Let’s Talk About Gallbladder Problems

WHAT IS GALLBLADDER?

Gallbladder is a pear shaped organ located just below the liver. It measures around 8-10cm long. The organ does not have any significant role than storing and concentrating the bile juice secreted by liver. Gallbladder per se is not an essential organ for survival.

Approximately 1500ml bile is secreted by liver everyday day for digestion of food that we consume especially fatty meal. All of it gets absorbed by the intestines while, 30-50ml is concentrated and stored in Gallbladder. Most of the bile directly enters the intestine for digestion, while the bile stored in gallbladder is secreted out when we consume a heavy/ fatty meal.

Hence, any disease pertaining to gallbladder needs removal of the organ itself and people can live perfectly normal lives without their gallbladder

Gallbladder problems arise when there is block or slowing to the bile flow. Few of the causes can be overweight, female gender, rapid weight loss, high cholesterol diet, genetics, pregnancy, birth control pills, etc.

HOW TO IDENTIFY GALLBLADDER ISSUE

There are variety of conditions that affect gallbladder and produce symptoms ranging from simple indigestion, nausea, vomiting to jaundice and even need for emergency hospitalisation requiring emergency surgery.

Most common problem associated with gallbladder are –

Gallbladder stones
Gallbladder Infection (a.k.a Cholecystitis),
Cholangitis
Biliary Pancreatitis
Gallbladder Cancer

GALLSTONES

Known as Cholelithiasis, most the times it is asymptomatic and goes unnoticed unless one gets an abdominal scan for other reason. However, in some cases, patients can present with pain abdomen which ranges from occasional upper abdominal pain following meal lasting for couple of hours to severe constant pain that may even require emergency hospitalisation. This pain is termed as ‘biliary colic’.

When pain is constant, removal of Gallbladder is treatment of choice.

CHOLECYSTITIS

This is inflammation of Gallbladder that occurs once the stones block the way to bile flow which causes increased pressure in the Gallbladder leading to Inflammation and further infection. This is a serious condition where patient has to be hospitalised and started on IV antibiotics and other supportive care, if not Cholecystitis can lead to pus formation and rupture which is lifethreatening situation. Rarely Cholecystitis can occur due to uncontrolled diabetes, Gallbladder cancer, sick patients admitted in ICU setup.

Common Symptoms of this condition:

Severe pain abdomen
Vomiting
Fever
Gallstones
Jaundice

Cholecystitis is treated with Hospitalisation and surgery i.e., Removal of Gallbladder (Cholecystectomy)

CHOLANGITIS

It is a serious condition where longstanding gallstones have slipped into Common bile duct ( a tube that allows bile flow into GUT). This leads to severe jaundice with pus and infection in the liver. Patient is usually very serious and toxic.

Here patient would need ICU admission with intense monitoring and care. Emergency releasing of the block from bile duct via endoscopy (ERCP) and allow jaundice to settle down. Later plan for Gallbladder removal surgically

BILIARY PANCREATITIS

The mechanism here is similar to Cholangitis, but the stone here gets impacted in Pancreatic duct instead of bile duct causing pancreatitis resulting in inflammation and infection of pancreas. Common symptoms are severe pain abdomen radiating to back, nausea/ vomiting, fever, jaundice. This condition is initially treated via Endoscopy (ERCP) followed by Gallbladder removal surgery once pancreatitis settles.

If left untreated, there can cause permanent damage to pancreas.

GALLBLADDER CANCER

This is very aggressive cancer that spreads to liver. Usually asymptomatic for long duration. Most commonly the condition is familial, also can be due to long standing untreated Gallstones. Symptoms may vary from mild abdominal discomfort, weight loss, loss of appetite to severe pain abdomen, jaundice. This needs proper evaluation and staging. Management differs for different stage of presentation.

GALLBLADDER REMOVAL SURGERY

Usually performed after panel of tests and complete physical examination, Biochemical tests and Imaging. This improve the success rate of surgery with better outcome and prevents risks during and after surgery.

Surgery is performed under General Anaesthesia.

The standard surgery performed worldwide is Laparoscopic Cholecystectomy (i.e., Gallbladder removal through keyhole surgery). Small 1cm cut in made in the belly button to insert the camera inside the abdomen and via their small 5mm cuts, surgery is performed and gallbladder is removed. Patient can be discharged the very next day.

Rarely conventional open gallbladder surgery maybe needed with a bigger cut. This maybe needed when there is severe complication, bleeding or for gallbladder cancer.