SCALE 23
GALLBLADDER DYSFUNCTION
 

CONTENTS

• EXPLANATION
• THERAPEUTIC OPTIONS
• FURTHER ASSESSMENT
• DOCUMENTATION
• AN OSTEOPATHIC PERSPECTIVE ON GALLSTONES

    The gallbladder is a small pear-shaped organ located beneath the liver on the right side of the abdomen. The gallbladder's primary functions are to store and concentrate bile, and secrete bile into the small intestine at the proper time to help digest food.  The gallbladder is connected to the liver and the small intestine by a series of ducts, or tube-shaped structures, that carry bile.  Collectively, the gallbladder and these ducts are called the biliary system.

    Bile is a yellow-brown fluid produced by the liver. In addition to water, bile contains cholesterol, lipids (fats), bile salts (natural detergents that break up fat), and bilirubin (the bile pigment that gives bile and stools their color). The liver can produce as much as three cups of bile in 1 day, and at any one time, the gallbladder can store up to a cup of concentrated bile.

    As food passes from the stomach into the small intestine, the gallbladder contracts and sends its stored bile into the small intestine through the common bile duct. Once in the small intestine, bile helps digest fats in foods. Under normal circumstances, most bile is recirculated in the digestive tract by being absorbed in the intestine and returning to the liver in the bloodstream.

    Gallstones are pieces of solid material that form in the gallbladder.  Gallstones form when substances in the bile, primarily cholesterol and bile pigments, form hard, crystal-like particles. The formation of gallstones is called cholelithiasis.  Gallstones may be as small as "tiny specks" or as large as the gallbladder itself.  Edgar Cayce sometimes referred to the tiny specks as "sand," "gravel," or "sediment."  According to Cayce, these tiny particles can sometimes be almost as disturbing as the larger forms.

    Gallstones may make their way out of the gallbladder and into the cystic duct, the channel through which bile travels from the gallbladder to the small intestine. If stones become lodged in the cystic duct and block the flow of bile, they can cause cholecystitis, an inflammation of the gallbladder.  Blockage of the cystic duct is a common complication caused by gallstones.

    The most common symptom of gallstones is episodic attacks of abdominal pain, most often located in the right upper abdomen but also can be felt in the back and right shoulder. Other symptoms include nausea, vomiting and intolerance to fatty foods. Gallstone pain (biliary colic) is usually caused by the gallbladder contracting in response to a fatty meal and pressing the stones against the gallbladder outlet (cystic duct opening) causing it to be blocked. As the gallbladder relaxes, several hours after the meal, the stones often fall back from the cystic duct and the pain subsides. Recurrent cystic duct blockages can progress to total obstruction causing acute inflammation of the gallbladder (acute cholecystitis), a serious condition which is associated with fever and requires immediate medical attention. Other complications may result if the gallstones migrate through the cystic duct and block the common bile duct causing jaundice, a yellow discoloration of the skin and eyes. It may also lead to infection of the bile ducts (acute cholangitis) causing pain, chills, and fever. Acute inflammation of the pancreas (pancreatitis) may also occur. If the bile duct remains blocked for a long period of time, irreversible liver damage may occur.

    Three hundred Cayce readings are indexed as cholecystitis, an indication that this was a common problem during Edgar Cayce's era.  These readings provide wide variety of etiological factors and treatment options.  Poor dietary habits and underactive (torpid) liver are primary contributing factors in gall bladder dysfunction.  Therapeutic options for gallbladder dysfunction include: improved diet, internal cleansing (via colonic irrigation, laxatives, and castor oil packs), manual therapy (including osteopathic drainage of the gall duct), mild electrotherapy, and medicines to improve digestion and cleanse the gall bladder.  Edgar Cayce sometimes recommended surgery for acute cases of cholecystitis involving high fever and inflammation.  Otherwise, the readings generally advised a slower, safer process for healing the gallbladder using the modalities listed above.  Although surgery is much less of a hazard than during Cayce's era, some people report residual effects which may be linked to the absence of the gallbladder.

DIET

    The Basic Cayce Diet provides a good foundation for dealing with gallbladder dysfunction.  Avoidance of fats and greases was consistently advised in the readings for this condition.
 

