Gallbladder Disease and Gallstones

Gallstones are small, hard deposits that can form in the gallbladder, a sac-like organ that lies under the liver on the right side of the abdomen. Most people with gallstones don’t even know they have them, but in some cases, a stone may cause the gallbladder to become inflamed, resulting in pain, infection or other serious complications.

While cholecystectomy, or the removal of the gallbladder, is the one of the most surgically common procedures performed in America every year, it is still a major surgery. At MedStar Health, our GI doctors are experts in diagnosing gallbladder and right upper quadrant pain. Using the most advanced diagnostic testing; our doctors can determine if gallbladder removal surgery is right for you.

Why do Gallstones Form?

Gallstones are usually composed of bile fluid, produced by the liver to aid in the digestion of fat, and cholesterol. The buildup of gallstones is a slow process; it may take up to a decade to develop symptoms.

In some cases, patients experience symptoms of gallstones without the appearance of the stones; this condition is known as acalculous gallbladder disease.

Symptoms

The most common symptom of gallbladder disease is pain. It is called biliary colic and occurs in the upper abdomen, near the rib cage. This kind of “gallbladder attack” is sometimes accompanied by nausea and vomiting. It is not relieved by over-the-counter pain relievers, but resolves by itself within a few hours. The attacks may be triggered by large or fatty meals, often waking patients up during the night. They may occur frequently, but not more than once a week.

If an occurrence of biliary colic lasts for more than a few hours, it may indicate a more serious condition, such as acute cholecystitis (gallbladder inflammation); in which gallstones or bile sludge block a bile duct (usually the cystic duct from the gallbladder to the common bile duct). The symptoms are similar to biliary colic but more painful and longer lasting. They include:

• Pain in the upper right or mid abdomen that is severe and constant. It may last for days. Pain frequently increases when drawing a breath.
• Pain may also radiate to the back or occur under the shoulder blades, behind the breastbone or on the left side.
• About a third of patients have fever and chills.
• Nausea and vomiting may occur.

If you experience these symptoms, you should seek medical attention. Acute cholecystitis can progress to gangrene or perforation of the gallbladder if left untreated. Infection develops in about 20 percent of patients with acute cholecystitis, and increases the danger from this condition. People with diabetes are at particular risk for serious complications.

Diagnosis

Because abdominal pain is a complaint common of many types of gastrointestinal conditions, your doctor will eliminate other diseases in order to confirm a diagnosis of gallstones or gallbladder disease. Physicians will perform a physical examination, blood tests and imaging studies (such as ultrasound or X-ray) when gallbladder disease is suspected.

Treatment

There are three ways to treat gallstones:

• Expectant management (“wait and see”)
• Surgical removal of the gallbladder

By and large, those patients whose gallbladder disease has not progressed to acute cholecystitis are recommended for expectant management, though a certain percentage of them can expect to have their gallbladder removed in the future.

Exceptions to this recommendation include people disposed to gallbladder cancer, members of ethnic groups particularly at risk for gallstones, or those patients whose gallstones are larger than 3 cm in diameter. (Tiny gallstones may also require surgery because of the risk of developing pancreatitis).

Thirty percent of patients are candidates for dissolving small gallstones using oral medications. However, this process can take up to two years and has largely fallen out of use in favor of laparoscopic gallbladder surgery.

Candidates for gallbladder removal often have, or have had, one of the following conditions:

• A very severe gallstone attack
• Several less severe gallstone attacks
• Endoscopic sphincterotomy for common bile duct stones (in patients with residual gallbladder stones)
• Cholecystitis (gallbladder inflammation)
• Pancreatitis (inflammation of the pancreas) secondary to gallstones
• High risk for gallbladder cancer (such as patients with anomalous junction of the pancreatic and biliary ducts or patients with certain forms of porcelain gallbladder)
• Chronic acalculous gallbladder disease (also called biliary dyskinesia), in which the gallbladder does not empty well and causes biliary colic, even though there are no gallstones present

Surgery for gallstones can usually be performed laparoscopically. (Other procedures may be recommended for patients with acalculous gallbladder disease). Each procedure has its risks, but removal of the gallbladder should remove all symptoms of gallbladder disease.

If symptoms persist call Gastrocure in West Orange, NJ at 973-736-1112 to schedule an appointment