What is the gallbladder?
The gallbladder is a pear-shaped structure that is found attached to the liver. The bile duct is a tube that transports bile from the liver to the small intestine. The gallbladder is attached to the bile duct by a small tube called the cystic duct. Bile is collected in the gallbladder between meals and empties into the bile duct through the cystic duct during a meal.
What are gallstones?
Gallstones are stone-like substances that are found in the gallbladder. There are two types of gallstones: pigment stones and cholesterol stones. In the majority of patients cholesterol stones are present. In many people the cause for gallstones appears to be interaction between hereditary causes and the diet. Certain population groups such as the Latino population have a an increase tendency to form gallstones.
Gallstones are formed when the bile that is produced by the liver becomes very enriched with fatty substances. In the majority of patients with gallstones, the gallbladder wall is abnormal due to many previous episodes of inflammation. Removal of the stones only is associated with rapid development of new stones in the gallbladder.
What symptoms do gallstones cause?
Gallstone causes symptoms that are usually associated with eating a fat rich meal. Many patients develop pain in the right upper part of the abdomen that may last from few minutes to few hours. Some patients complain of indigestion, feeling fullness, and discomfort in the upper part of the abdomen after a meal.
How are gallstones diagnosed?
Gallstones are diagnosed by a radiological test called ultrasound. In this test the radiologist utilizes an instrument that sends sound waves to the gallbladder. The sound waves detect the stones, which are then seen on the ultrasound. An ultrasound is an excellent test for gallstones and diagnoses the stones in more than 98% of all patients with gallstones.
What are the complications associated gallstones?
Gallstones can cause many serious complications. Some of the complications that are caused by gallstones include:
How are gallstones treated?
- Acute cholecystitis. In this condition a stone blocks the cystic duct and therefore the gallbladder cannot empty its content into the bile duct. The secretions in the gallbladder accumulate and become infected. Patients often develop a bad infection of the gallbladder with severe pain in the upper part of the abdomen, fevers, and other symptoms such as nausea and vomiting. Patients usually require admission to the hospital for treatment with antibiotics and emergent removal of the gallbladder.
- Jaundice. Jaundice develops when a stone passes from the gallbladder through the cystic duct into the bile duct and blocks the bile duct. Patients present with a yellowish discoloration of their skin associated with severe itchiness. An emergency procedure by a gastroenterologist is often required to remove the stones from the bile duct.
- Acute pancreatitis. In some patients passage of the stone from the gallbladder into the bile duct is associated with injury to the pancreas. Pancreatitis is one of the most severe complications of gallstones. Of all patients that develop pancreatitis, 85% of the patients get better very quickly however in 15% the attack can be severe and lead to hospitalization that may extend for many days to weeks in an intensive care unit. Pancreatitis develops with severe pain in the abdomen and back that is associated wit nausea, vomiting, and fevers.
- Cancer of the gallbladder. In some patients when gallstones are present over many years (usually more than 15 years) there is an increase risk of cancer in the gallbladder.
Gallstones are treated by removal of the gallbladder by a procedure called cholecystectomy. Cholecystectomy can be performed through an open surgical incision and by laparoscopic surgery. In the past the gallbladder was removed through an open surgical incision.
Today the almost all gallbladder surgery is performed by laparoscopic surgery. Laparoscopic gallbladder surgery is associated with a shorter hospitalization, less pain and discomfort after the surgery and a rapid recovery allowing many patients to go back to work within a short period of time after the surgery.