Thursday, February 11, 2021

Gallbladder: The Donald Trump Of Viscera

Though the outcome of Trump’s impeachment trial isn’t in doubt, it’s still going on, making now the obvious time to talk about your gallbladder, the Donald Trump of internal organs. Mostly unnecessary, it makes millions of people sick, and when it does, most are delighted by its removal and better off without it. Also, it has its own fake news.

Having separated a few thousand gallbladders from their owners in my surgical career, I claim more authority on the subject than, say, Trump on election fraud, Covid-19, or climate change. But this is bile of a different sort. 

Tucked underneath your liver, just below the midpoint of the bottom of your right-front ribcage, the gallbladder is a slightly pear-shaped sac. Unlike your other, generally earth-toned viscera, when healthy it’s a startlingly beautiful robin’s-egg blue. Empty, it’s about the size of my thumb, which is likely bigger than yours. Full, it can be more like that pear. 

Its purpose is storing bile, a liquid made in the liver to the tune of around a quart per day, passing into the gut via a tube called, appropriately enough, the bile duct. Most drips steadily into your intestine, where it facilitates fat absorption. Via a branch off the bile duct, a few tablespoons detour to your gallbladder, where it waits to be squirted into your intestine in response to eating, particularly a fatty meal. 

Before civilization and supermarkets, gallbladders were essential. Back then, humans and other bile-producing fauna might starve for a while between meals, so a bilious bolus when gorging on a kill made sense (during fasting, your gallbladder gets very full). Nowadays, since we eat regularly and frequently, food exits the stomach comparatively constantly, rendering bile storage mostly inutile. Remember: the gallbladder doesn’t make bile. With or without it, that daily quart gets to your gut; just a matter of pacing.

A complicated solution of salts and other stuff, bile makes fats soluble in water. Like detergent. Evolution, or whatever alternative you believe in, is imperfect. For reasons including heredity, diet, hormones, and gravidity, ingredients can become insoluble, forming crystals. Which, concentrated in the gallbladder, can grow into what we call gallstones. Looking like kaleidoscopic, multi-faceted agates, some are quite beautiful. I’ve seen them made into jewelry. Others are ugly, clay-like, or both. There can be hundreds of them. Or few, or single, large enough to fill the entire gallbladder.

Unlike Trump, gallstones aren’t always an affliction. Many – possibly most -- gallstone-bearers are asymptomatic, some never knowing they have them; so the discovery doesn’t always demand surgery (cholecystectomy, commonly an outpatient laparoscopic procedure). Except for the presence of certain risk factors, it’s typically done if stones are causing problems, which they can do in several ways.

Most often it’s pain, occurring if a stone blocks the outlet of the gallbladder when it decides to squeeze out some bile. That can be extremely painful, felt below the right ribs and straight into the back. Or shoulder. Or lots of places. Called biliary colic, it usually goes away in a few minutes or an hour or two, as the cramped gallbladder muscles relax. The pain pattern is not always “textbook,” leading to potential misdiagnosis. Which explains, I think, most of the people dissatisfied with treatment.

More easily diagnosed and more serious is a stone lodged tight, in which case the pain persists, the gallbladder become inflamed, sometimes infected (cholecystitis). Worse still is a stone (has to be fairly small) passing out of the gallbladder into the bile duct. If it passes out into the gut, the problem resolves. If not, obstructive jaundice, pancreatitis, or severe liver and blood infection can result (cholangitis).

As explained, with some exceptions people get along fine without a gallbladder; therefore, treatment is almost always surgical removal. Pills can dissolve certain kinds of stones, but it can take months and there’s a high recurrence rate; true of any treatment that eliminates stones, or claims to, without removing the gallbladder. Which brings us to the foreshadowed fake news: gallbladder and liver “flushes,” “detox” cleanses. All-consuming, alt-med bogosity.

If you drink olive oil along with some sort of acidic juice, curdled lumps of oil may appear in your stool. The internet and some naturopaths will assure you those turd-curds are gallstones and you’re cured. Convinced, people have brought me theirs in Dixie cups. Nope and nope. There’s a belly-full of reasons why; pathophysiology, anatomy, and biochemistry among them. Demonstrably false (have them tested, get another ultrasound), it’s nevertheless believed like Q among the credulous.

