About Gallbladder and Gallstones

The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

Gallbladder

The liver produces bile which aids in the digestion of fats. The bile travels through tiny canals which eventually drain through the common bile duct into the small intestine. The gallbladder stores excess bile that is not immediately needed for digestion.

The gallbladder is a muscular sac located under the liver. It stores and concentrates the bile produced in the liver that is not immediately needed for digestion. Bile is released from the gallbladder into the small intestine in response to food. The pancreatic duct joins the common bile duct at the small intestine adding enzymes to aid in digestion.

The gallbladder is a sac located under the liver. It stores and concentrates the bile produced in the liver. Bile is released from the gallbladder in response to food, especially fats, in the upper small intestine.

The gallbladder is a sac located under the liver. It stores and concentrates bile produced in the liver. Bile aids in the digestion of fats, and is released from the gallbladder into the upper small intestine (duodenum) in response to food (especially fats). Conditions that slow or obstruct the flow of bile out of the gallbladder result in gallbladder disease.

Types of gallbladder disease include:

• Cholecystitis (inflammation of the gallbladder)
• Cholelithiasis (gallstones)

Symptoms

• Abdominal fullness or gas
• Abdominal pain that is:
• Severe
• Located on the right side (right upper quadrant) or in the upper middle of the abdomen (epigastric)
• Decreased over 12 to 18 hours in uncomplicated cases
• Recurrent or similar to pain in past
• Occurring after meals
• Worse during deep intake of breath
• Radiating to back or below the right shoulder blade
• Worse after eating or drinking fatty foods or fluids
• Chest pain under the breastbone
• Chills and shaking
• Fever
• Heartburn
• Nausea and vomiting

Cholelithiasis (gallstones)

Normally a balance of bile salts, lecithin and cholesterol keep gallstones from forming. If there are abnormally high levels of bile salts or, more commonly, cholesterol, stones can form. Symptoms usually occur when the stones block one of the biliary ducts or gallstones may be discovered upon routine x-ray or abdominal CT study.

Definition

Gallstones are hard, pebble-like deposits that form inside the gallbladder. Gallstones may be as small as a grain of sand or as large as a golf ball, depending on how long they have been forming.

Causes

The cause of gallstones varies. Some stones form when there is too much cholesterol or bilirubin in the bile. (Bile is a liquid that helps the body digest fats.) Other stones form if there are not enough bile salts or if the gallbladder fails to empty properly.

One type of gallstones, called pigment stones, tend to occur in people who have medical conditions that cause the liver to make too much bilirubin. Pigment stones are also more common in persons with liver cirrhosis and biliary tract infections.

Gallstones are a common health problem worldwide. They are more common in women, Native Americans, and people over the age of 40.

Other risk factors include ethnic and hereditary factors, obesity, diabetes, liver cirrhosis, long-term intravenous nutrition, and some operations for peptic ulcers.

Symptoms

Gallstones often have no symptoms and are usually discovered by a routine x-ray, surgery, or autopsy.

Symptoms usually start after a large stone blocks the cystic duct or the common bile duct. The cystic duct drains the gallbladder, and the common bile duct is the main duct draining into the duodenum. Together, these ducts form part of the biliary system.

A stone blocking the opening from the gallbladder or cystic duct usually produces symptoms of biliary colic, which is cramping pain in the middle to right upper abdomen. If the stone does not pass into the duodenum, but continues to block the cystic duct, acute cholecystitis results.

If the common bile duct is blocked for a long period of time, bacteria may grow behind the stone in the stagnant bile, producing symptoms of cholangitis. Cholangitis is a serious condition and usually requires hospitalization. Continued blockage of normal bile flow may produce jaundice (yellow skin and eyes).

Stones blocking the lower end of the common bile duct (where it enters the duodenum) may obstruct secretion from the pancreas, producing pancreatitis. This condition can also be serious and may require hospitalization.

In general, pay attention to the following symptoms:

• Abdominal pain in the right upper abdomen or in the middle of the upper abdomen, which:
• May be recurrent
• May be sharp, cramping, or dull
• May radiate to the back or below the right shoulder blade
• May be made worse by fatty or greasy foods
• Occurs within minutes of a meal
• Jaundice
• Fever

Additional symptoms that may be associated with this disease include:

• Clay-colored stools
• Nausea and vomiting
• Heartburn
• Excess gas
• Abdominal indigestion
• Abdominal fullness

It is important to see a doctor if you have symptoms of gallstones. Gallstones are present in many people with gallbladder cancer.

Exams and Tests

There are numerous tests to detect the presence of gallstones or gallbladder inflammation:

• Abdominal ultrasound
• Abdominal CT scan
• Abdominal x-ray
• Oral cholecystogram
• Gallbladder radionuclide scan
• Endoscopic retrograde cholangiopancreatography (ERCP)

This disease may also alter the results of the following tests:

• Fecal fat
• Urine bilirubin
• Abdominal MRI

Treatment

Modern advances in surgery have revolutionized the treatment of gallstones. In general, surgery is used only if you have symptoms.

In the past, open cholecystectomy (gallbladder removal) was the usual procedure for uncomplicated cases. Today, a minimally-invasive technique called laparoscopic cholecystectomy is most commonly used. This procedure uses smaller surgical cuts, which allows for a faster recovery. A patient may have their gallbladder removed in the morning and be discharged from the hospital on the same evening or the next morning.

MEDICATION

In people with a functioning gallbladder, bile salts taken by mouth may dissolve gallstones. However, the process may take 2 years or longer, and stones may return after treatment ends.

Medicines called chenodeoxycholic acids (CDCA) or ursodeoxycholic acid (UDCA, ursodiol) may be given to dissolve the stones. Both CDCA and UDCA are useful only for gallstones formed from cholesterol.

In some cases, chemicals are passed into the gallbladder through a catheter. The chemical rapidly dissolves cholesterol stones, but potential toxicity, stone recurrence, and other complications limit its usefulness.

LITHOTRIPSY

Electrohydraulic shock wave lithotripsy (ESWL) has also been used to treat gallstones. However, its application is limited if there are a large number of stones present, if the stones are very large, or in the presence of acute cholecystitis or cholangitis. It can also be used in association with UDCA to improve its effect.

Outlook (Prognosis)

Gallstones develop in many people without causing symptoms. The chance of symptoms or complications from gallstones is about 20%. With current surgical approaches, the outlook is excellent for people with symptoms -- over 99% of patients have no recurrence of symptoms.