GALLBLADDER DISORDERS

Gallstones, Cholecystitis, Inflammation of the Gallbladder

Gallstones develop in the gallbladder when either the amount of cholesterol secreted into the gallbladder by the liver is too high, or the amount of other substances in the bile is too low to prevent the cholesterol from remaining in solution. In either condition, the cholesterol precipitates out as small crystals that eventually form larger stones. Many people have gallstones for years without any symptoms whatsoever. Symptoms from gallbladder disease usually consist of upper right quadrant abdominal pain especially after ingestions of heavy meals that contain rich foods. The pain may radiate around to the back and up under the shoulder blade. Sometimes nausea and vomiting occur. If severe inflammation of the gallbladder occurs, it is call cholecystitis, and the patient may develop severe abdominal pain and fever. The most common treatment for patients with symptomatic gallstone disease is a cholecystectomy (surgical removal of the gallbladder). This can be done by a surgeon using standard technique (an incision made in the upper right quadrant of the abdomen) or the new technique of laparoscopic removal. This new technique is performed with an instrument called a laparoscope that is inserted into the abdomen through a small incision made around the navel. In some patients who are not surgical candidates, stones may be dissolved by medicine or broken up by ultrasound of shockwave techniques (lithotripsy). The reoccurrence of stones once medicine is stopped can occur. Whether these techniques will avoid the need for surgery in all patients is unknown.