Lacking enough space here, I offer an ancient post on my surgery blog, where there’s more explication. And, found by searching “gallbladder” on the blog, more still. 


  1. I wouldn't be surprised to learn that Trump's gall bladder and spleen are HUGE. We already know he doesn't have a heart and his alimentary canal ends where it started.

  2. Fascinating! And, a perfect comparison I think!
    And, the good news about removal, is, once removed it is NOT going back in any way or form imaginable.
    He's gone folks! Never to return!
    There will be false reports I'm sure, some that won't dissipate for awhile, if you catch the "drift".
    This guy is not Cassius Clay, or Mohammed Ali, he is not a champion, and has no talent anyway.
    He won't even become president of a high-walled fortified tiny city in Northern Idaho! If anything, he'll reappear in a gold-encrusted multi-story tower in Russia (I agree with Jack!).
    Out of respect for Sid, I'll sign myself Democrat.

  3. Pence blew his chance to be the republican nominee in 2024. Drumpf will want Stephen Miller or Steve Bannon to be his running mate next time. He demands a puppet with 'gall'and devout subservience.

  4. In the "This is really gonna piss off the alt right white terrorists" Department...

    The Senate voted to award Goodman the medal – the highest honor Congress can bestow – by unanimous consent, meaning there were no objections. The medal has traditionally been used to honor military officers for distinguished service.

    Goodman was in the Senate chamber as Schumer spoke, and the entire Senate stood and turned toward him, giving him a standing ovation. He put his hand on his heart.

    Capitol police officer who steered mob away from Senate chambers hailed a hero
    Read more
    Goodman, who was promoted to acting deputy sergeant-at-arms for the Senate after his performance during the Capitol riot, has been in the chamber for much of the impeachment trial. As an armed mob of Trump supporters bore down on the Capitol, threatening lawmakers including Mike Pence, the former vice president, Goodman intercepted, engaging rioters and leading them away from the Senate chamber.

  5. (Sid-willing, of course)
    Our planet-saviour Bill(-ionaire) Gates is making gnews with multiple articles today about how he will save the world from what will, with certainty, happen in 100 years unless we do what he (and Jeff Bezos)say we should do. And, his words, "hey, we have 30 years"! (Bill's prediction of his non-imminent death until age 96+?).
    They make fun reading, but the not-fun part of it is what those mustards do to humanity while they play in the world's sandbox in their boredom.
    Incredible, but then that's what we live in in these last days.
    What does this have to do with Sid's article? A legitimate question, but I'll suggest it has everything to do with the current insanity. These 20 or so mega-Bill-ionaires are pumping the economy in their perversions like it hasn't been pumped since the world began 4.5+ Bill-ion years ago (wait, just yesterday now it's 5.5 Bill-ion! of was it 6.5? or is that the number of exo-planets? Sci-ence, so hard to keep up with in the current marketing of uselessness).
    Signed, Democrat. But one who would like us to work together for the masses for a change, rather than amassing our work for the very few to sit on top of in their little king-ships (for ships, think Flying Dutchman, the legend). If you read the articles, notice he didn't mention Elon nor did he mention Warren. Gee, I wonder why?
    As for the article, these Bill-ionaires are very much like gallbladders, if they were extricated, the world would be a much, much better place.

    1. Published, and almost entirely disagreed with. Gates isn't saying how HE will save the world. He's saying what it will take for US to save it. And, IMO, he's absolutely right. It is, in fact, science.

      And whereas we agree there's no need for any person to have as much money as he and Bezos and so many others, Bill, at least, is using his money in very meaningful ways. Literally saving hundreds of thousands of lives.

      (Okay, his school fetishes, less so.) Most R billionaires seem to want to keep their wealth, spend it on protecting their political interests. And yachts. Really big yachts. And planes.