MANUAL THERAPY

    Osteopathic treatment was often recommended for gallbladder problems.  Removal of specific lesions which may affect liver and gallbladder functioning was a high priority.  Osteopathic "drainage" of the gallbladder was also recommended in many readings for the elimination of gallstones or sand.
 

HYDROTHERAPY AND PACKS

    Abdominal castor oil packs over the liver/gallbladder area was the most common therapeutic recommendation for gallbladder dysfunction with approximately 129 readings indexed as cholecystitis prescribing this treatment.
 

MEDICINES

    Zilatone was recommended in 21 readings indexed as cholecystitis making it the most common treatment directed specifically for gallbladder dysfunction.  Lactated pepsin, milk of bismuth, and Alcaroid were also frequently suggested for the digestive upsets associated with gallbladder problems.  Mild laxatives (e.g., senna, Eno salts, Fletcher's Castoria) were recommended for person suffering from constipation.
 

ELECTROTHERAPY

    The most frequent form of electrotherapy recommended by Edgar Cayce for cholecystitis was the radial appliance (23 readings).  The violet ray appliance (13), wet cell battery (12), ultraviolet lamp (9), and sinusoidal appliance (9) were also prescribed in some readings.
 

SURGERY

    For acute cholecystitis involving significant fever and inflammation, surgical removal of the gallbladder was recommended.

    Options for further assessment include:

• Ultrasound imaging to detect gallstones.

(NOTE: The following excerpt comes from The Practice and Applied Therapeutics of Osteopathy by Charles Hazzard, D. O., published in 1905)
 

