Gallbladder and Gallstones

The Gallbladder

2006-10-18T00:39:00.000-07:00

An estimated 16 to 20 million people in the United States have gallstones. Most of the stones are so tiny that they are literally flushed through the digestive system without any symptoms.

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Gallstones develop in the gallbladder, which is a small pear-shaped organ located on the right side of the body below the liver. It is connected to the liver and the intestines via small tubes or ducts.

The gallbladder is used as a storage tank for bile that is produced by the liver. Bile is an enzymatic fluid, or digestive juice, that helps the body break down foods that are high in fat. When fatty foods are eaten, bile moves through the ducts into the small intestine to aid in digestion.

Bile is composed of a combination of elements such as water, cholesterol, fats, bile salts, and bilirubin. If this mixture becomes unbalanced, for instance, by containing too much cholesterol, crystals form and harden in the gallbladder.

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If the crystals, or gallstones, continue to grow, extreme pain will be felt when they pass through the tiny openings of the ducts and into the small intestine. Symptoms of gallstones can include a steady and severe pain in the upper abdomen, nausea, and vomiting. Management by a doctor is needed for the treatment of gallstones

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Before and During Gallbladder Surgery

2006-10-17T23:43:00.000-07:00

Gallbladder surgery typically takes place in a hospital. Patients should follow any preparatory steps recommended by their physician prior to surgery. These may include changes to diet or medication regimen.
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If gallstones are present in the common bile duct, a procedure called endoscopic retrograde cholangiopancreatography (ERCP) may be used to reduce or eliminate these stones either prior to or during the surgery to remove the gallbladder. During ERCP a long, flexible tube called an endoscope is passed through the mouth into the first part of the small intestine (duodenum) to the bile ducts. A catheter is inserted into the tube to scoop up the stone and remove it from the body. In some instances gallstones may pass spontaneously from the bile ducts.
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Before gallbladder surgery, patients are placed under general anesthesia, meaning they are unconscious and do not experience pain during the procedure.
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Gallbladder surgery is most often performed as a laparoscopic procedure. As part of this technique, the surgeon makes several small incisions in the abdomen. Carbon dioxide is used to inflate the abdomen, which increases the space in which the surgeon is able to work.
A thin, tube-like instrument called a laparoscope is inserted through a hollow instrument (cannula) into the incisions in the abdomen. A camera and light attached to the laparoscope provide images of the gallbladder that are transmitted to a monitor. The surgeon watches the monitor while inserting medical instruments into the laparoscope and separating the gallbladder from the liver, ducts and other structures. The cystic duct (duct that conveys bile from the gallbladder to the common bile duct) is cut and the gallbladder is removed through the incisions, which are then closed.

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Open surgery is either planned in advance or improvised if the surgeon finds that a procedure that started as laparoscopy cannot be completed using that technique. In open surgery, an incision 5 inches to 8 inches long (12.7 to 20.32 centimeters) is made on the right side of the abdomen just below the ribs and the gallbladder is removed. When gallbladder surgery is performed to remove advanced cancer, the surgeon may use a technique known as extended cholecystectomy. Liver tissue and nearby lymph nodes are removed in addition to the gallbladder during this procedure.
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After Gallbladder Surgery

2006-10-17T23:33:00.000-07:00

Recovery following laparoscopy usually involves just a single night in the hospital. Patients may be asked to restrict their activities for several days after the procedure.
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Open surgery may require a hospital stay of between two days and one week. The patient may also have to spend several weeks at home recovering and restricting activities.
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Potential Risks

2006-10-17T18:38:00.000-07:00

Most patients who have gallbladder surgery experience few complications. Patients who undergo any type of surgery face risks such as allergic reaction to anesthesia, infection or bleeding.

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Gallbladder surgery sometimes results in injury to the bile ducts. When this occurs, it may cause the bile duct to leak bile, resulting in a painful infection. If the injury is significant enough, additional surgery may be required to repair it.