      I don't understand why you seem always to single out Bill for your criticism of billionaires, when he's nearly alone among them in doing good works. "Good," I suppose, is relative. Still, the good parts of what he's doing are pretty undeniable.

    2. Thank you for discussion. At times I'll agree it might be best over coffee and/or email, but frankly one in particular...
      Bill is emblematic of the issue, and, easily thought of as something of a founder of the recent problem, though "he" can easily be seen in history, but nothing even remotely compares with the age of immediate notification of the masses "he" ushered in (if not him it would have been another).
      As for the "joy" he provides everyone, think of the summation of the 20+ mega-Bill-ionaires and what they extract from the masses, and hold in their greedy gall-sacks to grow stones that cause pain to the world, etc. It's a good metaphor, and with Bill's recent and many press releases of his "wisdom", realize what is happening. How many people when they look at Anderson Cooper realize he's the face of the Vanderbilts? (i.e. old money, alliance of new'n'old; imagine how much "good" that will do humanity if/when they started working together!)
      But the more important thing to imagine: what would things be like if they weren't extracting mind-boggling amounts through Wall Street, which they undoubtedly keep propped up through their corrupting influence on, yes, "our" government right up to the President himself?! (Joe is old money, Trump was a bizarre, strange thing that disrupted "what-is-to-be", but only for micro-seconds). And, if you can imagine something like that, think Kshama/AOC/Bernie and others, then wonder if we're truly served by their imaginings as they define what science is through their "contributions".
      If you agree with their plans/objectives, well, then I'm the one who's nuts. But then, most here think that anyway, no?
      I'm an Economist, which is the science of Opportunity Cost, valuation(s) of which are the next highest thing or things NOT done when one, the one, is chosen.
      I'm pretty sure Bill thinks himself immortal, but then, that's not really science, is it?

    3. Why not just raise taxes and break monopolies while at the same time reel in the internet with common sense laws designed to keep it in check for the peoples benefit.

    4. The issue with all your arguments is they are framed in a way that clearly shows bias and fear. It's framed politically instead of practically.

      Same style FOX 'news' uses.

  6. I have surmised that some evangelical Christian critics of Bill Gates and his wife Melinda blame them for not supporting the so-called "pro life" movement. In my opinion, the Gates and the Foundation they founded contribute more money and effort to saving lives throughout the world than all their critics combined.

    The pietists are hypocritical pro-lifers if they only defend pre natal life and ignore capital punishment, euthanasia, warmongering, and denigration of the poor.

    1. This is a fascinating example of how an article spreads disinformation, better, since it's on the presumably respectable "The Guardian" web:
      A casual glance would cause the reader to believe Bill and Warren "saved 122m lives". The article reads exactly the opposite, even claiming the bulk of what it is about happened well before Bill found his wife's Roman Catholic religion.
      But, these things don't matter. I wonder how many lives Bill has actually saved, but would fully agree it's more than his critics, since I couldn't find any evangelical Christian critics of him. Do you know of any? (Democrat)


  8. I had been thinking of the twin gallbladders, Trump in this column and KS Anonymous' evil Bill, and how unfair it is that such individuals have (or had) the power that they wield. A minor organ can really f-up the body or all the rest of us.

    David Frum has an interesting piece on the Atlantic site, "The Founders Were Wrong About Democracy", describing the Founders' concerns for the United States and their chosen solutions — that now appear to be failing gallbladders, not acting as intended. Worth reading.

  9. (thanks Dr.S, interesting Atlantic article)
    I had an over-the-coffee discussion of what is happening today, and no one reacted with "defense of Bill", and what resulted was one who realized how this compares with "the men who built America"; Vanderbilt, Morgan, Carnegie, Rockefeller.
    We have an equivalent today, but it manifests itself in private actions that are as if the participants were conspiring with each other, and yet they don't need to even speak with each other, so obvious is what the "Bills" of the world do that anti-monopoly rules can't apply! It's a data-driven thing.
    And, the list is 20+ that behave in this way, but their founder and now lackey is Bill! That's why we're hearing from him for the first time in years.
    But then, this could be a discussion among friends, not an attack on character. (Democrat)


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