Gallbladder Clinic

For such a small and insignificant organ, the humble Gallbladder can cause a lot of grief. The good news is that there is an easy solution.

 

What is the Gallbladder?

Gallbladder

The gallbladder is a small cyst-sized sac that sits firmly attached to the under-surface of the liver. It hangs off the main bile pipe (common Bile Duct, CBD) that runs out of the liver and joins into the duodenum. The gallbladder’s main job is to store bile that has been made by the liver. After eating a meal the gallbladder then contracts and expels all of its bile into the duodenum where it meets and mixes with food. Bile is essential to the digestion of food however the gallbladder itself is not an essential organ in our bodies.

 

Why do gallstones form?

Gallbladder

Gallstones are formed within the gallbladder when there is some dysfunction of the ability of the gallbladder to empty or when there is an alternation in the normal components that make up bile. Bile is made up of cholesterol, bilirubin and bile salts and when the balance of any one of these constituents is altered then gallstones are formed. Gallstones can either be made up of cholesterol and are yellowish in colour, or made up of bilirubin and bile salts and are black in colour. As women, gallstones are a lot more likely to affect us in one way or another, compared with our male counterparts. Pregnancy also has significant effects on the body generally but also on the function of the gallbladder itself and the biliary system. Gallstones are very common in our community and get more common as we age. It is not until the gallstones cause trouble that it is necessary to consider treatment in order to avoid more serious complications of gallstones. Other risk factors for developing gallstones include increased BMI (Body Mass Index), diet although the direct relationship between diet and gallstones is not well delineated, family history and rare conditions that cause increased breakdown of red blood cells (Sickle Cell Anaemias, Hereditary Spherocytosis).

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What symptoms do gallstones cause?

Gallstones

The vast majority of gallstones in the world are completely asymptomatic; in other words, they reside within the gallbladder and cause no trouble whatsoever. These gallstones don’t need any treatment at all. It isn’t until symptoms occur directly due to gallstones that treatment should be considered and the fact of the matter is that gallstones can cause some rather nasty problems that should well be avoided. The commonest of these is biliary colic and this is due to passage of the gallstone into a narrow area such as the outlet of the gallbladder. This causes a very nasty pain usually under the ribs on the right hand side. It can be colicky in nature or sharp and constant and is often severe enough to wake you up in the middle of the night.  The pain can radiate around to the mid back or up into the right shoulder blade. It is often associated with nausea and, it may go just as quickly as it came. Once the pain is gone you would feel back to normal. The commonest time for this to occur is in the middle of the night and often after having an evening meal which is particularly high in fat.

Acute cholecystitis has similar symptoms of biliary colic however they are often associated with systemic unwellness such as a temperature or general unwellness along with the pain. This is usually due to an infection in the gallbladder itself commonly caused by bacteria that live in the Gastrointestinal tract. This requires treatment with antibiotics. 

Those are two conditions that can occur as a result of gallstones being within the gallbladder itself however when gallstones travel there are a range of other complications that can occur. These include obstruction of the common bile duct with infection (cholangitis), pancreatitis or gallstone ileus as a result of a large gallstone being lodged and ultimately blocking the distal small bowel. All of these conditions are rather dramatic and can cause serious illness, prolonged hospital stays and even death.

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What should I do if I think I may have gallstones?

The humble gallstone is not to be taken lightly. If you think you may be having symptoms related to gallstones then it is essential to see your GP and he or she will arrange for blood tests and an ultrasound scan looking at the gallbladder itself.  Ultrasound obviously is quick, easy, painless and relatively accurate at diagnosing gallstones. Other tests such as a MRI scan looking at the biliary tree itself or ERCP for duct stone removal may be necessary.

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What about surgery for gallstones?

The best treatment for gallstones that are causing symptoms is removal of the gallbladder itself. This removes all of the gallstones within the gallbladder and greatly minimises and, in most cases, eliminates, the risk of developing further gallstones.  Whilst it sounds like quite a dramatic solution to the problem there has been no medical treatment that has been successfully able to dissolve or remove gallstones from the gallbladder with any long term success. Gallbladder surgery is now performed more than 95% using keyhole surgery. This means that small cuts are made and the gallbladder can be removed through these cuts. This minimises the postoperative pain and allows a speedy return to work or normal activities.  Gallbladder surgery is very much the bread and butter of operations at The Women’s Clinic. It is usually performed with minimal disruption to life and a one night hospital stay. It is worthwhile having an ultrasound scan if you feel that you may have gallstone problems. Please see your GP and come and visit us at The Women’s Clinic for further management

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For further information or advice: Contact The Womens Clinic on P: 524 8887, 0800 WOMENS or E: reception@womensclinic.co.nz