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The gallbladder, incorrectly called a bladder, is a reservoir into which the bile produced by the liver drains. The bile is stored and thickened in the gallbladder. It’s an important part of the digestive system, but you can live without it.
About 30 minutes after eating a meal, the walls of the bladder contract and the bile is ejected through the bile duct into the duodenum, where bile is involved in digesting fats in the first place. The most common diseases of the gallbladder include Oddi’s sphincter dysfunction, gallstones, cholangitis and cholecystitis. The most common is gallstone disease, which is referred to as the formation of deposits in the gall bladder or ducts, commonly known as stones.
Who is at risk?
Every fifth person is affected, but women are affected four times more often than men. The incidence of the disease increases with age. They are also favored by obesity, diabetes, genetic factors (familial occurrence of urolithiasis), high levels of triglycerides in the blood (hypertriglyceridemia), taking estrogens and cystic fibrosis. But we can also work on the formation of gallstones. They arise from an incorrect diet, i.e. when we eat fatty foods, we have elevated blood cholesterol levels. Another reason is the reduction of bile acid synthesis, which disrupts the bile composition and causes stones to precipitate, motor disorders, i.e. the functions of the gallbladder, which cannot effectively remove bile, resulting in the formation of stones. Specialists distinguish stones: cholesterol, pigment and mixed.
With and without symptoms
Gallbladder stones will not cause any discomfort if the stones do not clog the bile ducts. Stones are formed in the gallbladder, rarely in the bile ducts. If they are small, there is a possibility that they will travel through the common bile duct into the intestines and be excreted in the faeces. Stone deposits usually have quite sharp edges, which, when squeezing into the intestines, slightly injure the biliary outlet. One-off wounds heal without any sequelae. However, when this happens frequently, scars form that narrow the mouth. Then the outflow of bile is impaired, which in itself may cause further stone formation. Acute symptoms also appear when the stone completely clogs the bile ducts. Common symptoms include:
Pain – often appears after eating a fatty meal, it can last up to several hours, usually in the right hypochondrium. Pain increases with pressure, and has a colic or paroxysmal character.
Nausea and vomiting – these symptoms are often associated with pain.
Heartburn, a feeling of fullness in the upper abdomen – the unpleasant burning sensation in the esophagus does not go away even after taking medications to relieve heartburn, the overflow in the stomach can be compared to the sensations of overeating.
Jaundice – it is a yellowish shade of the whites of the eyes and skin.
Fever and chills – if they coexist, it may be a sign that you have developed cholangitis, which requires urgent medical attention.
Two faces of disease
Chronic inflammation the gallbladder is almost always a consequence of urolithiasis. After meals, especially fatty meals, you get stomach ache, but it can also appear around the heart, back or right shoulder.
Acute inflammation A gallbladder can also develop without stones. This applies to 10 percent. cases of this disease. It may be the consequence of a general bacterial infection. In children, these are usually streptococci, typhoid bacteria. Acute vesiculitis is also seen in people with diabetes.
What is colic
It is primarily an attempt by the body to get rid of the deposits accumulated in the bubble, i.e. stones. The gallbladder contracts strongly and pushes the plaque towards the gallbladder. It can perform this operation when its inner walls are not damaged by the inflammatory process. When they are scarred, they cannot shrink when they are thick. This explains why colic attacks are less frequent and weaker with long-lasting urolithiasis and chronic cholecystitis. Stones that cannot pass through the mouth of the bubble may return to its interior. If you manage to push them out, they travel on, but can get stuck at the mouth of the bile ducts into the intestines, causing bile stasis and then jaundice (called obstructive or mechanical). If jaundice occurs, this means that the bile cannot flow through the common bile duct. Wandering stones can also block the pancreatic duct, which connects to the intestines at the same point. The pancreas is damaged and inflammation usually develops. However, it often happens that the deposit will get through this critical point. The patient then feels a significant improvement in well-being. Those with a stone stuck in the duct are less fortunate. Then the only salvation is surgery.
Research is needed
Imaging tests that show enlargement of the gallbladder and dilatation of the bile ducts are the most effective in detecting gallstones. In the ultrasound image of the abdominal cavity, stones are not always visible, but their presence is evidenced by the dilatation of the bile ducts and the possible enlargement of the follicle. Each person suspected of having gallstones has a blood test and the level of liver and barrier enzymes (Aspat, Alat, Alkaline phosphatase and Pancreatic amylase) is determined from the taken sample.
Pharmacological treatment
They can be divided into two types. Treatment aimed at eliminating the symptoms, i.e. biliary colic attacks, which consists in taking antispasmodics. Such ad hoc therapy eliminates pain and avoids surgery, but does not eliminate the root cause of the disease. The treatment to remove the stones is to take medications that dissolve the gallstones. This treatment is used in people who, for various reasons, cannot undergo surgery. However, it must be remembered that it is only effective for small cholesterol stones. It does not give good results when the stones are pigmented, calcified or large. Dissolving stones is not performed in obese people, pregnant women and those who have other liver diseases.
Surgical treatment
The general rule is that operations are performed when urolithiasis causes severe symptoms, prevents normal functioning (pain, mechanical jaundice) or the patient has not responded to pharmacological treatment. Currently, most gallbladder operations are performed using a laparoscopic technique.
Laparoscopic cholecystectomy – it consists in placing the camera and surgical instruments through 3 holes made in the abdominal cavity. The doctor observes the image of the operating field on the monitor. The procedure is much less invasive than the classic operation, better tolerated by the patient, and enables faster recovery and full fitness.
Open method cholecystectomy – performed in the case of contraindications to laparoscopy, i.e. when there are numerous scars after previous operations or diffuse inflammation within the abdominal cavity.
If there are no complications, the prognosis after surgery is good. But complications are rare. If they do appear, it is Fr.stre and chronic cholecystitis, acute pancreatitis, liver abscess, gangrene with perforation and biliary peritonitis, and intestinal obstruction.
Text: Anna Jarosz