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A significant percentage of people who have gallbladder surgery go on to develop diarrhea. Although this usually improves with time, it can last for years. Diarrhea may be a result of an increase in bile that enters the large intestine because there is no longer a gallbladder to store bile. The bile that enters the large intestine prevents the absorption of water and acts as a laxative. Antidiarrheal medications and a high-fiber diet can help reduce this diarrhea. Patients also may be urged to avoid dairy products, fatty foods and spicy dishes. Patients who do not experience diarrhea may nonetheless find that their bowel movements increase in frequency and that their stool is softer following surgery. In some cases, a gallstone may be discovered in the bile ducts weeks or even years after the gallbladder has been removed. Endoscopic retrograde cholangiopancreatography is usually successful in eliminating such gallstones.
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Questions to ask your doctor and surgeon

2006-10-17T18:13:00.000-07:00

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to gallbladder surgery:

Will my procedure be performed laparoscopically or through open surgery?
Is it possible that my procedure will begin as laparoscopy and end as open surgery?
How should I prepare for the surgery? Do I need to change my diet or medication routine?
Will I have to spend time in the hospital following surgery?
What potential risks do I face if I have this surgery?
Will I have long and prominent scars following my surgery?
I’ve heard that many patients experience diarrhea following surgery. How can I lessen the odds of this occurring?
Which activities should I avoid following surgery?
How long will it take before I make a complete recovery?
If my bile ducts are injured, will I face the prospect of additional surgery?

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About Gallbladder Surgery

2006-10-17T16:52:00.000-07:00

Gallbladder surgery is a procedure used to treat conditions that affect the gallbladder, which stores excess bile not immediately needed for digestion. Also known as cholecystectomy, it is most often performed to treat gallstones that trigger symptoms and conditions such as pancreatitis. About 500,000 Americans have this surgery every year in the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

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Gallstones are formed from either cholesterol or bilirubin. The gallbladder may contain a few or many gallstones, which can range in size from microscopic to several inches in diameter. Gallstones may develop in people of any age, gender or ethnic background.

The surgery can be performed as either laparoscopy or traditional open surgery. In laparoscopy, surgery is performed using a thin tube that is attached to a camera and inserted into the body. Because this technique uses small incisions, it is not necessary to cut the abdominal muscles. This reduces scarring and the potential for post-surgical pain and complications.

In some cases, infection or other obstacles (such as severe inflammation of the gallbladder or scarring from other surgeries) may prevent use of laparoscopy and require that open surgery be performed. This is major surgery and will require an extended hospital stay and recovery period. About 5 percent of all cholecystectomies are performed using an open surgery technique, according to the NIDDK.In addition to gallstones, other conditions treated through this technique include gallbladder cancer, inflammation or infection of the gallbladder (cholecystitis), and abnormal gallbladder function (biliary dyskinesia).
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Summery:

2006-10-17T16:35:00.000-07:00

Gallbladder surgery – also known as cholecystectomy – is used to treat gallstones, cancer and other disorders that affect the gallbladder. The gallbladder is the organ that stores excess bile not immediately needed for digestion. About 500,000 Americans have this surgery every year in the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
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This surgery can be performed as either laparoscopy or traditional open surgery. During laparoscopy, several small incisions are made in the abdomen and a thin, tube-like instrument called a laparoscope is inserted into the body. A camera and light attached to the laparoscope provide images of the gallbladder that are transmitted to a monitor, allowing the surgeon to view the body’s interior while removing the gallbladder. This technique is used in the vast majority of gallbladder surgeries because it is less invasive and reduces scarring and the potential for post-surgical pain and complications.
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In some cases, infection or other obstacles (such as severe inflammation of the gallbladder or scarring from other surgeries) may prevent the use of laparoscopy. Traditional open surgery will then be performed, and the patient will likely experience a longer hospital stay and an extended recovery period.

