Gallbladder – an overview
The gall bladder is a pear-shaped sac of 7–10 cm that stores bile synthesized by the liver. The liver is the largest gland situated on the right-hand side of the upper portion of the abdominal cavity. It plays a very important role in the metabolism and digestion of food and also aids in the detoxification and elimination of harmful substances from the body.
Bile is a brownish-yellow fluid secreted by the liver and contains water, cholesterol (a waxy and fat-like substance), lipids (fats), bile salts (detergent-like chemicals that break up fats), and bilirubin (the brownish-yellow pigment that gives color to bile and stools). Bile is produced by the hepatic cells in the liver and transported to the gall bladder through the cystic ducts formed from the right and left bile ducts. When bile is required for the digestion of fats, it is carried through the cystic duct into the common bile duct. The common bile duct joins the pancreatic duct (the tube that connects the pancreas with the small intestines), and the bile is emptied into the duodenum (the first portion of the small intestines).
Formation of gallstones
When bile substances such as cholesterol and bile pigments form hard, stone-like materials either in the gall bladder or in the bile ducts, they are termed gallstones. A gallstone can be as tiny as a sand grain or as large as a golf ball.
80% of the gallstones are composed of cholesterol and are white or yellow in color. Cholesterol gallstones are formed when there is excessive cholesterol or bilirubin in the bile or when the bile in the gallbladder does not get emptied completely. Gallstones formed from bilirubin are called pigment stones, which are small and dark in color and account for the remaining 20% of all gallstones. Pigment stones are formed due to disorders such as cirrhosis of the liver or infections of the bile ducts or of the blood. Sometimes there can be one very large gallstone or several small gallstones. These can be either cholesterol stones, pigment stones, or mixed stones.
Risk of developing gallstones
You may have an increased risk of developing gallbladder stones if you are a woman, above the age of 60, of American Indian or Mexican descent, and have anybody with gallbladder stones in your family.
Overweight or obese people who take measures to reduce weight faster may increase cholesterol secretion, increasing the risk of developing gallstones. Individuals who consume high-cholesterol or high-fat-content diets or foods are at increased risk as it increases the secretion of cholesterol in the bile.
People who suffer from diabetes are also at high risk as they have high triglycerides, which increase the risk of gallstones.
Women who undertake hormone replacement therapy may have increased cholesterol content in the bile and decreased gallbladder movement, which can lead to the formation of gallstones. Excess estrogen hormones during pregnancy can increase the risk of developing gallstones. Birth control pills may also bring about changes in estrogen, which in turn may cause the formation of gallstones.
In most cases, gallstones do not exhibit any signs or symptoms, enabling them to be termed “silent stones”. However, when the gallstones get deposited in a duct or cause blocking of the duct, they may show the following symptoms:
- Unexpected and quickly intensifying pain in the upper portion of the abdomen and in the middle of the abdomen underneath the breastbone
- Pain between the shoulder blades at the back
- Pain in the right shoulder
- Increased perspiration, nausea, vomiting, increased body temperature, and skin color turning yellow
- Brown-colored stools or indigestion
The pain may last from several minutes to a few hours.
You may need immediate medical attention if the following are observed:
- Severe abdominal pain makes you unable to sit comfortably in any position.
- Your skin and the white portion of your eyes turn yellow.
- Elevated fever with shivers and shaking.
There can be serious complications if the gallstones are large or many or block a duct connecting the gallbladder, liver, or pancreas. The complications could be severe pain, inflammation, fever, organ damage, and even death.
Various tests are used to diagnose gallstones. During an ultrasound (sonography), high-frequency sound waves are directed toward the gall bladder and other related parts. The echoes of the sound waves sent back create electrical impulses, which are recorded, creating a map. If the gallstones are present, the sound waves are bounced back, which are recorded on the monitor, thus enabling their identification.
The CT scan uses X-rays to produce cross-section images of the body, including the liver and gallbladder. The procedure is non-invasive and can identify infections, inflammation, or rupture of the gallbladder or bile ducts.
A special scan called Cholescintigraphy (HIDA scan) can be done. In this test, the gallbladder is stimulated, and contractions are induced by injecting a harmless radioactive material. These contractions are measured to diagnose any abnormalities in the gallbladder or obstruction of the bile ducts.
Various blood tests are performed to identify any infection or obstruction of the liver or pancreas.
Gallstones that do not show any signs need not be removed. For those gallstones that become symptomatic, treatment approaches include surgery for removing the stones and medications for dissolving the stones.
The gall bladder can be removed through surgery. The bile is then passed directly from the liver to the intestines without the need for storage. Removal of the gallbladder does not affect your ability to digest food. A recent modification of the procedure involves performing the surgery through a very small incision using equipment called a laparoscope. It has a thin tube with a camera that is passed through the incision. The doctor can see your gallbladder on the screen, which enables your doctor to remove the gallbladder through another small incision.
Another procedure called Endoscopic Retrograde Cholangiopancreatography (ERCP), is done to locate the gallstones in the bile ducts and remove them.
As an alternative to surgery, medications can be used to dissolve the stones. These treatments are used for people for whom surgery is too risky. However, the disadvantage of oral medications is that they should be taken for months or years to dissolve the gallstones. An injection called a methyl-tert-butyl ether injection can be directly injected into your gallbladder to dissolve stones. This drug can dissolve stones in 1-3 days but may cause irritation and other complications.
A procedure called Extracorporeal Shock Wave Lithotripsy (ESWL) can also be used. In this procedure, shock waves are used to break the gallstones into tiny bits that can easily pass through the bile duct without causing any blockage.
Conclusion: Get rid of the stones
When bile hardens in the gallbladder, gallstones are formed. Most gallstones are silent stones needing no removal. However, you need immediate medical attention if you experience severe pain in the upper portion of the abdomen, develop nausea and vomiting, or if your skin and the white of your eyes become yellow. There are various procedures to diagnose gallstones. Gallstones can be treated surgically or non-surgically. Laparoscopic surgery is the most common treatment available to remove the gallbladder.