Gallbladder Disease

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Overview

The gallbladder and other parts of the biliary system are particularly vulnerable spots in the human body. Bile is the end product of a very complicated series of metabolic and excretory functions performed by the liver. The material excreted by the liver is first delivered into small ducts inside the liver.

A normally functioning gallbladder, located just below the liver, receives some of the excreted material, concentrates it, and then passes it back through the cystic duct and into the main bile ducts. These ducts join to form the common bile duct that passes toward the GI tract where the material needs to be delivered.

Gallstones

Gallstones may mean nothing and many people live their entire lives with them. Even though they may be harmless, gallstones do indicate a defect in the system. Often that defect can lead to more serious problems such as an acute gallbladder attack or blockage of the main bile duct.

One or two stones may move up into the duct that connects the gallbladder with the main bile duct, the cystic duct. In some cases, these stones make their way out of the body.

There is ongoing controversy concerning the need to remove gallstones in patients who have no symptoms. Some physicians believe it is better to remove the stones rather than waiting for infection to develop. Once infected or inflamed, surgery is riskier and more difficult. On the other hand, many people are never affected adversely by gallstones.

Gallbladder Attack (acute cholecystitis)

Acute Cholecystitis Click on image for enlarged scan.

If a small stone that formed inside the gallbladder gets stuck in the cystic duct with its valves and convolutions, bacteria may be trapped within the gallbladder, producing a serious infection. These bacteria are trapped in an almost perfect growing environment of warm, thick liquid with plenty of nutrients.

The walls that line the gallbladder get thicker and more filled with fluid (edema), causing tenderness over the area. The severe inflammation that ensues may be associated with other symptoms, such as fever and malaise. Repeated bouts of acute cholecystitis that are unrecognized or untreated can lead to chronic cholecystitis or chronic gallbladder disease.

Bile Duct Obstruction

In this situation, a small stone that formed inside the gallbladder passes through the cystic duct and into the common bile duct (CBD). After receiving the pancreatic duct, the CBD narrows as it begins to pass into the duodenum through the ampulla of Vater. It is this narrow area that is most vulnerable to gallstones. If a stone gets stuck there, pressure builds up in the entire system, all the ducts dilate, the gallbladder may dilate, and, sooner or later, the patient develops jaundice. Obstruction of the common bile duct by stones is often associated with clinical findings of colicky pain of rapid onset and other acute symptoms.

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