Gallbladder Disease/Gallstones

Introduction

Gallbladder disease is caused by conditions that slow or block the flow of bile from the gallbladder. Bile is a fluid that breaks down fat during the digestive process. Inflammation or gallstones can block the bile flow. Gallstones are solid particles that result from an imbalance of bile components. When gallstones or bile accumulate, the gallbladder can become painful and inflamed.

Gallstones may not produce symptoms, and some gallstones do not require treatment. Pain is the hallmark symptom when gallstone complications occur. The most common treatment for gallbladder disease is surgical removal of the gallbladder or treatments to eliminate gallstones.

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Anatomy

Your gallbladder is a small sac-like organ located in your upper right upper abdomen, under your liver. Your gallbladder works with your liver and pancreas to produce bile and digestive enzymes. Bile is a fluid that breaks down fat in the food you eat for digestion. Bile is produced by the liver and stored in the gallbladder until it is needed. When you eat high-fat or high-cholesterol foods, your gallbladder contracts and sends bile into your duodenum via the common bile duct. The duodenum is the first part of your small intestine.

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Causes

Gallbladder disease is caused by conditions that slow or block the flow of bile from the gallbladder. Cholelithiasis is a condition that occurs when gallstones form in the gallbladder. Cholecystitis, also called gallbladder disease, results when the gallbladder is inflamed.

Gallstones are solid particles that form when the gallbladder does not empty properly or when the components of the bile are imbalanced. Bile is composed of cholesterol, bilirubin, bile salts, and other substances. Most gallstones develop when there is too much cholesterol in the bile. These are called cholesterol stones. Stones formed by excess bilirubin are smaller and called pigment stones. Researchers are not sure why some people develop gallstones and others do not.

Cholecystitis occurs when the flow of bile from the gallbladder to the common bile duct is blocked. This leads to the build up of bile in the gallbladder. The over-accumulation of bile causes irritation and pressure in the gallbladder. This can lead to bacterial infection and tearing of the gallbladder. In most cases, gallstones cause the blockage that causes cholecystitis. Other less frequent causes of blockage include severe illness, tumors, and alcohol abuse.

Cholecystitis can be acute or chronic. Acute cholecystitis occurs suddenly usually causing severe pain in the right upper abdomen. Chronic cholecystitis is caused by repeated episodes of acute cholecystitis. Chronic cholecystitis causes the gallbladder to decrease in size and the gallbladder walls to thicken. The gallbladder eventually loses its ability to function.

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Symptoms

The majority of gallstones do not cause symptoms. Symptoms may occur when complications develop. The most common symptom of gallstone disease is constant severe and dull pain in your right upper abdomen. The pain usually begins about 30 minutes after eating a high-fat meal. It may spread to your right shoulder and back. The pain associated with gallstones commonly occurs at night and may even awake you from your sleep. You may also experience nausea, vomiting, fever, and indigestion.

The main symptom of acute cholecystitis is a similar pain in the right upper abdomen. Because this condition is usually associated with infection you may occasionally experience nausea, vomiting, and fever. Symptoms of chronic cholecystitis include frequent indigestion, abdominal pain, nausea, and belching.

You should go to the emergency department of a hospital if you also experience abdominal pain that cannot be controlled with over-the-counter medication, vomiting, fever, chills, sweats, or jaundice. Jaundice is a condition caused by an excess of bilirubin. Symptoms of jaundice include yellowing of the eyes and skin, dark urine, pale-colored stools, nausea, and vomiting.

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Diagnosis

Your doctor can start to diagnose gallstones or gallbladder disease by reviewing your medical history and conducting a physical examination. You should tell your doctor about your symptoms and risk factors. Your doctor may test your blood and urine to help confirm the diagnoses and rule out other diseases with similar symptoms. Your doctor may conduct a series of imaging tests to identify the presence of gallstones or inflammation. Imaging tests are painless and simply require that you remain motionless while pictures are taken. Commonly used tests include abdominal ultrasound, abdominal X-ray, oral cholecystogram, abdominal CT scan, gallbladder radionuclide scan, and endoscopic retrograde cholangiopancreatography (ERCP).

