Gallbladder Disease

Bile, used to digest food, is made in liver & stored in gallbladder (a sac tucked in under the liver; see Diagram — Gastrointestinal System).ย  The gallbladder releases it down a duct into the small intestine.ย  Sometimes bile can clump into stones, which can remain in the gallbladder without ever causing problems.ย  But sometimes a stone descends the duct and gets stuck, causing sudden pain called “biliary colic.”

The typical patient with gallstones is an obese woman around 40, but men, and people of any age or size, can also get them (they’re relatively common).  They’re more common among persons of Western European, Latino, or Native American descent, compared to African-Americans, Eastern Europeans, & Asians.  They often run in families.

We suspect biliary colic when a patient has sudden pain in the right upper abdomen (sometimes just the mid-upper, but not the left).  The pain may also be felt in the right side of the upper back or right shoulder.  There’s usually nausea and/or vomiting.

The pain usually lasts up to 6 hours, by which time the stone gets free.  If it lasts longer, there’s danger of developing serious infection (even with death), so we send such patients to the ER.  Diagnosis is easily made by ultrasound.  

The term โ€œCholecystitisโ€ means either โ€œinflammationโ€ or โ€œinfectionโ€ of the gallbladder (โ€œcholeโ€œ = โ€œgall,โ€ i.e. โ€œbileโ€; โ€œcyst-โ€œ = bladder; โ€œ-itisโ€ = inflammation or infection).  Clinically they may look the same, but infection is much more serious, usually accompanied by fever.  Choledocholithiasis refers to a stone stuck for good in a bile duct, which will surely cause cholangitis (bile duct infection) with fever and jaundice (turning yellow), likely fatal without treatment (IV antibiotics plus surgery)..

If we see a patient who describes typical pain which is now all better, we also get an ultrasound.  If gallstones are present in the gallbladder, we might refer to a surgeon to consider planning for an operation to remove the organ (cholecystectomy).  Certainly if a patient has had two typical episodes, and the ultrasound shows gallstones, we refer.  A person can live just fine without a gallbladder; bile will seep into the small intestine anyway, & other chemicals are always around for digestion.

We do not refer for surgery when we incidentally happen to notice gallstones while doing an ultrasound or CT scan for other reasons.  Those common asymptomatic gallstones are unlikely to ever cause problems.  We only refer patients who’ve had biliary colic.

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