What is the function of the gallbladder?

The gallbladder is an organ located under the liver. Bile that is produced by the liver is delivered via ducts into the small intestine where it acts to help digestion of fats. The gallbladder acts as a storage or reservoir of excess bile.

How are gallstones formed?

  • Too much cholesterol in the bile (cholesterol stones)
  • Too much bilirubin in the bile (pigment stones)
  • Incomplete emptying of bile from the gallbladder resulting in bile stasis and concentration

There is a possible link between family members having an increased risk of developing gallstones but this is not proven.

What are the symptoms of gallstones?

Gallstones may cause no signs or symptoms. If a gallstone lodges in the cystic duct and causes a blockage, the resulting symptoms may include:

  • Sudden pain in the upper right portion of your abdomen or in the centre of the abdomen just below the breastbone
  • Back pain between your shoulder blades
  • Pain in your right shoulder
  • Bloating sensation in the centre of the abdomen just below the breast bone
  • Nausea or vomiting

Gallstone pain (biliary colic) typically occurs after a heavy or oily meal and may last several minutes to a few hours.

Symptoms of Gallstones

What are the symptoms of gallstones?

Complications from gallstones are associated with the passage of such stones from the gallbladder into the common bile duct where they lodge and cause an obstruction of bile flow. Depending on the level of obstruction along the bile duct, it gives rise to the following conditions:

  • Cholecystitis (acute inflammation of the gallbladder)
  • Obstructive jaundice (yellowing of skin and eyes)
  • Ascending cholangitis (infection arising from obstructive jaundice)
  • Acute pancreatitis (inflammation of the pancreas)
  • Gallbladder cancer (low risk)

Diagnosis of gallstones

Abdominal ultrasound – This is the most sensitive imaging for detecting gallstones within the gallbladder. Further advantage is the lack of radiation exposure as well as the low cost and ease of undergoing this test

Endoscopic ultrasound (EUS) – This is a procedure that can help to identify smaller stones that may be missed on an abdominal ultrasound. A small ultrasound device is attached to the end of an endoscope is inserted through the mouth into the digestive tract.

Endoscopic retrograde cholangiopancreatography (ERCP) – Similar to the EUS, a specialised scope is inserted through the mouth into the digestive tract and additional instruments are inserted to enable a radiograph of the bile ducts as well procedures to remove stones

Magnetic resonance cholangiopancreatography (MRCP) – An MRI designed to detect the presence of gallstones or abnormalities within the bile ducts

What is the treatment of gallstones?

The main treatment for gallstones is to remove the source ie gallbladder with all the stones within (laparoscopic cholecystectomy). In the past, this operation was performed in an open fashion ie by making a big cut in the abdomen to remove gallbladder. These days, the surgery is almost always performed laparoscopically. This is achieved by making four small incisions in the abdomen, introducing an inert gas into the abdominal cavity to create a surgical space so that instruments are inserted to surgically remove the gallbladder.

The advantages of laparoscopic cholecystectomy are:

  • Reduced postoperative pain
  • Reduced surgical scarring
  • Reduced length of stay in hospital
  • Reduced operative time
Treatment of Gallstones

What can I expect after surgery? Life without a gallbladder

Patients generally recover very well from laparoscopic cholecystectomy. Food intake is allowed soon after the surgery. Most patients are discharged the next day but some are well enough to go home the same evening after surgery.

Patients are advised to observe a low-fat, low-oil diet in the initial weeks after surgery. This is to avoid symptoms such as abdominal bloating and watery stools due to the reduced efficiency in digesting fatty foods. Over time, the digestive system adapts such that most patients are able to resume a normal diet.

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