An abdominal ultrasound is used to provide images of your abdominal organs including your gallbladder, liver, pancreas, and spleen. An abdominal ultrasound is useful for identify gallstones, infection, inflammation, or organ enlargement. To take an ultrasound, a technician will gently move and place a small device across your abdomen. The device transmits sound waves to a monitor for viewing.

An abdominal X-ray is used to find a mass or gallstone. An oral cholecystogram (OCG) involves using a dye to enhance the X-ray images. The dye is safe and swallowed before the X-ray is taken. Abdominal ultrasound and OCG are considered to be excellent methods for identifying gallstones.
An abdominal CT scan is used to examine the gallbladder and bile ducts. It can show gallstones, blockages, and other structural complications. A CT scan takes pictures in slices that together, compose a full picture of the abdomen. A CT scan shows more detail than an X-ray.

A gallbladder radionuclide scan, also called a Cholescintigraphy (HIDA scan), is used to check gallbladder function and identifying acute gallbladder infection or blocked bile ducts. For the test, a radioactive substance is injected into a vein. The substance pools in the liver and flows into the gallbladder, as bile would. Scanning reveals the route of the substance on images.

An ERCP uses an endoscope to view the biliary system. An endoscope is a thin tube with a light and a viewing instrument at the end of it. After sedation, a thin tube is passed through your mouth and into your small intestines. It can administer dye to enhance views. In some cases, it is used for surgery to remove a gallstone.

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Treatment

The treatment you receive depends on the degree of your gallbladder disease, gallstones, and symptoms. Many people with gallstones do not have symptoms and do not need treatment. Some cases of cholecystitis can improve with the use of medications such as antibiotics. However, when symptoms persist, surgery may be used to remove the gallbladder and the gallstones. The most common surgery is laparoscopic cholecystectomy.

Laparoscopic cholecystectomy uses a small lighted camera, a laparoscope, to guide the surgery. A Laparoscopic cholecystectomy uses small incisions, which shortens the recovery time. It is feasible to have the surgery in the morning and return home on the same day.

Medications may be used to treat gallstones. The medication works to dissolve the gallstones. This process can take a long time, up to a few years.

Electrohydraulic shock wave lithotripsy (ESWL) can also be used to treat gallstones. ESWL uses high-energy shock waves to break up the gallstones. This method is sometimes used in conjunction with dissolving medications.

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Prevention

Researchers do not know why some people form gallstones and others do not. Researchers do not know how to prevent gallstones. Maintaining an appropriate weight and consuming a low-fat, low-cholesterol diet may help reduce the symptoms of gallbladder disease and gallstones.

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Am I at Risk

Risk factors may increase your likelihood of developing gallbladder disease and gallstones. People with all of the risk factors may never develop the disease; however, the chance of developing the condition increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for gallstones:

• Obesity is one of the biggest risk factors for gallstones. Obesity is associated with increased levels of cholesterol leading to the production of gallstones.
• Increased levels of estrogen can increase cholesterol levels and result in reduced bile emptying. Women who are pregnant, taking birth control pills or hormone replacement therapy have higher levels of estrogen.
• Native Americans and Mexican Americans have higher incidence of gallstones.
• Women develop more gallstones than men.
• Gallstones are more common in older people.
• People with diabetes have an increased risk for gallstone formation because they tend to have higher levels of triglycerides, a type of blood fat.
• Losing weight rapidly can cause the liver to produce extra cholesterol, which is associated with gallstone formation.
• Fasting or not eating for extended periods of time can cause a reduction in gallbladder contractions and lead to gallstone formation.
• People with liver disease, blood disease, or high levels of bilirubin are at risk for developing pigmented gallstones.

Risk factors for chronic cholecystitis include:

• Repeated episodes of acute cholecystitis can lead to chronic cholecystitis.
• Gallstones are the most common cause of cholecystitis.
• Cholecystitis occurs more frequently in women than men.
• Most cases of cholecystitis occur after the age of 40 years old.

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Complications

Complications from gallbladder disease and gallstones include infection or tissue death in the gallbladder and inflammation in the lining of the abdomen. Pancreatitis can occur from jaundice or bile duct obstruction. Pancreatitis is a condition that causes the pancreas to be inflamed.

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