Gallbladder surgery typically takes place in a hospital. Prior to the procedure, patients should follow any preparatory recommendations made by their physician. These may include changes to dietary and medication regimens. Patients will also be placed under general anesthesia before surgery, which means they are unconscious and do not experience pain during the procedure.
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Most patients who have gallbladder surgery experience few complications. However, a significant percentage of patients will have diarrhea. This can be reduced by using antidiarrheal medications and making certain dietary changes.
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Recovery from gallbladder surgery varies depending on which procedure was performed. Patients who undergo laparoscopy usually spend a single night in the hospital. Open surgery may require a hospital stay of between two days and one week. In both cases, patients may be asked to restrict their activities for a certain time period.Gallbladder surgery sometimes results in injury to the bile ducts. When this occurs, it may cause the bile duct to leak bile, resulting in a painful infection. If the injury is significant enough, additional surgery may be required to repair it.
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Gallbladder Polyp

2006-03-22T22:48:00.000-08:00

Gallbladder Polyp
From Wikipedia, the free encyclopedia

Gallbladder polyps are growths or lesions resembling growths (polypoid lesions) in the wall of the gallbladder. True polyps are abnormal accumulations of mucous membrane tissue that would normally be shed by the body. The main types of polypoid growths of the gallbladder include cholesterol polyp/cholesterosis, cholesterosis with fibrous dysplasia of gallbladder, adenomyomatosis, hyperplastic cholecystosis, and adenocarcinoma.

Epidemiology
Polypoid lesions of the gallbladder affect approximately 5% of the adult population.[1] The causes are uncertain, but there is a definite correlation with increasing age and the presence of gallstones (cholelithiasis). Most affected individuals do not have symptoms. The gallbladder polyps are detected during abdominal ultrasonography performed for other reasons.
The incidence of gallbladder polyps is higher among men than women. The overall prevalence among men of Chinese ancestry is 9.5%, higher than other ethnic types.[2]
http://www.mayoclinic.com/health/gallbladder-polyps/AN01044

Pathology
Most small polyps (less than 1 cm) are not cancerous and may remain unchanged for years.[3] However, when small polyps occur with other conditions, such as primary sclerosing cholangitis, they are less likely to be benign.[4] Larger polyps are more likely to develop into adenocarcinomas.

Cholesterolosis is characterized by an outgrowth of the mucosal lining of the gallbladder into fingerlike projections due to the excessive accumulation of cholesterol and triglycerides within macrophages in the epithelial lining.[5] These cholesterol polyps account for most benign gallbladder polyps.

Adenomyomatosis describes a diseased state of the gallbladder in which the gallbladder wall is excessively thick, due to proliferation of subsurface cellular layer. It is characterized by deep folds into the muscularis propria. Ultrasonography may reveal the thickened gallbladder wall with intramural diverticulae, called Rokitansky-Aschoff sinuses.[5]

Symptoms and Diagnosis
Most polyps do not cause noticeable symptoms. Gallbladder polyps are usually found incidentally when examining the abdomen by ultrasound for other conditions, usually abdominal pain.

Therapy
Most polyps are benign and do not need to be removed. Polyps larger than 1 cm with co-occurring gallstones occurring in people over the age of 50 may have the gallbladder removed (cholecystectomy), especially if the polyps are severe or appear malignant. Laparoscopic surgery is an option for small or solitary polyps.

References
^ Myers RP, Shaffer EA, Beck PL (2002). "Gallbladder polyps: epidemiology, natural history and management.". Can J Gastroenterol. 16 (3): 187–94. PMID 11930198.
^ Lin WR, Lin DY, Tai DI, Hsieh SY, Lin CY, Sheen IS, Chiu CT (2008). "Prevalence of and risk factors for gallbladder polyps detected by ultrasonography among healthy Chinese: analysis of 34,669 cases.". Journal of Gastroenterol Hepatology 23 (6): 965–9. doi:10.1111/j.1440-1746.2007.05071.x. PMID 17725602.
^ Lee KF, Wong J, Li JC, Lai PB (2004). "Polypoid lesions of the gallbladder.". American Journal of Surgery 188 (2): 186–90. doi:10.1016/j.amjsurg.2003.11.043. PMID 15249249.
^ Karlsen TH, Schrumpf E, Boberg KM (2008). "Gallbladder polyps in primary sclerosing cholangitis: not so benign". Curr Opin Gastroenterol 24 (3): 395–9. doi:10.1097/MOG.0b013e3282f5727a. PMID 18408471.
^ a b Owen CC, Bilhartz LE (2003). "Gallbladder polyps, cholesterolosis, adenomyomatosis, and acute acalculous cholecystitis.". Semin Gastrointest Dis 14 (4): 178–88. PMID 14719768.