About the Gallbladder; problems and surgery
December 14th, 2009The Gallbladder is a storage organ that is attached to the undersurface of the liver. It stores bile produced by the liver which dissolves the fat in food. Bile travels down the ducts from the liver and is stored in the gallbladder. The gallbladder receives a signal, “CCK” from the stomach when food reaches the stomach, especially fatty foods. The gallbladder then squeezes the bile through the ducts into the intestine where it mixes with the food helping to break down fat.
Stones in the gallbladder can block the exit from the gallbladder causing pain, nausea, vomiting and bloating. This typically occurs after a fatty meal such as pizza, fried chicken or a cheese burger. As the gallbladder tries to squeeze out the bile, the stones move to the neck of the gallbladder blocking the exit. As the gallbladder tries harder and harder to squeeze out the bile the patient experiences pain and the other symptoms. This is termed biliary colic. Over time with repeated episodes of biliary colic the gallbladder wall may become thickened and diseased. The gallbladder becomes contracted and this is referred to as chronic cholecystitis.
These problems are resolved by removing the gallbladder and stones contained. It is done as a day surgery, laparoscopically with small cuts less than the width of a dime using a camera and clever laparoscopic instruments.
If gallstones suddenly get stuck at the neck of the gallbladder completely obstructing the exit a severe attack develops. The gallbladder becomes distended with bile and the fluid that it produces itself. The bile becomes infected and the wall of the Gallbladder becomes swollen and inflamed. Severe symptoms occur such as persistent abdominal pain in the right upper region of the abdomen worse on taking a deep breath and accompanied by nausea and vomiting. A fever may also develop. This is known as acute cholecystitis. The best treatment for this is to give intravenous antibiotics and to remove the gallbladder within three days of the commencement of symptoms. During this window the inflammation around the gallbladder is soft and surgery is relatively easier and safer. As time goes on beyond the initial 3 days, the inflammed tissue around the gallbladder becomes dense and stuck to surrounding structures making surgery at this time more difficult with more risk of complications. The inflammation and infection, if possible, is best allowed to subside with antibiotics at this point. Surgery is then done at an interval usually around 3 weeks when the inflammation is resolved.
Occasionally, in the absence of gallstones, patients have the symptoms of gallbladder disease such as pain in the mid or right upper abdomen after a fatty meal with nausea, bloating. This is due to a condition termed biliary dyskinesia where the gallbladder is unable to contract effectively to empty most of its bile when it receives the signal ‘CCK” from the stomach after a fatty meal. The ineffective efforts to contract cause
pain and the gallbladder becomes distended with bile and fluid giving the sensation of bloating. Patients sometimes describe that they feel like there is a tennis ball under the right lower ribs. The gallbladder then progressively becomes inflammed and diseased. When biliary dyskinesia is suspected, a HIDA scan is used to make the diagnosis by demonstrating that not more than 30-40% of the gallbladder content is emptied when CCK is given. The patients symptoms are also commonly reproduced on giving CCK. This is another indication for gallbladder removal.