GALLSTONES

    DEFINITION: Concretions in the gallbladder, chiefly of cholesterin, due to a pathological
process usually caused by spinal lesion to sympathetic nerves in charge of liver functions.
    CASES: Very numerous cases of gallstones, some of gallstones, some of them noted, have been
successfully treated.  It is one of the most common things treated, and in no class of cases have more uniformly good, even striking, results been attained.
    (1) In a case of gallstones, with chronic constipation and dysmenorrhea, the muscles of the lower
dorsal region were much contracted, and there was lesion between the  11th and 12th dorsal
vertebrae.  The case was cured.
    (2) A case of gallstones after typhoid fever, in which operation had been advised.  The stones
were passed under osteopathic treatment.
    (3) A serious case of gallstones and catarrh of the stomach, in which every medical means of cure
had been tried without avail.  The patient grew continually worse.  After a few osteopathic
treatments the stones began to pass, and a large number of them, a large sized teacupful were gotten
rid of.  After this a copious passage of mucus, amounting to several pints, took place.  Much of
the mucous membrane lining of the intestines, gallbladder, duct and stomach was cast.  The stones
continued to pass, and two as large as a man's thumb were among them.  At the passage of the last
large stone the patient's limbs and lips were paralyzed, and her condition became critical.  The crisis
was safely passed under treatment, however, and entire recovery followed.
    (4) In man of 45, who had been troubled for years with gallstones, the common bile-duct became
impacted, and the ordinary methods of treatment were of no avail.  Hypodermic injections of
morphine gave no relief from the pain, and an operation was advised.  The intense pain was relieved
at the first treatment, which opened the duct.  After the second treatment thirty stones passed from
the bowel.  The case was entirely cured.
    (5) A case of gallstones of 18 years standing, lesion was found as a depression of the 10th right
rib, infringing the 10th intercostal nerve, which was sensitive along its entire course.  The treatment
was directed to the lesion, and to the gallbladder and duct.  By two treatments, the colic and pain
were overcome, and the case entirely recovered under further treatment.
    The LESIONS found in these cases are usually low down in the splanchnic area, affecting the
lower four ribs upon either side, frequently upon the left, for the spleen.  Lesions of the 11th and
12th vertebra may not be too low to cause it.  However, any of those lesions to the ribs and
splanchnic area, characteristic of bad gastrointestinal conditions may, from the nature of the case,
affect the liver to produce gallstones.  The liver is innervated from the same nerve supply,
gastrointestinal diseases are usually complicated with deranged liver function, and it is reasonable to
find in the usual lesions producing the latter a sufficient cause for disease in the former, which, owing
to some particular form, degree, or concentration of lesion, results in cholelithiasis.
    ANATOMICAL RELATIONS of lesion to disease: The liver is supplied by the splanchnics
through the solar plexus, the secondary plexus, the hepatic, in the formation of which the left
pneumogastric nerve participates, having special charge of the liver activities.  Its branches ramify
throughout the liver upon the branches of the portal vein and the hepatic artery, the chief supply
being to the latter.  The blood supply from both of these sources is thought to be essential to the
activities of the liver cells.  The nutrient blood supply (hepatic) is chiefly governed by branches of the
sympathetic.  A cystic plexus of the sympathetic supply is spread upon the gallbladder and bile
ducts.  The American Textbook of Physiology states that special investigation has shown that these
nerves are similar in function to vaso-constrictor and vaso-dilator nerves, and that stimulation of the
peripheral end of the cut splanchnics causes a contraction of the bile ducts and gallbladder, while
stimulation of the cut end of the same nerve cause reflex dilatation.  According to the same
investigator, stimulation of the central end of the vagus nerve causes contraction of the gallbladder
and at the same time an inhibition of the sphincter muscle closing the opening of the common bile
duct into the duodenum.
    These interesting and instructive facts  cannot but be of much significance to the Osteopath.
Doubtless he could not avail himself of these detailed facts to manipulate at will the activities of the
biliary apparatus, but spinal and other lesions affecting the sympathetic connections of the organs
must be efficient causes in producing abnormal function.
    Osler states that any cause, such as tight lacing, bending forward at a desk, enteroptosis, etc.,
which produces stagnation of bile favors cholelithiasis.  From an osteopathic standpoint, and in view
of the above facts, it is a reasonable conclusion that certain spinal lesion, acting through this nerve
mechanism above described, may cause a stimulated, irritated, or overactive condition of the dilator
fibers of the ducts and gallbladder, thus maintaining a permanent dilated or sluggish condition of the
apparatus, favoring stagnation of the bile and the formation of gallstones.  Likewise one must
concede the possibility of lesion to the central end of the vagus nerve, cutting off the normal impulses
through the nerve which contract the gallbladder and relax the sphincter of the common duct, thus
allowing of a lack of normal contraction of the bladder and opening of the duct; in other words,
favoring a sluggish condition of the biliary apparatus leading to retention and stagnation of bile, thus
to cholelithiasis.  If any osteopathic spinal lesion can interfere with sympathetic visceral supply, a
point placed beyond controversy by demonstrated facts, it is a reasonable conclusion that spinal
lesion to the sympathetic supply to the liver can become the cause of gallstones in this way.
    According to the catarrhal theory of the formation of gallstones, lithogenous catarrh of the mucosa of the bladder and duct modifies the chemical constitution of bile and favors the deposition of
