Gallbladder Disorder, Pain Caused by Gallstones

Gallbladder Disorder, Pain Caused by Gallstones

The gallbladder is a small, pear shaped organ situated beneath the liver. The gallbladder stores bile, a greenish yellow digestive fluid produced by the liver. until it is needed by the digestive system. Bile consists of bile salts electrolytes, bilirubin, cholesterol, and other fats (lipids). Bile makes the cholesterol, fats and vitamins in fatty foods more soluble, so they can be better absorbed by the body. Bile salts stimulates the large intestine to secrete water and other salts, which help move the intestinal contents along and out of the body. Bilirubin, a waste product consisting of the remains of worn-out red blood cells, is excreted in bile.

When food enters the small intestine, a series of hormonal and nerves signals trigger the gallbladder to contract and a sphincter to open. Bile then flows from the gallbladder into the small intestine to mix with food contents and perform its digestive functions.

Common gallbladder disorders include gallstones or cholelithiasis, cholecystitis or inflammation of the gallbladder, both acute and chronic and bile duct tumours.

Gallstones:
Gallstones are collections of crystals in the gallbladder or the bile ducts (biliary tracts). When gallstones are in the gallbladder, the condition is called cholelithiasis; when gallstones are in the bile ducts, the condition is called choledocholithiasis.

Gallstones are more common in women than in men and increases in incidence in both sexes and all races with aging. Gallstones are also more common in certain group of people such as Red Indians. The risk factors for gallstone formation include old age, obesity, a Western diet, and a genetic predisposition. The major component of gallstones is cholesterol. Some are made of calcium bilirubinate and calcium carbonate stones may form singly or in combination i.e. composed of multiple components. Pure bilirubin stones may occur at any age and result from haemolysis. Usually bile contains large amounts of cholesterol that remains liquid when bile becomes oversaturated with cholesterol, however, the cholesterol may become insoluble and precipitates out of the bile. Most gallstones in the bile ducts travel there from the gall bladder. Stones may form in a bile-duct when bile backs up because a duct has narrowed abnormally or after the gallbladder has been removed.

Gallstones in the bile ducts can lead to a severe or life threatening infection of the bile ducts (cholangitis), the pancreas (pancreatitis), or the liver. When the bile duct system is obstructed, bacteria can flourish and quickly establish infection in the ducts The bacteria may spread to the bloodstream and cause infections elsewhere in the body.

Symptoms:
Cholelithiasis is frequently asymptomatic and is discovered fortunately in the course of routine radiographic or sonographic imaging. Gallstones, if remaining in the bladder, may not cause any symptoms for a long period. Rarely, however, large gallstones may gradually erode the gallbladder wall and enter the small or large intestine where they can cause an intestinal obstruction, called a gallstoncikeus. Much more typically, gallstones pass from the gallbladder into the bile ducts. They may pass through these ducts and into the small intestine without incident, or they may remain in the ducts without obstructing the flow of bile causing symptoms.

When gallstones partially or transiently obstruct a bile duct, a person experiences pain.

The path tends to come and go such is referred to as colic, Typically the pain rises slowly to a peak and then falls gradually The pain may be sharp and intermittent; lasting several hours The location of the pain varies, though most of the time it is in the right upper part of the abdomen. This place may feel tender. The pain may extend to the right shoulder blade. Often the patient feels nauseated or may vomit; if an infection develops with duct obstruction, the patient has a fever, chills and jaundice.

Usually the obstruction is temporary and is not complicated by an infection. Symptoms of indigestion and intolerance of fatty foods often are mistakenly blamed on gallstones

A person who experiences belching, bloating; a feeling of fullness, and nausea, is just as likely to have peptic ulcer disease or indigestion as to have gallstones. Pain in the right upper part of the abdomen that occurs after eating fatty foods may result from gallstones.

Diagnosis:
Ultrasound scanning is the best method for diagnosing gallstones in the gallbladder. Cholecystography also is effective. With cholecystography, an X-ray shows the path of a radiopaque contrast substance as it is swallowed, absorbed in the intestine, secreted into the bile, and stored in the gallbladder. If the gallbladder isn't functioning, the contrast material won't show up in the gallbladder. If the gallbladder is functioning, the outline of the gallstone is revealed in the X-rays by the contrast material. Blood test results usually show a pattern of abnormal liver function that suggests bile duct obstruction.

Treatment:
Most people who have "silent" gallstones in the gallbladder (Asymptomatic) do not require treatment. People with intermittent pain can try avoiding or reducing their intake of fatty foods. Doing so may help prevent or reduce the number of pain episodes.

If gallstones cause recurring attacks of pain despite dietary changes, physician may recommend gallbladder removal (Cholecystectomy). Gallbladder removal doesn't cause nutritional deficiencies, and no dietary restrictions are required after surgery.

Laparoscopic cholecystectomy was introduced in 1990 and in an amazingly brief time has revolutionised surgical practice. With laperoscopic cholecystectomy the gallbladder is removed through tubes that are inserted through small incisions in the abdominal wall.

The whole procedure is performed with the help of a camera (laparscope), also placed in the abdomen through the incisions.

Additional Resources:

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