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Digestive Disorders

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Gallbladder Disorders

Symptoms

Moderate to severe pain in the upper-right abdomen, often spreading into the chest, right shoulder, and back. Pain due to gallstones may occur in separate episodes lasting from 30 minutes to four hours. Inflammation of the gallbladder causes pain that gradually increases in severity and may worsen upon deep breathing. Cancer of the gallbladder produces steady pain.

Possible nausea and vomiting accompanying the attacks of pain.

Fever and chills (gallbladder inflammation).

Abdominal fullness or bloating.

Severe belching, heartburn, and gas.

Weight loss (cancer of the gallbladder).

Jaundice.

When To Call Your Doctor

Call a doctor if you develop severe abdominal pain.

Emergency: Call an ambulance if you experience upper-right abdominal pain and nausea accompanied by shortness of breath and sweating. Such symptoms may also signal a heart attack.


What Is It?

The gallbladder, a small, pear-shaped organ located just below the liver, concentrates and stores bile, a substance produced by the liver to aid in the digestion of fats. Bile is stored in the gallbladder and secreted into the duodenum (the portion of the small intestine joined to the stomach) during digestion. Gallstone formation—known as cholelithiasis—is the most common gallbladder disorder. It usually occurs when excessive amounts of cholesterol in the bile clump together into solid masses. People with hemolytic anemia (marked by rapid destruction of red blood cells) may develop gallstones composed of bilirubin, a bile pigment.

The quantity and size of gallstones may vary from one large stone to thousands of tiny ones. More common in women than in men, most gallstones are referred to as "silent gallstones," as they cause no symptoms and so require no treatment. Sometimes, however, gallstones produce acute symptoms by blocking the cystic duct (which leads from the gallbladder to the common bile duct) or the bile duct. Blockage of the cystic duct causes inflammation of the gallbladder, known as cholecystitis. A blocked bile duct is also prone to bacterial infection. In some cases an infected gallbladder may become filled with pus, a condition known as empyema, which requires immediate surgery. Rarely, the gallbladder may be the site of tumor formation. For reasons that are unclear, gallstones increase the risk of gallbladder cancer; although few people with gallstones develop cancer, the majority of those with gallbladder cancer also have gallstones. Cancer of the gallbladder, which normally strikes at age 70 or older, is inoperable upon diagnosis in 75% of cases, and the outlook is generally poor.

Treatment for most gallbladder disorders involves surgical removal of the gallbladder (cholecystectomy). Gallstones may be dissolved with chemical agents or sound waves, but tend to recur if the gallbladder is not removed. The absence of the gallbladder does not inhibit digestion; bile simply passes directly from the liver into the small intestine.

What Causes It?

The exact cause of gallstones is unknown, but cholesterol stones are usually associated with an abnormal composition of the bile.

Age, obesity, a high-calorie diet, very rapid weight loss, Crohn disease, cirrhosis, hemolytic disorders, or intestinal surgery increases the risk of gallstones.

Multiple pregnancies, oral contraceptives, or estrogen therapy may provoke the development of gallstones in women.

Obstruction of the cystic duct (usually by gallstones), injury, or bacterial infection (usually in conjunction with bile duct obstruction) may lead to inflammation or abscess of the gallbladder.

Gallstones are associated with a higher risk of gallbladder cancer.

Hereditary factors may play a role; for example, among certain Native American tribes such as the Pima Indians of Arizona, nearly 70% of the women have gallstones by age 30.

Prevention

Maintain ideal body weight.

Check with your doctor before pursuing any diet for rapid weight loss.

Diagnosis

Physical examination is needed. The doctor may press on the upper abdomen to feel for an enlarged or tender gallbladder.

Ultrasound scans may be performed.

ERCP (endoscopic retrograde cholangiopancreatogram) may be done using a thin, lighted viewing tube (endoscope), which is passed down the throat into the small intestine. Contrast material is injected into the bile duct, and x-rays are taken.

How To Treat It

Cholecystectomy, or surgical removal of the gallbladder, is the treatment of choice for most gallbladder disorders and virtually prevents further attacks of gallstones by eliminating their source. Conventional abdominal surgery may be used, although increasingly, a newer procedure called laparoscopic cholecystectomy is preferred. With this method, a scope is inserted through small abdominal incisions and then used to excise the gallbladder. The technique dramatically reduces postoperative pain and recovery time.

Prior to surgery, meperidine or pentazocine is given to relieve pain. Intravenous feeding and fluids are also initiated, and antibiotics may be administered to prevent or treat an associated bacterial infection.

In patients who have acute gallbladder inflammation but are too weak for cholecystectomy, a surgical opening in the gallbladder (cholecystostomy) may be created and a tube inserted to drain the gallbladder’s contents. Complete removal of the gallbladder may be performed after the patient’s condition has improved sufficiently.

Oral ursodeoxycholic acid or chenodeoxycholic acid—bile acids that dissolve cholesterol gallstones over a period of months or years—may be prescribed. However, such therapy is effective only for small stones composed entirely of cholesterol. It is expensive and is successful less than 50% of the time. Even when it does work, there is a 30% to 50% chance that stones will recur.

A long, thin needle may be used to infuse the solvent methyl tert-butyl ether (MTBE) directly into the gallbladder via a catheter. This method dissolves cholesterol gallstones within one or two days. Again, recurrence is a possibility.

Sound-wave therapy (extracorporeal shock-wave lithotripsy) has been used with limited success to shatter some types of gallstones and avoid surgery.

Radiation or chemotherapy may be used to treat cancer of the gallbladder.

 

From Johns Hopkins Symptoms and Remedies, the complete home medical reference. You can order this book now on our secure server.

 

 


 


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2005
WHITE PAPERS
Digestive Disorders

The Digestive Disorders White Paper from The Johns Hopkins White Papers series is an annual, in-depth report written by Hopkins physicians.


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Johns Hopkins Symptoms and Remedies
An easy-to-use reference work that can help you pinpoint the cause of hundreds of symptoms, from abdominal pain to skin rash to swollen glands.

 

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