsteroidal anti-inflammatory drugs can be used to relieve bilary (when gallstones block bile duct) pain.

Laparoscopic cholecystectomy (gallbladder removal) is the treatment of choice for symptomatic gallbladder disease. Patients may go home within a day of the procedure and return to work within days. The procedure is often performed on an outpatient basis and is suitable for most patients, including those with acute cholecystitis.

Now about non-alcoholic fatty liver disorder. The principal causes of fatty liver are obesity, diabetes mellitus and hypertriglyceridemia in association with insulin resistance. The risk of fatty liver in persons with metabolic syndrome is up to 11 times higher than that of persons without insulin resistance. Other causes of fatty liver include corticosteroids, and certain medications.

The risk is greater in persons with psoriasis. Soft drink consumption has been reported to be associated with fatty liver.

Physical activity protects against the development of fatty liver. Most patients with fatty liver are asymptomatic or have mild right upper quadrant discomfort.

Treatment consists of lifestyle changes to remove or modify the offending factors. Weight loss, dietary fat restriction, and exercise (through reduction of abdominal obesity) often lead to improvement in obese patients. Exercise may reduce liver fat. Resistance training and aerobic exercise are equally effective in patients with fatty liver and type 2 diabetes.

Fatty liver often has a benign course and is readily reversible with treatment of underlying conditions; if untreated, it could lead to severe health issues. The course may be more aggressive in diabetic persons.

Dr Asok Cheriyan is specialist diabetologist at Al Waha Clinic Diabetes Centre, Dubai. Got a problem? Our fantastic panel of renowned experts is available to answer all your questions related to fashion, well-being, nutrition, finance and 
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