What is a gallbladder? The gallbladder is an egg-sized hollow organ that stores bile which is produced in the liver. In fact the gallbladder is partially attached to the liver and joins the duct system that exits the liver.
Where in your body is the gallbladder located? The gallbladder is located in the right side of the upper abdomen.
Can it ever be located somewhere else? Yes. A condition named situs inversus is present in 1/100,000 people. In these situations the person’s organs a located on the opposite side of normal. I have encountered this twice during my career.
What does the gallbladder do? The purpose of the gallbladder is to store bile and then eject the bile into the intestine when you eat.
Why is bile important? Bile acts as a detergent to break fatty foods into smaller particles which are more easily digested.
Does the gallbladder make bile? No. The gallbladder only stores the bile. The bile is actually produced in the liver. A duct system exits the liver and a small channel between the gallbladder and this duct system allows the passage of bile into and out of the gallbladder.
How does the gallbladder know to send bile into the intestine? Sensors in the lining of the stomach are activated by fat molecules that you eat. Those sensors release a chemical into your blood stream call CCK (cholecystokinin). The CCK travels to the gallbladder and tells it to push the bile into the duct system that ends in the intestine.
What are gallstones? Sometimes a crystal forms within the stored bile of the gallbladder and slowly a stone grows. This is similar to a pearl forming within an oyster. Stones can grow quite large or they may remain small like sand particles.
How do gallstones affect you? At times, these stones or particles can obstruct the outlet of the gallbladder. If an obstruction is present while the gallbladder contracts to eject bile, a person will generally feel a sharp attack of pain and possibly nausea and vomiting. Some people only sense nausea but no pain. These attacks are generally after eating.
Where is the pain located? The location of the pain varies from patient to patient. Most frequently the pain is in the middle of the upper abdomen (the epigastrium). Others experience pain in the right side of the abdomen. Some will relate pain from both locations. Often this pain radiates to the back or shoulder blade. Rarely the pain is in the right side of the lower abdomen or left side of the upper abdomen.
How long does the pain last? Fortunately, most gallbladder attacks will fade away with a few minutes to hours. Some attacks are minor and others create severe pain. Once a person has developed a gallbladder attack, they will probably have additional attacks in the future.
Can more serious problems occur? Sometimes a gallbladder becomes completely obstructed to the point that infection is produced. This requires immediate attention. In rare cases a gallbladder may actually rupture.
How do you know if you have gallstones? The best test to look for gallstones is an ultrasound of the abdomen. This will not detect all gallstones, however ultrasound is about 95% accurate. A CT scan is not as good at finding gallstones as an ultrasound, but it is sometimes helpful.
What if I have gallbladder symptoms but I do not have gallstones? The bile within the gallbladder can become thick like motor oil. When this happens, it can be difficult for the gallbladder to eject the fluid through its outlet. Imagine trying to suck thick syrup through a straw? The gallbladder will send your brain the same signals as if it were obstructed.
How do you know if your gallbladder is having trouble ejecting the bile? A gallbladder test called the HIDA scan can measure the ability of the gallbladder to eject the bile. A special tracer is placed through an IV that accumulates in the bile. The messenger chemical, CCK, is then injected through your IV to stimulate gallbladder contractions. The scanner will watch the gallbladder and calculate how well it ejects the bile (ejection fraction). Normally, the ejection fraction is 70-90%. When the ejection fraction approaches 35%, it is likely that symptoms are due to a dysfunctional gallbladder. This condition is also known as biliary dyskinesia.
What is the treatment for biliary dyskinesia? The only treatment is gallbladder removal (cholecystectomy). Biliary dyskinesia is not life-threatening, so a person can decide that their symptoms are not severe enough to warrant surgery. Very few people are willing to volunteer to be subjects of gallbladder surgery research, so scientific data is limited and conclusions of studies vary. We do know that greater than 90% of patients will feel better after gallbladder removal. We know that many patients will experience miserable episodes until their gallbladder is removed. We also know that some patients may experience many years of normal life in between attacks. Overall, it depends upon how bad a person feels.
What if my HIDA scan is normal but I experience gallbladder symptoms? If CCK administration recreated your gallbladder symptoms, then gallbladder removal will be beneficial in 90% of cases. If CCK did not recreate your symptoms, then we need to look for other causes of pain such as ulcers, Crohn’s disease, ulcerative colitis, irritable bowel syndrome, or more rare disorders. In some situations, no cause for the symptoms can be identified and gallbladder removal has been helpful for these patients.
Can gallstones pass through the channel out of the gallbladder? Yes. This is a less common but more serious problem. After gallstones leave the gallbladder, they may obstruct the ducts between the liver and the intestine. This can produce a severe life-threatening infection called ascending cholangitis.
Can gallstones cause pancreatitis? This is true. The duct of the pancreas joins the duct that passes from the liver to the intestine. When a gallstone travels through the bile duct, it may temporarily obstruct the pancreas duct and lead to inflammation of the pancreas.
How are gallstones treated? Since there is no easy way to get of rid of the gallstones, surgery to remove the gallbladder (cholecystectomy) is the treatment of choice. A medicine to dissolve gallstones exists, but it does not work very well and is reserved for patients that can not safely undergo gallbladder surgery.
Can sound waves be used to destroy gallstones? This is a useful technique for some kidney stones, but it is more complicated for gallstones. First, as the gallstones are fragmented they are likely to leave the gallbladder and clump together in the bile duct that passes between the liver and the intestine. This obstruction can, in turn, create life-threatening complications of liver infection or pancreatitis. When kidney stones are fragmented, a stent is placed in the urine passageways to prevent obstruction. Stenting of the major bile duct is much more difficult and carries its own risks. In addition, a person who forms gallstones is likely to form more in the future. That patient would have to face this same problem once again. Have you ever known a person that has suffered from multiple kidney stone attacks?
Can a drain be placed in their gallbladder? This can useful if someone has developed a gallbladder infection and is so severely ill that surgery is not safe. After numbing the abdominal wall, a drain is placed through the skin into the gallbladder with X-ray or ultrasound guiding the doctor. This is called a cholecystostomy tube. The drain will need to stay in place for 6 weeks and then surgery can be performed when it is safer.
What happens if a gallstone is lodged in the bile duct between the liver and the intestine? Usually these stones can be retrieved through tiny instruments that are passed through a special scope which is placed through the mouth, down the esophagus and stomach, into the intestine. This is called endoscopic retrograde cholangiopancreatography or ERCP for short. In rare circumstances ERCP is not possible and the bile duct must be approached through a surgical procedure.