Re: Some GB Questions Please

>> if one gets his GB removed and the liver continues to make these stones, WHERE do they go? Do they just sit in the liver from then on, clogging it up or what?


You are right! You see, you already know the answer.

They usually stay inside liver bile ducts, or inside common bile duct, depend on where those stones were formed, or how far they were pushed-by or washed-by bile.

When person eats a very fatty meal after several days of fasting, liver will produce more bile, and that bile may flush some of those stones, flush them out into intestines, what is good!

All religions and most traditions value fasting.

In old time, people use to fast at least 2 days every week, and few times a year long fasts, several days or weeks.
They would usually end fast with fatty meal.

Christians would fast 40 days before Christmas and 40 days before Eastern, and then they would end fast with foods rich in fats and proteins, that would trigger a lot of bile!

Orthodox Christians still follow those rules.

Eating fatty meal after a long fast will naturally flush the liver bile ducts, and if that is done often enough, stones would never get a chance to grow big enough to cause pain or attack.


Today, we are smarter, we don't fast, and as a result, we have epidemyc of liver and gallbladder disease and epidemyc of gallstones.


The next part of this message is not placed here to propagate Christian religion, it is placed to propagate fasting and it's benefits.

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>> Someone else said the bile just drips onto or into the intestines after surgery, but that seems a very "bad idea" due to the irritating nature I suppose of this bile material. <<


Bile flow through the common bile duct is regulated by the bile pressure and by the Sphincter of Odi - valve/sphincter muscle that keeps common bile duct closed.



Gall Bladder stores bile produced by the liver, and concentrates bile by removing up to 90% of water!

Bile, a watery greenish fluid is produced by the liver and secreted via the hepatic duct and cystic duct to the gall bladder for storage, and thence on demand via the common bile duct to an opening near the pancreatic duct in the duodenum.

Gallbladder is linked with Liver through Hepatic Duct and Cystic Duct.
Bile enters and exits Gall Bladder via the Cystic Duct.

The Cystic and Hepatic Ducts unite to form the Common Bile Duct that unites with Pancreatic Duct and lead to the sphincter of Odi - the "gate keeper" - gate to duodenum.


When Gall Bladder is removed, then bile ducts MUST overtake main function of the gallbladder - storing bile and concentrating bile, removing 90% of water from the bile! In other words, common bile duct and Hepatic Ducts become alternative "gallbladder" for storing bile.

Removal of gallbladder often leads to enlarged bile ducts and after longer time, to the sphincter of Odi disfunction.

Once sphincter of Odi is unable to keep bile inside bile ducts, bile will start dripping out and causing diarrhea.

Over 20% of people experience chronic post-gallbladder surgery diarrhea.


Pancreas produces pancreatic amylase and other enzymes for the breakdown of carbohydrates and proteins.
Pancreatic Duct delivers pancreatic juices to the common bile duct, ampula of Vader; from there it should passes through the sphincter of Odi to reach the duodenum.


There are three levels of control for the secretion of bile: chemical, neural, and hormonal.

1 Chemical - Bile salts in the plasma stimulate bile flow.
2 Neural - Vagal stimulation increases bile secretion.
3 Hormonal - Cholecystokinin stimulates the contraction of the gall bladder as well as the relaxation of the Sphincter of Odi which regulates bile flow through the common bile duct.


When stones migrate from the liver or from the gallbladder and are retained within the common bile duct a condition called choledocholithiasis is present.
Choledocholithiasis is the medical term for stones within the common bile duct.
Since stones in the common bile duct may migrate and block the pancreatic duct, gallstone pancreatitis may occur.
Other complications associated with common bile duct stones include Cholangitis , gallstone pancreatitis, fistulous tract formation, and liver damage.

The best treatment for choledocholithiasis is Liver Flush!

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Pancreaticobiliary ductal anatomy in Thai People

Journal of Hepato-Biliary-Pancreatic Surgery
http://link.springer-ny.com/link/service/journals/00534/bibs/9006001/90060079.htm

ISSN: 0944-1166 (printed version)
ISSN: 1436-0691 (electronic version)

Table of Contents

Abstract Volume 6 Issue 1 (1999) pp 79-85

Pancreaticobiliary ductal anatomy in Thai People
Chumpon Wilasrusmee, Paisal Pongchairerks


Department of Surgery, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Bangkok 10400, Thailand


