human gallbladder

This small organ is not found in advertisements, and when it grabs the right side, few people remember: oh, probably, the gallbladder. Let’s see what we generally know about this mysterious organ.

Maybe someone will be surprised, but the gallbladder does not produce bile – in fact, it is a reservoir for storing it. Bile is produced in the liver, up to 1000 ml per day, while the gallbladder accumulates only 60-80 ml of concentrated bile. Another 80% of water is lost in the process.

The main role of the gallbladder in humans is the accumulation of bile and its further release into the duodenum for digestion of food. So even such a small organ is an important component of the digestive system of the human body.

What is important to know about the human gallbladder

Where is the human gallbladder

Finding the gallbladder is easy: we draw a line from the superior anterior iliac bone (the bone of the pelvis, which is easy to feel in the front left) through the navel. At the point of its intersection with the right costal arch, the gallbladder is located. It should be borne in mind that due to the individual characteristics of the structure of the body, the location of the organs may differ slightly.².

What does the gallbladder look like and how does it work?

The gallbladder in newborns is spindle-shaped and has a length of about 3 cm.³. By about 6-7 months, the organ expands and acquires a pear-shaped or funnel-shaped shape.

The bottom of the gallbladder is located in front and is its widest part. The middle part is called the body of the gallbladder: it passes into a narrow neck, from which the cystic duct proceeds. There is also a physiological “pocket” in the neck, which is where the stones usually hide. This part of the gallbladder is called Hartmann’s pouch.⁴.

At the junction of the neck of the gallbladder and the cystic duct is a layer of muscle, which is called the sphincter of Lutkens. This sphincter, contracting, helps to “evacuate” bile from the bladder through the ducts into the intestine. Another sphincter of Oddi is involved in the process, which is located at the confluence of the common bile duct into the intestine. These two sphincters are a kind of valves: they help keep bile from passing until the body needs it, and when the need arises, they contract and speed up the process of its movement.

The liver continuously produces bile. Through the ducts, it enters the gallbladder, where it gets rid of excess fluid, and the concentrate accumulates – waiting in the wings. When a person has eaten, the gallbladder receives a signal to give a portion of bile and 5-20 minutes after food enters the stomach, it begins to contract.¹. Through the sphincters and ducts, bile from the bladder enters the duodenum, stimulating its contraction and clearing the small intestine of the remnants of food chyme (partially digested food) for a new portion.

Why can a person’s gallbladder hurt?

There are the following diseases of the gallbladder and ducts:

• dyskinesia of the gallbladder and sphincter of Oddi;
• inflammatory diseases (cholangitis, cholecystitis);
• cholelithiasis;
• neoplasms;
• parasitic diseases caused by parasites and helminths.

According to clinical signs, gallbladder lesions can be confused with liver diseases. But if it pricks and pulls in the right hypochondrium, this is most likely a problem with the gallbladder or its ducts.

Only a competent diagnosis will help to reliably find out the cause of discomfort and other suspicious symptoms. To detect a particular problem with the gallbladder, as a rule, the following diagnostic methods are used:

1. laboratory: blood test (general and glucose);
2. fecal analysis or coprogram if cholecystectomy (removal of the gallbladder) was performed;
3. biochemical blood test for bilirubin, cholesterol, triglycerides, alkaline phosphatase, transaminases, pancreatic amylase;
4. general urine analysis;
5. FGDS;
6. ECG;
7. Ultrasound of the gallbladder (if necessary – with a trial breakfast);
8. duodenal sounding with bile culture (if necessary).

Dyskinesia

Dyskinesia is a decrease in the contractility of the gallbladder and bile ducts. Causes of the disease: violation of the nervous control over the emptying of the gallbladder, hormonal changes, the effect of cholesterol on the walls of the gallbladder⁵.

Allocate primary and secondary dyskinesia. Primary – an independent disease. It is less common, accompanied by pain in the right hypochondrium and digestive disorders.⁶. Primary dyskinesia usually appears after severe stress and is most often observed in young women with an asthenic physique. Symptoms of primary dyskinesia – increased irritability, heart palpitations, headaches. If dyskinesia is left untreated, prolonged bile stasis can develop, and as a result, inflammation and stones.

Secondary dyskinesia occurs against the background of hormonal disorders and diseases of the abdominal cavity: cholelithiasis, pancreatitis, gastritis. The main symptom is severe or moderate pain in the epigastric region and right hypochondrium. This pain often occurs at night, lasts more than 30 minutes, and does not improve with going to the toilet or changing body position.⁶.

Cholangitis

This is an inflammation of the bile ducts, which occurs due to obstruction of the biliary tract and infection of the bile. As a rule, this disease develops with stagnation of bile and the presence of stones in the ducts. Signs of purulent cholangitis are: jaundice, fever, chills, pain in the right hypochondrium.

Acute cholecystitis

This is an inflammation of the gallbladder, the main causes of which are gallstone disease and infection ascending from the lumen of the intestine.⁷. Acute cholecystitis is the second reason for hospitalization of patients with diseases of the abdominal cavity after acute appendicitis. The disease is dangerous for its complications – peritonitis, gangrene and perforation of the gallbladder.

