Gallbladder Diseases

Gallstones and inflammation are the most common diseases

The gallbladder, a pear-shaped organ, is located in the liver. Your gallbladder’s main function is to store the bile produced by your liver and pass it along through a duct that empties into the small intestine. Bile helps you digest fats in your small intestine.

Your gallbladder is most likely to cause problems if something blocks the flow of bile through the bile ducts. That is usually gallstones that form when substances in bile harden. Rarely, you can also get cancer in your gallbladder. Many gallbladder problems get better with the removal of the gallbladder. Fortunately, you can live without a gallbladder. Bile has other ways of reaching your small intestine.

Cholecystitis

Cholecystitis is the most common type of gallbladder disease. It presents itself as either an acute or chronic inflammation of the gallbladder. Acute cholecystitis is generally caused by gallstones. But it may also be the result of tumors or various other illnesses. It may present with pain in the upper right side or upper middle part of the abdomen. The pain tends to occur right after a meal and ranges from sharp pangs to dull aches that can radiate to your right shoulder. After several attacks of acute cholecystitis, the gallbladder can shrink and lose its ability to store and release bile.

Abdominal pain, nausea, and vomiting may occur. Surgery is often the needed treatment for chronic cholecystitis.  Signs and symptoms of cholecystitis may include severe pain in your upper right abdomen, pain radiating to your right shoulder or back, tenderness over your abdomen when it’s touched, nausea, vomiting & fever. Cholecystitis signs and symptoms often occur after a meal, particularly a large or fatty meal.

The main symptom of acute cholecystitis is a sudden sharp pain in the upper right-hand side of your tummy (abdomen). This pain spreads towards your right shoulder. The affected part of the abdomen is usually very tender, and breathing deeply can make the pain worse. Unlike other types of abdominal pain, the pain of acute cholecystitis is usually persistent and doesn’t go away within a few hours. Some people may have additional symptoms, such as fever, nausea and vomiting, sweating, loss of appetite, yellowing of the skin and the whites of the eyes (jaundice) and a bulge in the abdomen.

The causes of acute cholecystitis can be grouped into two main categories: calculous cholecystitis and acalculous cholecystitis. Calculous cholecystitis is the most common, and usually less serious, type of acute cholecystitis. It accounts for around 95% of all cases.

Calculous cholecystitis develops when the main opening to the gallbladder, called the cystic duct, gets blocked by a gallstone or a substance known as biliary sludge.  Biliary sludge is a mixture of bile, a liquid produced by the liver that helps digest fats, and small cholesterol and salt crystals.

The blockage in the cystic duct causes bile to build up in the gallbladder, increasing the pressure inside it and causing it to become inflamed. In around one in every five cases, the inflamed gallbladder also becomes infected by bacteria. Acalculous cholecystitis is a less common, but usually more serious, type of acute cholecystitis. It usually develops as a complication of a serious illness, infection or injury that damages the gallbladder.

Gallstones

Gallstones accumulate in the gallbladder without causing any symptoms at first, but it usually gets worse when a gallstone causes a blockage in the ducts that connect the gallbladder, the liver, and the small intestine, resulting in severe pain. Gallstones form when substances in the bile form crystal-like particles. They can range from the size of a grain of sand to the size of a golf ball. The presence of gallstones causes pressure, irritation, and may cause infection. The walls of the gallbladder begin to thicken over time. Eventually, the gallbladder starts to shrink.

These changes make it harder for the gallbladder to function properly. The gallbladder’s main purpose is to store and concentrate bile. The liver produces bile, a liquid that helps digest fats and carries toxins excreted by the liver. Bile is passed from the liver through a series of channels called bile ducts into the gallbladder, where it’s stored.

Over time bile becomes more concentrated, which makes it more effective at digesting fats. The gallbladder releases bile into the digestive system when it’s needed. Gallstones may cause no signs or symptoms. If a gallstone lodges in a duct and causes a blockage, the resulting signs and symptoms may include sudden and rapidly intensifying pain in the upper right portion of your abdomen, sudden and rapidly intensifying pain in the center of your abdomen, just below your breastbone, back pain between your shoulder blades, pain in your right shoulder, nausea or vomiting.

Factors that may increase your risk of gallstones include:

• Being female
• Being overweight or obese
• Being pregnant
• Eating a high-fat, high-cholesterol, low-fiber diet
• Having a family history of gallstones
• Having diabetes
• Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugs
• Losing weight very quickly

Laparoscopic cholecystectomy

Laparoscopic cholecystectomy is increasingly being used for detection and removal of common duct stones. The surgeon makes a number of small incisions into your abdomen, so that slender instruments can reach into the abdominal cavity.  A tube blowing a gentle stream of carbon dioxide gas is inserted. This separates the abdominal wall from the underlying organs, the surgeon views the gallbladder on a TV monitor by using a tiny camera attached to the laparoscope.

With laparoscopic cholecystectomy, you may return to work sooner, have less pain after surgery, and have a shorter hospital stay and a shorter recovery time. Surgery to remove the gallbladder with a laparoscope does not require that the muscles of your abdomen be cut, as they are in open surgery. 

After the surgery, the patient may feel nausea and vomiting but can only have fluids at first. Feeling pain may be normal after the operation but will soon disappear after taking painkillers. The most important thing to start with is to avoid fatty foods while drinking fluids and consuming healthy food for at least two months after the surgery.