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Removal of the gallbladder and digestion of fat

Question
Hello,
I have the following question:
in case of a CF patient with a high need of pancreatic enzymes (and in spite of this frequent fatty stools) the gallbladder should be removed because of gall stones.
Would this in addition even more restrict the digestion of fat (he is already very underweight) or does this play no role?
Is there a correlation between need of enzymes (and function of enzymes) and the bile?
Many thanks and best regards.
Answer
Hello,
the removal of the gallbladder (reservoir for the bile acid) can have as a consequence that large amounts of fat in a meal cannot be tolerated well. A normal meal is usually well tolerated.
After removal of the gallbladder it has to be tested individually, how much fat the patient can tolerate.
As, according to your remarks, the patient has even without removal of the gallbladder an insufficient digestion of fat, it rises the question, if Nortase® is already used in addition to the normal enzyme substitution. Additionally it should be checked, if the patient receives an acid blocker.
If necessary, the usage of ursodeoxycholic acid should be considered.

Best regards,
Prof. Dr. Joachim Bargon
29.09.2014