Overview:
Gall bladder is a cystic organ 7-10 cm long that accommodates about 50 ml and takes shape of a pear, located in the right upper quadrant of abdomen just below liver and is connected to the main hepatic duct
gallbladder acts as a bile tank which secreted by the liver and assist in food digestion process
gallbladder shrinks to empty its contents in the duodenum when the food passes in order to complete the digestion process
Gallstone is hard, pebble-like pieces of material, usually made of cholesterol or bilirubin, ranging in size from a fine grain of sand to a large diameter stone
Etiology:
Bile consists of 95% water, cholesterol, bilirubin, amino acids, bile salts and other components such as vitamins and heavy metals
Bile contains enough chemicals to dissolve cholesterol, but when amount of cholesterol secretion from liver increases significantly, the excess turns into crystals that eventually turn into stones (cholesterol stones are the most common in gallbladder and are yellow in color)
Bile contains bilirubin, and when increased secretion of bilirubin (as in liver cirrhosis and sickle cell anemia) the excess turns into stones (stones are dark brown or black in color)
When gallbladder does not empty its contents (as in long fasting and dysfunction of gallbladder) increases the concentration of bile, which predisposes to occurrence of stones
Symptoms:
Symptoms appear due to impaction of stones in neck of gallbladder, which leads to its blockage and may lead to calculous cholecystitis
The symptoms are:
- Sudden severe abdominal pain in the right upper quadrant
- Sudden severe abdominal pain in the epigastric region (upper and middle abdomen)
- Sudden severe pain between shoulders
- Sudden severe pain in the right shoulder
- Nausea and vomiting
Gallstones may cross the neck of the gallbladder and stop in common bile duct causing blockage and inflammation, with symptoms of:
- Severe abdominal pain
- Jaundice
Gallstones may block common bile duct under level of its connection with pancreatic duct, leading to acute pancreatitis
Causes:
risk factors
- High cholesterol food
- Sickle cell anemia
- liver cirrhosis
- Gender: most common in females
- Age: common in the fourth decade
- Obesity
- Pregnancy
- Genetic factors
- Diabetes mellitus
- Rapid weight loss (such as after sleeve gastrectomy and hard diets)
- Estrogen
Diagnosis:
- Clinical examination
- Laboratory tests: to determine the inflammatory status and jaundice
- Radiologic investigations: most common examination here is abdominal ultrasound to diagnose gallstones and cholecystitis
we may need an MRI to assess bile duct and pancreas
we may need an upper gastrointestinal endoscopy with retrograde cholangiopancreatography ERCP
Treatment:
- Asymptomatic stones (discovered accidently during routine abdominal ultrasound for another reason): this case is controversial and most doctors tend not to perform surgery (only close monitoring)
- symptomatic stones: laparoscopic cholecystectomy: where the abdomen is inflated with Gas (CO2) and the endoscope and surgical instruments are inserted through small holes in abdominal wall,
ligating biliary artery and biliary duct
dissection of gallbladder away from its liver bed
removal of gallbladder via endo bag through one of the small incisions
- In obstructive jaundice: upper gastrointestinal endoscopy with removal of gallstones ERCP followed by laparoscopic cholecystectomy.
