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Gallbladder Problems

I have abdominal pain. How can I tell whether my gallbladder is causing it?

Suspect gallbladder problems if your pain is in your right upper abdomen. You may have nausea and vomiting. Fatty foods may trigger pain. If you have these symptoms, see your regular doctor. He will question you and examine your abdomen. If he thinks your gallbladder is the problem, he will order gallbladder tests.

What does my gallbladder do?

Your gallbladder stores bile. Bile is a yellow fluid, produced by the liver, which helps digest fat. Bile travels from the liver to the small intestine to mix with fats you've eaten. Part of the bile travels to the gallbladder, where it is stored and concentrated. When you eat fatty foods, your gallbladder contracts, forcing extra bile into your small intestine. Your liver makes about one pint of bile each day. Your gallbladder absorbs 90% of the water from the bile and has room to store one day's concentrated bile.

How does the gallbladder cause problems?

Crystals may form in bile as the gallbladder absorbs water. These crystals grow into gallstones, which may block the passage out of the gallbladder. When a gallstone blocks this passage, the gallbladder swells and hurts. The blockage may cause nausea and vomiting. Bacteria may then grow in the gallbladder, causing infection. Typically, the gallstone passes out of the gallbladder or bounces back up into the gallbladder and the pain goes away. Later, another stone blocks the gallbladder passage, again causing pain and vomiting. Each gallbladder attack scars the gallbladder, making surgery more difficult. Less commonly, gallstones block the main bile passage from the liver to small intestine.

What happens if gallstones block the main bile passage?

Bile backs up into the liver and spills into the blood, turning the skin and eyes yellow. Bacteria grow in the bile passage and spill into the bloodstream, causing a life-threatening infection.

What tests will my doctor order to check my gallbladder?

Your doctor will order a sonogram (sound wave test) to check for gallstones.

My sonogram was normal, but I still think my pain is from my gallbladder. What other tests can I have to check my gallbladder?

The sonogram finds almost all gallstones. If these tests are normal, you probably don't have gallstones. Most gallbladder pain comes from gallstones, but a few people have pain without gallstones. In these cases, the gallbladder hurts because it fills and empties poorly or because it contains bile crystals, which partially block the bile passages.

You may have an Upper GI endoscopy with duodenal drainage to check for bile crystals in the gallbladder. You may also have a Nuclear Medicine hepatobiliary scan with gallbladder ejection fraction to check gallbladder filling and emptying.

What is a hepatobiliary scan with gallbladder ejection fraction?

This test shows the liver, main bile passage and gallbladder. The Nuclear Medicine technician first injects a small amount of radioactive dye into a vein. The dye collects in the liver, then travels through the bile passages to the gallbladder and small intestine. Dye should collect in the gallbladder. If it does not, the gallbladder is blocked. Gallbladder surgery will help.

If the gallbladder fills with radioactive dye, the technician gives a Kinevac injection to squeeze the gallbladder. A scanner measures the radioactivity leaving the gallbladder. This shows how well the gallbladder empties. A gallbladder that empties poorly can cause pain. Gallbladder surgery may help.

What is an upper GI endoscopy with duodenal drainage?

This is a test which shows whether their are crystals in gallbladder bile. In this test, a surgeon or gastroenterologist inserts a lighted scope through the mouth into the stomach and duodenum. Kinevac is injected to empty the gallbladder. The surgeon or gastroenterologist then collects gallbladder bile from the small intestine. The Pathologist checks the gallbladder bile for crystals. If crystals are present, they may cause pain as they pass out of the gallbladder. Gallbladder surgery may help.

Who gets gallbladder problems?

While most common in overweight women in their forties, gallbladder problems occur in both men and women and at any age.

How do you treat gallstones?

Shock waves can break up gallstones, allowing them to pass through the bile passages. Pills can dissolve gallstones. However, gallstones come back as long as the gallbladder remains. We, therefore, recommend gallbladder removal to permanently remove gallstones.

What happens to the bile if I don't have a gallbladder to store it?

Your bile will travel from your liver to your small intestine. You won't have a gallbladder to store bile or absorb water from bile. Most people tolerate this. A few people get diarrhea; this usually improves after about a month. A few people have diarrhea permanently after gallbladder surgery.

Tell me more about gallbladder surgery. First, tell me about the new laparoscopic surgery.

We operate through five small incisions. We first make a small incision though your navel. We then inflate the abdomen with carbon dioxide. We place a camera through the navel incision and watch ourselves operate on TV monitors. We place graspers, dissectors, clip appliers and scissors through four more small incisions. We clip and cut the cystic duct and artery. We cut the gallbladder attachments to the liver. We then pull the gallbladder out through a small incision.

Most people go home the same day or the next morning. Most people return to work in one to two weeks. The advantages of laparoscopic surgery compared to compared to conventional open surgery are less pain and less time off work. The disadvantages of laparoscopic surgery are more risk of bleeding or injuries to the bile passages. It is also difficult to remove gallstones from the main bile passage


 
Pros and Cons Traditional Surgery Laparoscopic Surgery
Cost Usually lower Usually higher
Hospital Stay 3 days 1 day
Gallstones in common bile duct Treated during surgery May require open surgery or endoscopic sphincterotomy (removal of gallstones from the bile passage with a lighted scope inserted through the mouth)
Lifting restriction 6 weeks None
Off work 4-6 weeks 1-2 weeks
Pain More Less
Common bile duct injury About 1 in 1000 operations Up to 3 in 100 operations

 
through the lighted scope. If you have gallstones in this bile passage, your surgeon may recommend open gallbladder surgery or endoscopic sphincterotomy after your laparoscopic gallbladder surgery.

What is endoscopic sphincterotomy?

In this procedure, a surgeon or gastroenterologist inserts a lighted scope through the mouth into the stomach and then into the duodenum. The surgeon or gastroenterologist enlarges the junction between the small bowel and main bile passage and removes gallstones.

When isn't the new laparoscopic surgery a good choice?

The new surgery is unsafe if you have severe scarring and inflammation around the bile passages and arteries. We will not know how much scarring you have until we try laparoscopic surgery. If we cannot safely complete laparoscopic gallbladder surgery, we will open your abdomen for conventional surgery.

Some patients with heart disease can't tolerate carbon dioxide inflation of the abdomen. In these patients, carbon dioxide can cause heart failure or even a heart attack, so for them, open surgery is safer.

Tell me about conventional gallbladder surgery.

We make an incision below your right rib cage and remove the gallbladder. We often take X-ray dye pictures of the bile passages to check for gallstones. If there are stones in the main bile passage from liver to small intestine, we remove them during the same operation. Although no operation is completely safe, conventional gallbladder surgery is safer than laparoscopic surgery. Disadvantages of conventional surgery are more pain and more time off work.

How can you remove the gallbladder through such a small incision?

The gallbladder is a small, thin-walled sac filled with bile fluid. Bile fluid can move within the sac, so the sac can be pulled through a small opening, like a balloon through a hose.

If you have large gallstones, the incision must be at least as large as the largest stone. We enlarge the incision a little to remove gallbladders containing large gallstones.

   

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Copyright © 2000 Gail Waldby, MD, General Surgery, Sioux Falls, South Dakota and Livingston, Montana, USA
All rights reserved Last modified April 3, 2005
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