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.
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?
- Age: more common in patients greater than 40
- Rapid weight loss
- Sex: more common in women, especially women of childbearing age who have had children
- Estrogen intake
- Ethnic background: Certain ethnic groups have a higher prevalence (Native Americans, Mexican-Americans)
- Diabetics have a higher rate
- Lipid lowering agents
What are the symptoms of gallbladder disease?
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.
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.
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.
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:
- Lab tests to check for jaundice and signs of liver inflammation
- Blood Amylase level to check for pancreatic inflammation
- Ultrasound:Uses sound waves to image the intra-abdominal organs including the gallbladder
- CT scan: Computer constructed x-ray images of the abdominal organs
- Heida scan: Uses a low level radioactive tracer that is taken up by the gallbladder to measure gallbladder function.
- MRCP: A type of MRI scan that visualizes the common bile duct to check for bile duct obstruction.
- ERCP:A test where a scope is passed via the mouth into the common bile duct allowing dye to be injected into the common bile duct. X-ray pictures are then taken. This test gives the most accurate assessment of the common bile duct. It also is sometimes required to extract stones from the common bile duct
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
University of South Carolina - very comprehensive site
clinic - comprehensive site, good anatomical diagrams