Received for publication on March 25, 1998; accepted on Oct. 26, 1998

Abstract: The complex anatomy of the pancreaticobiliary duct was studied to demonstrate basic data in Thai people. Fresh specimens of the pancreas, common bile duct, and duodenum were obtained en bloc from the autopsies of 103 patients who had died of causes not related to trauma or disease of these organs. The length of the pancreas, the location of the pancreatic ducts in relation to the surface of the pancreas, the length and types of the common channels, as well as the anatomy of the ampulla, were studied, using methylene blue infusion via the pancreatic duct cannulation and careful dissection. Ninety-three male and 10 female patients were included. Their ages ranged from 15 to 76 years (mean 31.38 ± 12.98 years). The length of the pancreas ranged from 10.9-19 cm (mean, 15.60 ± 1.80 cm). The intrapancreatic portion of the common bile duct showed patterns of three types; most common (90/103; 87.38%) was type A, in which the anterior surface of the common bile duct was totally covered, while its posterior surface was partially covered, by the pancreatic parenchyma. On dissection of the accessory duct of Santorini in the pancreatic substance, the accessory duct was traceable to the duodenal wall in 59 specimens (57.26%). The anatomy of the Wirsung-choledochus confluence was grouped into five different types. The common channel (junction of the common bile duct and pancreatic duct) was found in 76.70% of specimens and its length varied from just a common junction (so-called "V-type" anatomy) to 15 mm (Y-type-b). Separate papillae (so-called "II-type") were found in 12.62% of specimens. Separate openings in the same papilla (so-called "U-type") were found in 10.68% of specimens. The Wirsung duct at the pancreatic neck was most often located posterior and superior in relation to the surface of pancreas. This study demonstrated several important points regarding the anatomy of the pancreaticobiliary junction and pancreatic ductal system in a Thai population. Some of these data were different from those reported in the literature for other population groups.

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Fast and feast - Orthodox Christians

An important part of the Orthodox faith is its four fasting seasons, which church members believe helps them prepare more room in their hearts for God. All fasts are vegetarian in nature and include increased prayer, Scripture reading and alms-giving. Feasts close out the fasts as a reward:

• Advent, or the Nativity Fast: 40 days from Nov. 15 to Dec. 25 eve. Focuses on preparation of the heart for the coming of the son of God in the flesh and the fulfillment of Old Testament prophecy with the coming of Christ. Followed by a fast-free period to the eve of Theophany on Jan. 5.

• Great Lent: Begins eight weeks prior to Holy Week, consisting of 40 days, excluding Saturdays and Sundays, on which fasting is less strict. It is the most ancient and strictest fasting period. It is the time of joyful repentance and reorientation and recommitment of life to God. Followed by one of three fast-free weeks on the church calendar.

• The Apostle's Fast: Precedes the feast of Sts. Peter and Paul, the foremost of the Apostles of Christ, on June 29. The duration varies, from several weeks to several days, depending upon the date of Pascha, or Easter.

• Dormition: Begins on Aug. 1 and is completed on Aug. 15, the day of the feast. "The focus is on the role of Mary in our salvation, her faithfulness to God which results in the son of God assuming our human nature and our sharing in the resurrection," said the Rev. Michael Shanbour, of Sts. Peter and Paul Orthodox Christian Church.

• The faith also requires fasting on Wednesdays and Fridays throughout the year.

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Fasting and traditions:

from Making God Real in the Orthodox Christian Home
Light and Life Publishing, 1977, p. 51-52


Fasting in the Orthodox Christian Church
by A. M. Coniaris

The Orthodox Church has always placed great emphasis on fasting. We fast on Wednesdays because on this day the decision was made to arrest Jesus. We fast on Fridays because it is the day on which Jesus was crucified. Fasting helps us remember that these are special days in the history of salvation. Other periods of fast are during Lent, Advent (pre-Christmas fast), the first fifteen days of August, etc.

Orthodox Christians fast from meat and products derived from meat, i.e., milk, cheese, eggs, butter, etc.

The purpose of such fasting is threefold:

- it helps us concentrate more on prayer. A full stomach is not as conducive to prayer as one not so full;
- it helps strengthen our will power. By learning to say "no" to certain types of food, we shall find it easier to say "no" to temptations;
- it is a way of helping us identify with those who hunger and provide food for them.

Jesus fasted. He tells us in the Bible, "When you fast ..." He does not say, "If you fast ..." He expects us to fast.

An early Christian, Aristides, wrote:

"If there is a poor person among the Christians and they do not have the means to help him, they fast two or three days and give the food they have saved through fasting to the hungry person."

Orthodox Christians are called upon to fast not only for reasons of self-control and prayer, but also for reasons of love: to deny ourselves something that we may share what we have saved with a needy person.

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