Acute cholecystitis is usually preceded by an attack of biliary colic – long-term constant or cramping pain in the upper abdomen and right hypochondrium. The pain may radiate to the right shoulder, shoulder blade and the area between the shoulder blades. Perhaps bloating, vomiting, shortness of breath, a slight increase in temperature.

Chronic cholecystitis

Chronic inflammation of the gallbladder usually occurs against the background of gastrointestinal diseases: gastritis, hepatitis, pancreatitis. The cause of inflammation can be bacteria: most often E. coli, staphylococci and streptococci. A provoking factor for the development of cholecystitis is stagnation of bile due to dyskinesia, as well as against the background of stress, endocrine pathologies, disorders of the autonomic nervous system.

Chronic cholecystitis is characterized by a long course with exacerbations. With exacerbation, there is a dull aching pain in the right hypochondrium, which gives up to the area of ​​uXNUMXbuXNUMXbthe right shoulder and scapula. The pain occurs for no apparent reason or after overeating, drinking alcohol, fried and fatty foods. There is often belching, bitterness and a metallic taste in the mouth, nausea and bloating.

Gallstone disease (GSD)

With cholelithiasis, the exchange of cholesterol and bilirubin is disturbed, and stones are also formed in the gallbladder and bile ducts. This is the second most common disease of the gastrointestinal tract, after gastritis and duodenitis. According to some estimates, every 10 men in the world and every 4 women suffer from gallstone disease.¹⁰.

Factors provoking cholelithiasis: a sedentary lifestyle and unhealthy diet (a large amount of fat and sugar, little fiber). Among other reasons: high cholesterol in bile, hormonal disorders, inflammatory diseases of the gallbladder.

In most cases, gallstones do not manifest themselves for a long time.⁷. But other symptoms regularly appear: for example, biliary colic. During biliary colic, a person experiences severe pain in the right hypochondrium. Usually an attack occurs due to dietary errors, after physical exertion, and sometimes for no apparent reason.⁵.

In 30–80% of people with gallstone disease, “right hypochondrium syndrome” is observed – a constant feeling of heaviness and discomfort under the right rib.

gallbladder cancer

Takes 5th place in the structure of oncological diseases of the gastrointestinal tract¹¹, and the risk of the disease is 2-3 times higher in women than in men.

Abdominal pain, unexplained weight loss, jaundice may indicate a malignant tumor. As a rule, patients go to the doctor already in the later stages of the disease. With ultrasound diagnosis, you can pay attention to the uneven thickening of the gallbladder wall, its heterogeneous structure, polyps. If the size of the polyp exceeds 18 mm, there is a high risk that it is cancer.⁵.

Predisposing factors include: cholelithiasis for more than 5 years, calcification of the gallbladder walls, obesity, primary sclerosing cholangitis, adenoma, papillomas¹¹. That is why it is recommended for patients with problems of the gastrointestinal tract to undergo an examination 1-2 times a year.

vermin

Parasites often affect the human gastrointestinal tract. If you have animals in the house, you drink raw water and eat poorly thermally processed meat or fish (for example, raw or lightly salted), the risk of infection with parasites increases.

Trematodes, flukes, Giardia can live in the human gallbladder. The most common disease is opisthorchiasis. The problem is that its symptoms can easily be confused with gastritis. Therefore, there is only one advice: if you feel something is wrong, go to the doctor.

How is the human gallbladder treated?

Depending on the causes and nature of gallbladder diseases, doctors can use different methods of treatment: conservative or radical.

Conservative methods include diet, drug treatment. Radical methods involve surgery.

Diet

To regulate the process of bile secretion, you need to adjust the diet. The main rule: there should be no big or small breaks between meals. The most optimal range is 3-5 hours.

A specific diet for the patient is individually selected by the doctor, taking into account the characteristics of his body and the course of the disease.

Medicines

A number of diseases of the gallbladder are treated with choleretic agents: choleretics (increase the formation of bile) and cholekinetics (contribute to the release of bile into the intestinal lumen from the gallbladder). But, for example, with cholelithiasis, choleretic drugs are categorically contraindicated.

Ursodeoxycholic acid (UDCA) preparations are the main treatment for gallstone disease⁹. As a result of therapy, gallstones often dissolve or decrease in size. The most pronounced effect of treatment is observed in patients without impaired cholesterol metabolism.

If treatment with UDCA is ineffective, surgery may be indicated. Moreover, even with successful treatment, the likelihood of relapse is high. Especially if you do not remove the cause that caused the disease.

Direct medicinal methods of getting rid of stones are also used: special drugs are injected into the gallbladder, but in this case there is a high risk of complications.

shock wave lithotripsy

This method is used to remove stones, but on condition that there are no more than three stones, and the contractile function of the gallbladder is not impaired. With the help of a special apparatus, the stones are crushed by a shock wave, and then removed from the body. However, supportive drug therapy (UDCA) is also needed here. In addition, in half of the cases there are relapses.

