What is the gallbladder?
The gallbladder is an organ in the shape of a pear that is located directly underneath the liver. It’s function is to store bile produced by the liver. When a person eats fatty food, the gallbladder is stimulated and it contracts, releasing bile toward the small intestine. The duct that carries the bile from the gallbladder to the intestine is called the chole duct.
The formation of stones within the gallbladder is referred to as cholecystitis. Its prevalence is difficult to determine due to the lack of symptoms. In the United States, about 10-15% of the population develops said stones, with approximately 1 million cases each year. Gallbladder stones are the leading cause of hospitalizations due to gastrointestinal complications.
What is cholecystitis?
When a stone obstructs the gallbladder’s exit duct bile accumulates, causing inflammation and pressure increase within the organ. This may lead to an infection and eventual perforation of the gallbladder, resulting in peritonitis.
What are the symptoms?
The majority of individuals with gallbladder stones do not present any symptoms; however, those who do have a higher propensity of developing complications. 70 to 80% of symptomatic patients complain of biliary cramps. A biliary cramp is pain caused by the obstruction of the cystic duct by a stone. Is characterized as episodic and sever, occurring underneath the ribs on the right side and, less frequently, on the stomach. Generally it has a sudden start, increasing progressively in intensity, particularly after ingesting fatty food or dairy products. The pain may run toward the back and toward the right shoulder, and is frequently accompanied by nausea and vomiting. The biliary cramp can also present with stomach pain, intolerance to fatty food, heartburn, and sweating.
If jaundice, or yellow coloration of the skin, is present, it may be moment to suspect of complications such as cholangitis and choledoco litiasis. These complications require immediate medical attention.
How is the diagnosis made?
A physical exam in patients who present symptoms can have a totally normal outcome. However, the symptoms can still be suggestive of cholecysitits.
The most effective, non-invasive test for detection of cholecystitis is the abdominal ultrasound due to its high specificity and sensibility (90-95%). Ultrasound is a procedure in which sound waves are directed at the body and used to generate an image of the internal organs. This is a simple procedure which requires no special preparation (other than a 6hr fast) and provides precise anatomic information. The ultrasound can indicate a distal obstruction from finding of dilated intra or extra hepatic bile ducts.
What is the treatment?
Cholecystectomy, or the surgical resection of the gallbladder, is the only definitive treatment for biliary stones. Each year there are approximately 500,000 cholecystectomies performed in the United States alone.
An open cholecystectomy was the standard surgical option for many decades. Currently, laparoscopic cholecystectomy has substituted surgery as the most effective form of treatment. Laparoscopic cholecystectomy is a minimally invasive procedure in which the removal of the gallbladder is accomplished through small incisions in the abdomen with the use of special tools and a camera to visualize the organs in the abdominal cavity. The gallbladder is identified and separated from its connections to the liver and bile ducts through the laparoscope, and is then removed through the incisions in the abdomen. The procedure offers outcomes with less pain and shorter hospitals stay when compared to traditional surgery. In rare occasions, the laparoscopic procedure can be turned into an open surgery in case of encountering scaring, infection, or variations to the normal biliary anatomy during the procedure. The most common complication is damage to the biliary duct. This can be treated by endoscopic treatment (ERCP) by the placement of a stent to facilitate the healing of the injured biliary duct.