Gallbladder Disease

Gallbladder disease is one of the most common surgical problems in the US.

It affects about 25 million Americans.

What is the Gallbladder?

It is a sac that concentrates and stores bile.

Bile?

Bile is a substance created by the liver that helps in the digestions of food particles mainly fats. This bile is excreted by the liver and transferred to the gallbladder for storage and eventual use when needed.

When you eat food, once it gets to the stomach signals are sent that cause the gallbladder to squeeze sending bile to the first part of the small intestines to help in food digestion. Once the bile is sensed in the small intestines, signals are released that tell the gallbladder to stop squeezing.

This happens whenever you eat and can sometimes happen during fasting.

What are gallstones?

One of the functions of the gallbladder is to concentrate the bile produced by the liver. in some people, during this concentration, crystals are formed, and these crystals can clump together to form gallstones.

What do gallstones do?

The majority of gallstones do nothing and people who have them never even know they're present. The gallbladder has a duct that exits it and leads to the small intestine. In some people the gallstones can roll down and block this duct. Once this happens, when the signal to release bile comes, the stone blocks the exit. This prevents bile from reaching the small intestine. This means that the signal to stop squeezing never comes wither and so the gallbladder continues to squeeze. This can cause a condition called symptomatic cholelithiasis.

What is symptomatic cholelithiasis?

Symptomatic cholelithiasis is when the gallstone blocks the bile from being excreted. Much like any worker who does their job and gets no credit for it, the gallbladder gets irritated when there's no stop signal. It continues to squeeze and squeeze and get more and more irritated. This irritation results in a condition called localized peritonitis where that area of the abdominal cavity becomes sensitive and begins to hurt. This is why some people with gallstones will have pain in their abdomen after meals. The pain is usually in the right upper part of the abdomen under the rib cage. This pain can also be more centralized.

In most cases the gallstone eventually rolls back leaving the exit duct open and bile is excreted and the signal to stop is released. This allows the gallbladder to rest and causes the pain to resolve. If the gallstone doesn't roll back, you can get a condition called acute cholecystitis.

What is acute cholecystitis?

Acute cholecystitis is when the gallstone stays impacted long enough that the gallbladder becomes more acutely inflamed and begins to be infected. This is an urgent condition and usually requires surgery. as the gallbladder continues to squeeze and bile continues to be blocked, the gallbladder expands and dilated and becomes more inflamed. This inflammation cases more peritonitis and eventually causes the gallbladder to become infected. At this point surgery is usually required to resolve this spiraling condition.

What does gallbladder disease feel like?

Gallbladder disease usually starts out as pain in your abdomen. This is most often in the right upper abdomen under this rib cage. This can also be in the middle of the abdomen under your breastbone. This pain usually occurs after a meal. It can be associated with nausea or vomiting. Rarely it can also be associated with fevers and chills or jaundice (yellow skin or eyes, really dark coca-cola olored urine or white or very pale colored stools). The pain is often episodic or it comes and goes, but can eventually be constant. People often have several isolated instances of the pain which resolves on its own after a few hours.

How do I know if my gallbladder is causing my problems?

The best way to tell is to see your doctor. If it seems that your gallbladder is causing you problems, we will usually start with a test called an ultrasound that can see what your gallbladder looks like and can tellif there are any stones in your gallbladder. You may also need laboratory studies done and occasionally more specialized imaging.

What is the treatment of gallbladder disease?

The treatment of symptomatic cholelithiasis or acute cholecystitis is usually removal of the gallbladder. This is most often done laparoscopically. This means with small (around 1 cm) incisions and a camera. The procedure is to remove the gallbladder to prevent this situation from worsening or happening again.

Can't my stone just be blasted with lasers like kidney stones?

Unfortunately, this procedure, called laser lithotripsy doesn't work very well with gallstones. The recurrence rate is very high and assuming you can tolerate surgery you are much better served with surgical removal of the gallbladder.

What does gallbladder surgery entail?

Using small incisions, a camera and special instruments, the gallbladder is carefully removed.

What are the risks of this surgery?

The risks of the surgery are relatively uncommon. Most surgeries are accomplished without any complications and recovery is swift. Having said that, the risks of surgery range from general surgical risks such as bleeding and infection to more specific risks such as damage to surrounding structures. In this case that means bowels, the liver, the duodenum the ducts that join the liver to the duodenum. This last complication can be a big problem if it happens as reconstruction of these ducts requires quite a significant surgery. Fortunately, this risk is very small ranging from 0.25% to around 1.7% of cases. The other potentially major risk is damage to the bowels. usually this is recognized and fixed during the operation. Occasionally though, this is not recognized and can lead to a need for repeat surgery and can make you very sick and can even result in death. These injuries are also very rare and occur in about 0.13% of cases. Finally, there are anesthesia risks to consider, and these include pneumonia, clots in the lings or legs, heart attack, stroke, and death. fortunately, these complications are all also extremely rare.

What can I expect after surgery?

Depending on whether surgery is urgent or scheduled, people usually go home the same day. You will usually feel poorly for 1-3 days although this can last for up to a month. I want you walking around the day of surgery. The worst thing you can do is sit on the couch and be lazy. This will increase your risk of clots and pneumonia as well as delay your recovery. I would like you to walk around the house as much as you're comfortable the first few days after surgery. You can also go up stairs, one flight at a time. I DO NOT want you doing any heavy lifting for the first 2 weeks. Heavy lifting will increase your risk of hernia from your incisions and will also make you feel worse. Most people are back to all of their normal activities by about 1 month.

I still have questions!

This is very common. I recommend all of my patients write down their questions either in their phone notes or on paper. This allows you to have them ready at your appointment so I can answer them. It is very common to walk out of the door after your office visit only to realize your forgot to ask about something. Writing the questions down prevents this. If you do forget to ask something though don't worry! Feel free to call my office and we will be sure to answer your questions!

Thank you!

Thank you for allowing me to take care of you or provide you information. I hope this article was helpful and appreciate any feedback. Every patient has a unique and personal history and situation. Although I tried to present very broad and non-specific information, nothing in this should constitute or override the specific medical advice from YOUR surgeon.