Gallbladder Disease

The Liver makes bile and excretes it into a long tube (the bile duct) that joins the first part of the bowel. Bile is a salty solution that helps to make fats that we eat dissolve in water (so that we can absorb them). When there is no fat in the gut, the bile is stored in the Gallbladder. When we eat fat, a chemical messenger makes the Gallbladder contract, squeezing bile into the gut.

Around 1 in 10 adults have Gallstones. These begin as small crystals in the Gallbladder and grow over time. These stones can cause irritation to the Gallbladder, particularly when fat is consumed, causing pain and nausea (biliary colic).


Predisposing factors

We are unsure why certain people get Gallstones and others don’t. Some factors that have been found to be associated with Gallstones are:

  • Obesity

  • Female gender

  • Family history of Gallstones

  • Increasing age


Most Common Symptom of Gallstones (Biliary Colic)

Biliary colic is the most common symptom of Gallstones. It is pain or discomfort, in the upper abdomen, usually brought on by food (especially rich food). It lasts for minutes to hours, until the Gallbladder relaxes. It may occur most times you eat, or sometimes there are months between attacks. Most patients who develop more severe complications of Gallstones have had previous bouts of biliary colic. Patients with Gallstones and biliary colic are advised to have a Cholecystectomy (Gallbladder Removal) prior to the development of severe complications.


Complications of Gallstones

Acute Cholecystitis
This is a severe infection of the Gallbladder. It begins like biliary colic, but fails to improve, and is associated with fever. Acute Cholecystitis will usually settle somewhat with antibiotics in hospital. Early surgery is the usual approach as this allows a quicker return to normal health and function.

Cholangitis
If Gallstones escape from the Gallbladder into the bile duct, they may cause partial or complete blockage of the bile duct. This will lead to abnormalities of the liver function blood tests. When severe, jaundice with dark urine and a fever indicate an infection of the bile duct (Cholangitis). This condition is managed either before or at the time of Gallbladder removal, by removing the stones from the bile duct.

Pancreatitis
This is an inflammation of the pancreas which is a digestive organ at the back of the abdomen. Small Gallstones that have escaped from the Gallbladder into the bile duct can sometimes obstruct the duct from the Pancreas and cause it to become inflamed. Pancreatitis can range from a minor pain through to a severe life threatening illness. The Gallbladder is usually removed as soon as possible after a bout of Pancreatitis, so that there is little chance of a further attack.

Gallbladder Cancer
A rare condition that usually affects older people with a long history of biliary colic is Gallbladder Cancer. Gallstones predispose to the cancer, but fear of cancer in itself is not an indication for surgery because it is so rare. Gallbladder Cancer may be discovered incidentally during the removal of a symptomatic Gallbladder, and is usually cured in these circumstances. More advanced cancers may require much bigger surgery, and unfortunately some are incurable.


Who needs a cholecystectomy (Gallbladder Removal)?

Patients with any of the severe complications of Gallstones or with should have their Gallbladder removed. Patients with Gallstones and symptoms should have a Cholecystectomy, before the development of severe complications. Occasionally patients without Gallstones, who have significant symptoms, will require a Cholecystectomy (once other causes have been ruled out). Rarely, patients with large Gallbladder polyps (growths) will have a Cholecystectomy because of the possibility of developing cancer.


What tests are done?

Most patients have Gallstones diagnosed by ultrasound. An ultrasound scan is a simple and quick and accurate test. An ultrasound can occasionally miss stones but this is rare. The ultrasound will also show the width of the bile duct, which will help to determine the risk of Gallstones outside the Gallbladder. The ultrasound will also show the liver and other organs to a lesser extent.

Patients with Gallstones will have some routine blood tests including liver function tests. The liver function tests also help to determine if there are stones in the bile duct.


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