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Gall Bladder

Conditions

Gallstones

Gallstones are hard deposits of digestive fluid (bile) that develop in the gallbladder (a small, pear-shaped organ located on the right side of the abdomen just below the liver). Gallstones may be as small as grain of sand to as big as a golf ball.

Gallstones develop because of imbalance in the substances that make up bile. It is still unclear why these imbalances occur. However, it is believed that gallstones may form if bile contains unusually high levels of cholesterol, bilirubin, or not enough bile salts.

Many people with gallstones do not have any symptoms or are not aware that they have gallstones unless detected in tests carried out for another reason. If symptoms occur, they may include:

  • Constant cramping pain that is sharp or dull which occurs in the right upper or middle upper abdomen for at least 30 minutes. Gallbladder attacks usually occur in the evening or during the night. The attack usually stops when gallstones move into the small intestine.
  • A high temperature
  • Jaundice

Other symptoms include nausea, vomiting and clay colored stools.

You are at risk of developing gallstones if you:

  • Are a woman
  • Are more than 40 years of age
  • Are taking birth control pills or pregnant
  • Have a family history of gallstones
  • Are of American Indian or Mexican descent
  • Have diabetes
  • Are overweight or obese
  • Are on a high calorie and low fiber diet and have recently lost weight very quickly

Diagnosis of gallstones is done with the help of tests which include ultrasound scan of the abdomen, CT scan of the abdomen, magnetic resonance imaging (MRI) scan, endoscopic retrograde cholangiopancreatography (locate the affected bile duct and the gallstone), cholescintigraphy (diagnose abnormal contractions of the gallbladder or obstruction of the bile ducts). Your doctor may also order blood tests to look for signs of infection or inflammation of the bile ducts, gallbladder, pancreas, or liver.

The usual treatment for gallstones is surgery to remove the gallbladder. The most commonly used technique is called laparoscopic cholecystectomy (involves small incisions, which allow for a faster recovery). Open cholecystectomy (incision of about 4 to 6 inches long is made in the abdomen and thus requires more time to heal) was the technique used in the past. However, this technique is less common now.

Nonsurgical treatments (endoscopic retrograde cholangiopancreatography) may be used to dissolve or remove stones if a person cannot undergo surgery or to remove stones from the common bile duct. Your doctor may also prescribe medications. However, the disadvantage of taking medicine is that you may need to take it for years and there are chances that the stones may come back if you stop taking the medicines.

Cholecystitis

Cholecystitis is inflammation of the gallbladder. The gallbladder is a pear-shaped organ which lies just below the liver. The gallbladder stores bile, a digestive fluid that is sent from the liver. Most cases of cholecystitis are caused by gallstones. Gallstones are crystalline structures that develop in the gallbladder or the bile ducts and can interfere with the normal flow of bile leading to inflammation. Other less common causes include injury to the gallbladder due to trauma or surgery, infection or tumors.

Cholecystitis can be chronic (ongoing) or acute (sudden). Symptoms vary but will often occur after eating fatty meals and may occur at night awaking one from sleep. Common complaints include:

  • Abdominal pain in the upper right quadrant that increases rapidly and lasts from 30 minutes to several hours
  • Abdominal bloating
  • Nausea or vomiting
  • Indigestion, flatulence and belching
  • Pain in the back between the shoulder blades
  • Low grade fever
  • Intolerance to fatty foods

Your risk of developing gallstones and subsequently cholecystitis increases if you are a woman, over the age of 60, obese, diabetic or have liver disease or pancreatitis.

To diagnose cholecystitis, your physician will review your history and perform a physical examination. Imaging tests such as an ultrasound or a HIDA scan may be performed. Blood tests may be performed to look for signs of infection, obstruction, pancreatitis, or jaundice.

Initial treatment for cholecystitis includes bowel rest, medications to control pain and inflammation and antibiotics in case of infection. Cholecystitis is usually treated by surgical removal of the gallbladder. This is commonly performed using a minimally invasive technique called laparoscopic cholecystectomy. Gallbladder removal is safe and does not cause any nutritional deficiencies.

Treatments

Cholecystectomy

The gallbladder is a small pear-shaped storage organ located under the liver on the right side of the abdomen. It stores bile (yellowish-brown fluid) produced by the liver, which is required to digest fat. As food enters the small intestine, cholecystokinin (a hormone) is released, which signals the contraction of the gallbladder to release bile into the small intestine through the common bile duct (a small tube connecting liver and intestine).

Although the gallbladder helps in digestion, it is not an essential part of the body as bile can reach the small intestine in many other ways. Therefore, gallbladder removal is a safe treatment for gallbladder problems. Major gallbladder diseases include gallstones (concentrated bile) that can block the ducts (biliary colic), and cholecystitis (inflammation of the gallbladder). The removal of the gallbladder is performed by a procedure called cholecystectomy and is the most effective way to treat gallstones or other gallbladder diseases.

Procedure

Surgical removal of the gallbladder can be done one of two ways:

Open cholecystectomy

Open method involves a 5-7-inch incision in the upper right-hand side of the abdomen, below the ribs. Your surgeon removes the gallbladder through the large, open incision.

Laparoscopic cholecystectomy

Laparoscopic cholecystectomy is a less invasive surgical method that uses a device called a laparoscope. The laparoscope is a small, thin tube with a light and tiny video camera (connected to a television monitor) attached at the end, which helps visualize inside the abdomen during the operation.

The surgery is performed under general anesthesia. Your surgeon makes 3-4 small incisions in the abdomen. The laparoscope is inserted into the body through one of the incisions. The television monitor will guide the surgeon to insert other surgical instruments through the other incisions. Air or carbon-dioxide is injected into the abdomen to inflate the abdominal cavity so that the gallbladder and other adjacent organs can be visualized easily. Your surgeon first cuts the bile duct and blood vessels leading to the gallbladder, and then removes the gallbladder.

Your surgeon may also perform a procedure called a cholangiogram during the surgery, which uses X-rays and a dye injected into the body to view the bile ducts. This is done to identify gallstones that could have been missed, obstructions or narrowing of the bile ducts. If stones are present, the surgeon uses a special instrument and removes them.

Post-operative care

Following laparoscopic surgery, you can go home on the same day or the next day after recovering from the effects of anesthesia. You can return to normal activities within 24 hours and resume work in a week. However, you should not engage in strenuous activities for a few more weeks.

Risks and Complications

The removal of the gallbladder is generally a safe procedure, but like all operations, there are risks and complications associated with the procedure. Some of these include bleeding, infection, injury to the bile duct, leakage of bile fluid, and damage to the bowel and large blood vessels when surgical instruments are inserted through the abdominal incisions.

Advantages

The advantages of laparoscopic cholecystectomy when compared to open surgical technique include shorter hospital stay, smaller incisions, less post-operative pain and faster recovery.

Affiliations

  • American Society for Metabolic & Bariatric Surgery
  • Bariatric Medicine Institute

City Creek Surgical Services

1046 E. 100 S, Suite D
Salt Lake City, UT 84102

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