WHAT IS A GALLBLADDER - WHAT DOES IT DO?
The gallbladder sits on the right side of the abdomen below the liver. It is a small pear shaped organ that stores a type of fluid called bile when the body is fasting. Bile is made in the liver and aids digestion of fats and certain vitamins. After eating, the bowel sends a signal to the gallbladder to contract and release bile down the main bile duct into the small intestine to help break up fat in a similar manner to washing-up liquid.
WHAT ARE GALLSTONES - WHY DO YOU GET THEM?
Gallstones are stones, usually made of cholesterol and calcium that form in the gallbladder. They vary in size and can be large or small. In some cases they do not cause any symptoms and do not need to be treated. Gallstones can cause a variety of symptoms depending on the patient. Gallstones are more common in women due to oestrogen production, especially in women who have had multiple pregnancies. They are more common with age, but can occur in young patients too. A western diet of high saturated fats is also a risk factor for gallstones forming.
POTENTIAL GALLBLADDER PROBLEMS
Biliary colic is a sharp, severe pain in the right upper part of the abdomen, and may radiate to the back or shoulder. The pain typically lasts for several minutes or hours and then subsides. It is caused by stones blocking the gallbladder as it contracts. It may occur at any time, although is common after eating a fatty meal which stimulates the gallbladder, and occasionally in the early hours of the morning.
This is inflammation of the gallbladder wall. It is caused by gallstones blocking the outflow of your gallbladder. Patients with cholecystitis suffer severe pain in the right upper part of the abdomen. Often this will radiate to the back or shoulder. The pain is constant in nature but may be worsened by movement or coughing. Patients may also show signs of infection such as a high temperature and fast heart rate.
JAUNDICE / CHOLANGITIS
Sometimes a gallstone may migrate out of the gallbladder and into the bile ducts. If this happens it may block the flow of bile into the intestines. This causes yellowing of the skin and eyes known as jaundice. If there is an associated infection, patients may develop a high temperature and abdominal pains. This condition is known as cholangitis and requires urgent treatment.
Sometimes a gallstone may migrate out of the gallbladder and into the bile ducts. If the stone lodges in the lower bile duct it may irritate the pancreas causing a condition known as acute pancreatitis. This may cause nausea, vomiting and severe upper abdominal pain which radiates through to the back. The condition may be very serious and requires urgent treatment.
Gallbladder dysfunction is a relatively rare condition causing recurrent pain in the right upper part of the abdomen. The gallbladder does not contract and empty in the normal way although there is no clear obstruction of the gallbladder seen on ultrasound. Removal of the gallbladder is usually effective at relieving the pain.
SPHINCTER OF ODDI DYSFUNCTION
The ampulla (muscular sphincter at the base of the bile duct) may be overactive. This may result in sharp upper abdominal pains, nausea and mild derangement in a patient’s blood tests. Imaging investigations (ultrasound and/or MRI) may demonstrate a swollen bile duct without evidence of a blockage. This condition may require endoscopic treatment with a procedure known as ERCP.
Gallbladder polyps are growths that protrude into the gallbladder from the lining of the gallbladder wall. They are commonly seen on ultrasound scans and are often symptomless. The vast majority (more than 95%) are benign but very occasionally larger gallbladder polyps may become cancerous. Small polyps (less than 1cm) do not require treatment but your surgeon may decide to perform a repeat ultrasound scan after several months to ensure they are not growing. Large polyps (more than 1cm) should be removed along with the gallbladder. On occasion, gallstones that are stuck to the gallbladder wall can be misdiagnosed as polyps.
COMMON BILE DUCT STONES
10-20% of patients with gallstones in their gallbladder will also have stones in their common bile duct (the duct that connects the liver to the intestine). These stones can be identified on imaging investigations such as ultrasound or MRCP. Bile duct stones may cause complications such as jaundice, cholangitis and pancreatitis and therefore must be removed. This may be done by either surgical exploration of the bile duct, or an endoscopic procedure known as ERCP. Bile duct stones can sometimes declare their presence at any time after removal of the gallbladder with recurrence of previous symptoms.