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Gallstones, Cholecystitis, and Gallbladder dysfunction

What is the gallbladder?

The gallbladder is a structure on the underside of the liver on the right side of the abdomen. The function of the gallbladder is to store bile that is produced in the liver before the bile is secreted into the intestines. Bile secreted into the intestines helps the body digest fats.

Anatomy of the upper abdomen

What are gallstones?

Bile is composed of three major components: cholesterol, bile salts, and bilirubin. When the gallbladder is not functioning properly, the components of the bile become out of balance leading to the formation of solid crystals. The majority of stones (80%) are composed of cholesterol, the remainder are pigmented stones consisting of bilirubin. Stones can be large or small, single or multiple. These factors do not necessarily predict the frequency of symptoms or the severity of the disease. In many cases gallbladder symptoms are caused by the dysfunctional gallbladder that is forming stones rather than the stones themselves. The exception to this is when stones block off the cystic or common bile duct.

What are the risk factors for gallbladder disease?

What are the symptoms of gallbladder disease?

Asymptomatic cholelithiasis

The large number of patients with gallstones have no symptoms at all. Stones in these patients are found incidentally during medical tests for other conditions.

Biliary Colic

For patients who do have symptoms, gallbladder symptoms can be variable. Classic gallbladder attacks consist of right upper quadrant abdominal pain which is pain just under the rib cage on the right side.) The pain often radiates around the abdomen to the back and is associated with nausea and sometimes vomiting. The pain is severe and lasts from 30 minutes to several hours. Often this is followed by less intense soreness in the area that lasts for a day or so. Attacks are often instigated by a fatty meal. Gallbladder disease can also cause chronic nausea.

Cholecystitis

A more serious form of gallbladder disease, cholecystitis is an infection or inflammation of the gallbladder often caused by obstruction of the cystic duct. The symptoms are similar to biliary colic but more prolonged. Patients can also have fever, chills and an elevated white blood cell count.

Choledocholithiasis (common bile duct stones) - Stones can drop out of the gallbladder into the common bile duct. These stones often pass into the intestines without incident. Sometimes they can cause obstructions in the bile duct leading to jaundice and life threatening infections of the bile ducts.

Biliary pancreatitis

When stones pass by the pancreatic duct the pancreas can be irritated leading to this potentially serious condition. Symptoms usually consist of mid-abdominal pain radiating to the back with nausea and vomiting.

How are gallbladder problems diagnosed?

Some tests used to evaluate the above conditions include:

How are gallbladder problems treated?

In most situations gallbladder problems require surgical treatment. Since gallstones are often just a sign of the problem, treatment is directed towards the gallbladder rather than the gallstones. The treatment involves removing the gallbladder. This is done in most cases using laparoscopic surgery. Sometimes a procedure called SILS can be used to improve the cosmetic results of gallbladder removal. Non-surgical treatments such as dissolution therapy and lithotripsy have a poor success rate an

Additional information

Medical University of South Carolina - very comprehensive site

Mayo clinic - comprehensive site, good anatomical diagrams