Gall Bladder limedigital March 25, 2024
Gall Bladder

Gallstones and Cholecystectomy (Gall Bladder removal)

Gallstones occur in the gallbladder. The gallbladder is generally diseased and this is why it is necessary to remove the gallbladder as well as the gallstones otherwise they will simply reform. Pleasingly the gallbladder is not a vital organ and only acts as a storage apparatus for bile. It also concentrates the bile and contracts releasing it after eating a meal aiding in digestion particularly fat. The bile is manufactured in the liver so is still available to aid digestion.

Gallstones can be caused by a variety of factors including high cholesterol, obesity, weight loss of any cause, family history, female gender and blood disorders. There are other less common causes and in some folk we don’t know why they form.

Gall Bladder symptoms include

What is a Gallbladder?

Your liver makes bile, a yellow fluid that helps to digest fatty or rich foods. It gets stored and concentrated in the gallbladder, a pouch which sits underneath the liver collecting the bile and concentrating it. When you have a meal special gut hormones are released which cause the gallbladder to contract and discharge the bile into the gut to help digestion. It works a bit like soap and emulsifies the fat. 

What are Gallstones?

These are stones that form in the gallbladder. They are generally formed from cholesterol. These stones are the commonest and can form in patients for many reasons including weight loss (dieting), fasting and high cholesterol. Patients at risk include those with a family history, women and obesity. Occasionally patients with blood disorders  can form a different type of stone called a pigment stone which can cause similar problems to cholesterol stones. 

Sometimes they sit there happily and don’t cause any symptoms. However they can also cause severe pain felt in the upper abdominal region and chest.  

How do you diagnose Gallstones? 

Generally an ultrasound scan will diagnose gallstones. Sometimes an MRI is required particularly if we are interested in looking at the main bile ducts as well. CT scanning is particularly useful at looking at acute inflammatory processes of the gallbladder such as acute cholecystitis. Occasionally we do nuclear medicine scans (HIDA) which look at the function of the gall bladder. Each test has its own strengths and weaknesses and sometimes multiple tests are required to clinch the diagnosis. 

What are Gallstone complications? 

Biliary ColicThe stone  gets stuck in the neck of the gallbladder and causes severe pain whilst they are blocking and the pain often resolves  when the gallbladder deflates and the stone  is no longer obstructing. Pain is generally less than an hour or two, intense and patients often rate it 10/10 and they are unable to get comfortable. Sometimes patients think they are having a heart attack, severe reflux or severe indigestion. 

Acute CholecystitisThe gallbladder becomes acutely inflamed and thick walled. A gallstone generally remains stuck in the neck of the gallbladder. At its worse the gallbladder can become gangrenous which is a surgical emergency and requires immediate surgery. 

Chronic cholecystitisThis is generally regarded as Biliary Colic. Patients can have multiple attacks and feel fine in between attacks.  If there are abnormal liver function tests then one needs to have a high index of suspicion for stones that have traveled or are blocking the main bile duct.

Acute CholangitisThe stones have moved from the gallbladder into the main bile duct and are causing blockage and infection. This can be a life threatening situation. Immediate treatment is required including antibiotics, decompression of the main common bile duct and removal of stones by endoscopy(ERCP). Removal of the gallbladder(cholecystectomy) is then required  as the gallbladder is the source of the stones. 

Acute (Gall stone)PancreatitisAcute pancreatitis is commonly caused by gall stones. Stones can travel from the gall bladder down into the main bile duct and down to the bottom of the duct where the main duct for the pancreas is. If the stone blocks the duct to the pancreas the patient can get pancreatitis which can range from being a relatively short attack to serious life threatening. Paradoxically it’s the small stones that can travel and cause these complications.  

Biliary colic

Severe intermittent upper abdominal/ chest pain sometimes rated 10/10 with patients often unable to get comfortable. Symptoms often occur at night and can be precipitated by eating rich or fatty foods.

Patients generally feel fine between attacks.

Acute Cholecystitis

The pain is constant, doesn’t go away and it may hurt to breathe or move. It generally means a stone has become impacted in the neck of the gall bladder and causes secondary inflammation, a bit like appendicitis.

Acute Cholangitis and Pancreatitis

These are serious complications of gallstones and carry a significant mortality rate. Here the stones manage to move into the main bile duct and cause obstruction to the liver. This can result in jaundice(going yellow), severe infection and acute pancreatitis. This can be a life threatening condition. 

The treatment for these conditions includes gallbladder removal (Laparoscopic Cholecystectomy) which is the source of the Gallstones and prevents further ones forming.

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