Other conservative methods

For the treatment of acute cholecystitis, the following measures are used:

• hunger (if there is no vomiting, you can drink),
• local hypothermia (put an ice compress on the gallbladder area),
• medicines (antibiotics, antispasmodics, detoxification therapy).

Surgical methods

For the treatment of a number of diseases, for example, cholangitis, endoscopic operations are used: papillotomy (dissection of the ampulla of Vater to remove stones and remove bile), external drainage of the gallbladder and biliary tract using a catheter.

Removal of the gallbladder is usually performed with advanced forms of cholecystitis and various forms of gallstone disease. Also, cholecystectomy may be required if malignant tumors are detected.⁵.

There are 3 types of cholecystectomy:

1. Open or cholecystectomy by laparotomy (removal of the gallbladder through an incision about 15 cm long on the abdominal wall). The disadvantages of such an operation are a significant injury to the abdominal wall, which threatens with various complications, long-term rehabilitation and disability, and limitation of the patient’s physical activity.
2. Mini-laparotomy with elements of open laparoscopy. The difference from the first type is that the incision is smaller (only 4-5 cm), and the removal is done using mirror hooks and special lighting.
3. Laparoscopic cholecystectomy (video monitoring) is a minimally invasive surgical technique. It is favorably distinguished by less trauma, faster recovery (only 2-5 days in the hospital), better cosmetic effect (smaller scar). However, the risk of complications is high, so this operation requires the best equipment and highly qualified specialists.

Cholecystostomy is another method of surgical intervention when there is no need to remove the organ, but there is a need to take the infected bile out. It is carried out in three ways: drainage of the gallbladder under ultrasound control, laparoscopically or by laparotomy.

How to keep your gallbladder healthy at home

Any doctor will say: it is better to prevent a disease than to treat it. Therefore, preventive measures in the case of the gallbladder are no less important, as, for example, the prevention of caries.

Since the gallbladder is located in the digestive system and is involved in its functioning, it is logical that first of all it is necessary to pay attention to nutrition.

Popular questions and answers

The gallbladder is a small organ and can cause many problems. What rules must be followed to minimize the risks of developing diseases of the gallbladder and biliary tract? Our expert answers this and other questions gastroenterologist, preventologist, nutritionist Yana Prudnikova.

Sources of:

1. The role of the gallbladder (literature review). Ya.L. Tyuryumin, V.A. Shanturov, E.E. Tyuryumin. Bulletin of the VSNC SO RAMS. 2011. No. 4 (80). pp. 347-351. https://cyberleninka.ru/article/n/rol-zhelchnogo-puzyrya-obzor-literatury/viewer
2. Diseases of the liver and gallbladder: treatment and cleansing. A. Sadov. SPb – Peter. 2010. 192 p. https://vk.com/doc12756212_607727202
3. The system of staged treatment of diseases of the biliary tract in children. E. Golovatenko. Teaching aid. Pediatrics. 2007. https://pandia.ru/text/77/348/72675.php
4. Secrets of digestion. V.V. Vasilenko. 2010. Moscow – GEOTAR-Media. 288 p. https://www.gastroscan.ru/literature/authors/9901
5. Cholelithiasis. Educational and methodical manual, ed. A.A. Shchegolev. Moscow. 2015. https://goo.su/UdHO
6. Possibilities of treatment of biliary dyskinesia. THEM. Shcherbenkov. Medical advice. 2013. S. 47-51. https://cyberleninka.ru/article/n/vozmozhnosti-terapii-diskinezii-zhelchevyvodyaschih-putey-1/viewer
7. Diseases of the liver, gallbladder and pancreas. Tutorial. Blagoveshchensk, 2018. https://www.amursma.ru/upload/iblock/55e/Bolezni_pecheni,_ZhP_i_PZh._Uchebnoe_posobie._2018.pdf
8. Medical decision support system. Gastroenterology: clinical treatment protocols. D.S. Bordin, K.A. Nikolskaya, I.G. Bakulin and others. Moscow. 2021. https://mosgorzdrav.ru/uploads/imperavi/ru-RU/sppvr_doc003.pdf
9. Gallbladder diseases: possibilities of therapy with ursodeoxycholic acid preparations. Toolkit. O.A. Sablin, T.A. Ilchishina, A.A. Ledovskaya. SPb. – Absolut N. 2013. 34 p. https://goo.su/I4aavKp
10. Diagnosis and treatment of cholelithiasis with selective antispasmodics. THOSE. Polunina, I.V. Maev, I.V. Rychkov. Medical advice. 2010. S. 33-37. https://cyberleninka.ru/article/n/diagnostika-i-lechenie-zhelchno-kamennoy-bolezni-selektivnymi-spazmolitikami/viewer
11. Diagnosis and surgical treatment of gallbladder cancer. HELL. Lelyanov, co-authors. Experimental and clinical gastroenterology. 2011. No. 9. pp. 67-71. https://cyberleninka.ru/article/n/diagnostika-i-operativnoe-lechenie-raka-zhelchnogo-puzyrya/viewer