Gallstones

Gallstones

What is the gallbladder?

The gallbladder is a small pear-shaped sack-like organ located beneath the liver in the right upper abdomen.  Bile produced in the liver is carried by bile ducts to the gallbladder where the bile is stored.  During a meal, the gallbladder contracts and pushes the bile into the small intestine where the bile serves mainly to digest fats.  Fatty meals tend to cause the gallbladder to contract more vigorously and oftentimes cause more symptoms in patients with gallbladder disease.  Gallstones are small hard collections of bile that can accumulate within the gallbladder.

What are the symptoms of gallstones?

Interestingly, most patients with gallstones never experience symptoms. Symptoms occur when gallstones either block the outlet of the gallbladder or bile ducts or when the stones irritate the gallbladder and cause gallbladder inflammation (cholecystitis).  Stones that obstruct the outlet of the gallbladder (cystic duct) cause steady pain in the upper abdomen, usually on the right side under the ribs.  The pain may radiate to the midback or under the right shoulder blade.  Pain oftentimes occurs after eating when the gallbladder contracts and may last for several minutes up to several hours.  Nausea or vomiting may also occur.

Stones that obstruct the bile ducts may cause pain, nausea, vomiting or jaundice.  Stones that cause bile duct obstruction may also lead to bacterial infection in the bile ducts called bacterial cholangitis, which generally causes fever, chills and jaundice.  Occasionally bacteria can spread to the blood stream (sepsis) and be life threatening.  Gallstones can also block the opening of the pancreatic duct and cause inflammation of the pancreas (gallstone pancreatitis).

How do I know if I have gallstones?

An ultrasound of the abdomen is usually the initial diagnostic test in patients with a clinical history suggesting gallbladder disease.  This test looks at the anatomy and structure of the gallbladder, liver and bile ducts.  Stones within the gallbladder or thickening of the gallbladder wall may be seen in patients with symptomatic gallstones.  Enlarged or dilated bile ducts can be seen by ultrasound in some patients with bile duct obstruction.

Some patients with symptoms suggestive of gallbladder disease may have a normal abdominal ultrasound. In these patients a study of gallbladder function called a hepatobiliary (HIDA) scan is often done.  During this test a small amount of radioactive material is injected into the bloodstream through an intravenous catheter.  The radioactive material circulates to the liver and concentrates in the gallbladder.  An agent is then given through the IV that will cause the gallbladder to contract and empty.  A diseased gallbladder usually does not contract and empty very well indicating a poorly functioning gallbladder.  During this test patients with a diseased gallbladder oftentimes experience pain when the gallbladder is made to contract.  ERCP (endoscopic retrograde cholangiopancreatography) can be helpful in detecting and removing stones from the bile ducts.

Treatment

Treatment of symptomatic gallbladder disease usually involves surgical removal of the gallbladder (cholecystectomy).  Most patients undergo laparoscopic surgery in which three or four tiny incisions are made in the abdomen and small instruments are used to remove the gallbladder.

Rarely and only in special circumstances gallstone dissolving medication can be used to treat symptomatic gallstones.  Most gallstones take one to two years to completely dissolve and often recur after medication is stopped.

Most patients function quite well without the gallbladder.  The liver continues to produce and secrete bile into the small intestine allowing fat digestion and absorption to occur normally.  Occasionally after cholecystectomy patients may experience diarrhea with meals.  Postcholecystectomy diarrhea generally improves or resolves with time and is easily treated with dietary modification and occasionally medication.

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