The gallbladder is a small pear shaped organ and is attached to the liver. Its function is to store and concentrate the bile that is produced by the liver and delivered to the duodenum when we eat. The bile mixes with the food and aids in the absorption of fats and certain vitamins that are dissolved in the fats. Gallbladder stores bile, produced by the liver. Bile is a watery, yellow-green fluid made by liver to digest fat.
This describes the path by which bile secreted in the liver is transported via the hepatic duct and common bile duct to the intestine to aid in the absorption of fats and certain vitamins. The gallbladder is connected to the bile duct by the cystic duct. Blockage of the bile duct causes jaundice. The causes of blockage of the bile duct are most commonly stones or tumour, but can include parasites and benign strictures (narrowing).
Bile duct cancer is uncommon and is mostly referred to as cholangiocarcinoma.
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Gallbladder diseases occur if there is infection, inflammation, tumours, stone formation, and blockage of the gallbladder.
Some of the types of gall bladder diseases include:
- Cholecystitis: It is the inflammation of the gall bladder, which causes severe abdominal pain. There are two types; acute and chronic cholecystitis. Acute cholecystitis occurs if inflammation or gallstones block the flow of bile. Chronic cholecystitis is caused by repeated attacks of acute Cholecystitis, which cause the walls of the gallbladder to thicken.
- Cholelithiasis: It is caused due to presence of one or more gallstones inside the gallbladder. These stones are made up of cholesterol or bilirubin (pigment of the bile). It most commonly occurs in women than men.
- Acalculous gallbladder disease: It is an inflammatory disease of the gallbladder that shows symptoms of the stones, but when examined provides no evidence of gallstones. It results when there is reduced blood supply or inability of the gall bladder to empty the bile.
- Gangrenous gallbladder: Destruction of the tissue in the gall bladder due to inadequate blood supply can lead to gangrenous gallbladder. Inflammation of the gallbladder caused due to blockage of bile by gall stones can lead to gangrenous gallbladder.
- Gallbladder polyps: Are the growth of tissue that protrude from the lining of the gallbladder. These polyps are larger than 10mm in diameter and are more likely to cause cancer if untreated.
- Sclerosing cholangitis: It is a chronic liver disease caused by progressive inflammation, scarring, and destruction of the bile ducts inside and outside of the liver.
- Congenital defects of the gall bladder: Congenital defects of the gallbladder such as abnormal or unusual positioning of gallbladder, presence of double gallbladder, cyst formation and other anomalies may occur during the development of gallbladder.
- Tumours: Benign or malignant tumours may be found in the gallbladder. Benign tumours include fibromas, lipomas, haemangiomas, and granular tumours. Commonly occurring malignant tumours include adenocarcinoma, cholangiocarcinoma, and sarcomas.
- Gallstones :Gallstones are small stones made up of cholesterol or bilirubin (pigment of the bile) that can form in your gallbladder. People who have gallstones may experience nausea, vomiting, or pain in the abdomen, back, or just below the right arm. Endoscopic retrograde cholangiopancreatography (ERCP) is used to discover and remove the gallstones. Cholecystectomy is a surgical procedure to remove gallbladder. It is either performed laparoscopically or through open surgery.
A gallstone is a lump of hard material usually ranges in size from a grain of sand to 3-4 cms. They are formed inside the gall bladder formed as a result of precipitation of cholesterol and bile salts from the bile.
Types and causes of gallstones
- Cholesterol stones
- Pigment stones
- Mixed stones – the most common type. They are comprised of cholesterol and salts
Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason.
Pigment stones are small, dark stones made of bilirubin. The exact cause is not known. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anaemia in which too much bilirubin is formed.
Other causes are related to excess excretion of cholesterol by liver through bile. They include the following
- Gender – Women between 20 and 60 years of age are twice as likely to develop gallstones as me
- Obesity – Obesity is a major risk factor for gallstones, especially in women
- Oestrogen – Excess oestrogen from pregnancy, hormone replacement therapy, or birth control pills
- Cholesterol – lowering drugs
- Diabetes – People with diabetes generally have high levels of fatty acids called triglycerides
- Rapid weight loss – As the body metabolises fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones
Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called "silent stones”. Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis. So, accurate diagnosis is important.
Symptoms may vary and often follow fatty meals, and they may occur during the night.
- Abdominal bloating
- Recurring intolerance of fatty foods
- Steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours
- Pain in the back between the shoulder blades
- Pain under the right shoulder
- Nausea or vomiting
- Indigestion & belching
Ultrasound is the most sensitive and specific test for gallstones.
Other diagnostic tests may include
- Computed tomography (CT) scan may show the gallstones or complications
- Endoscopic retrograde cholangiopancreatography (ERCP). The patient swallows an endoscope–a long, flexible, lighted tube connected to a computer and TV monitor. The doctor guides the endoscope through the stomach and into the small intestine. The doctor then injects a special dye that temporarily stains the ducts in the biliary system. ERCP is used to locate and remove stones in the ducts
- Blood tests. Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice
Course of illness
Bile-duct blockage and infection caused by stones in the biliary tract can be a life-threatening illness. With prompt diagnosis and treatment, the outcome is usually very good.
The obstruction caused by gall stone may lead to biliary colic, Inflammation of gall bladder (Cholecystitis). Other complications may include
- Cirrhosis- Cirrhosis is the result of chronic liver disease that causes scarring of the liver (fibrosis – nodular regeneration) and liver dysfunction
- Cholangitis- Cholangitis is an infection of the common bile duct, which carries bile (which helps in digestion) from the liver to the gallbladder and then to the intestines
Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones. The most common operation is called laparoscopic cholecystectomy. For this operation, the surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close up view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures.
If gallstones are in the bile ducts, the physician (usually a gastroenterologist) may use endoscopic retrograde cholangiopancreatography (ERCP) to locate and remove them before or during the gallbladder surgery.