cholesterin about some nucleus, such as epithelial debris.  Cholesterin and lime salts are produced by the inflamed mucous membrane to form the calculus.  As shown above, both the hepatic and portal
blood supply is under control of the hepatic plexus, i. e., of the solar plexus and the splanchnics.
According to the American Textbook of Physiology, stimulation or inhibition (section) of the
splanchnics produces at once vaso-constriction or vaso-dilatation of the blood vessels of the liver.
Here, as in the case of gastric or intestinal catarrh, spinal lesion to the splanchnics could disturb
vaso-motor equilibrium in the liver and cause catarrh of the mucous membrane.
    It is the practice of Osteopaths to give close attention to the condition of the spleen in case of
gallstones.  Important lesions to this organ are often found in such cases (8th to 12th left ribs, A. T.
Still).  Removal of this lesion seems to prevent further formation of the calculi.  What influence the
spleen naturally exerts upon the liver is not known.  The splenic and superior mesenteric veins unite
to form the portal vein.  The abundant venous flow from the spleen is carried directly to the liver in
the portal circulation.  The American Textbook shows that there is little doubt that the materials
actually utilized by the liver cells in forming their secretions are brought to them mainly by the portal
vein.  The blood which has circulated through the spleen must compose an important part of the
blood brought by the portal vein to the liver.  It may be that certain products of splenic activity are
useful in maintaining the fluidity of the cholesterin and in preventing the formation of gallstones.  The
spleen is enlarged and tender in this case.
    Sensory nerves pass through the sympathetic from the (6th, 7th, 8th, 9th and 10th spinal nerves
(Quain).  This fact may explain the radiation of the pain in hepatic colic to the spine and right
shoulder, and forms a good anatomical reason why inhibition over this spinal region will aid in
stopping the pain.
    The PROGNOSIS is good, even in serious cases in which operation has seemed advisable.  The
case is frequently presented to the Osteopath as the last resort before operation, and results have
been almost uniformly good.
    TREATMENT: The success of the treatment seems to rest mainly upon the mechanical effect and
upon the relaxation of all tissues concerned, gall ducts included, gained by the use of osteopathic
methods.  The main treatment in these cases is locally about the region of the liver; is much of the
relaxing and inhibitive treatment, and the main work of removing the stone are done here.  Spinal
work is important, as here inhibition for the pain of the colic is made, lesion is corrected, and
circulation is stimulated.  Nervous control is an important factor in the treatment.  It is gained by both spinal and abdominal work, perhaps alone by the removal of lesion.
    The objects of the treatment are: (1) To remove the stone, (2) To restore normal liver function
and prevent further formation of stones.
    The former is palliative treatment; the latter is the real cure.
    In the acute case, if colic is present the first step is to make strong inhibition over the 7th to 10th
spinal nerves.   (Some say upon the right side).  This will lessen or stop the pain, and allow of work
upon the abdomen.  This is deep, relaxing inhibitive work upon the tensed abdominal walls, over the
epigastric and lower anterior thoracic regions, and over the course of the duct.
    The pain, which is due to inflammation of the mucosa of the duct and to the rotary motion of the
stone, which is given this motion by the spiral arrangement of the Heisterian valve within the duct, is
usually relieved in a few minutes.
    The stone is removed by working it along the duct after the preliminary relaxing treatment.  The
patient should lie upon his back with knees flexed and shoulders slightly raised.  The lower ribs are
raised, by inserting the fingers beneath their anterior edges, and manipulation is made deeply over the site of the fundus of the gallbladder (tip of 9th rib) and down along the coarse of the duct.  The latter
may vary from its course on account of sagging of the intestines sometimes found.  This treatment
must be thorough and persistent.  It should be firmly and deeply, but most carefully applied.
Sometimes a few minutes work will pass the stone, but often continued treatment for three-quarters
of an hour or an hour be devoted to it.  Only careful manipulation could be borne by the patient for
this length of time.  As long as the stone remains in the duct and causes the colic the attempt to
remove it should be continued, though it may not be advisable to treat continuously all of the time.
The stone may or may not be large enough to be felt in the duct.  Stones are often passed without
pain.  Some stones are soft and may be carefully broken down by the treatment.
    The spleen is treated by careful abdominal work over and beneath the lower left ribs, anteriorly.
It is chiefly affected by treatment to the splanchnics, raising the lower left ribs (8th to 12th), and
removal of lower spinal and rib lesion.
    The jaundice, if intense, indicates impaction of the stone in the common duct.  Its cure depends
upon the removal of the stone.  The kidneys should be kept active.
    Fever, if present, is allayed in the usual manner.  Fatal syncope sometimes occurs.  If imminent,
the patient should be fortified against it by thorough stimulation of the heart. For obstruction of bowel by calculi, see Intestinal Obstruction.
    A dilated gallbladder and duct are treated locally by manipulation to remove the obstruction as for removal of the stone.  Thorough treatment must be given the liver locally, and thorough spinal
treatment must be kept up for the purpose of increasing circulation, etc.
    According to Dr. A. T. Still the lesion of the 6th to 10th left ribs, found in cases of gallstones, is
obstructing pancreatic secretions.  These, he says, dissolve gallstones.  They are absorbed from the
intestines by the lacteals and carried by them into the portal circulation, and thus to the liver as portal
blood, where they may influence the secretion of bile, and, mingling with the latter as a constituent of
the bile, act upon stones already formed.  The patient should drink plenty of alkaline waters.