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.
nausea and vomiting accompanying the attacks of pain.
and chills (gallbladder inflammation).
fullness or bloating.
belching, heartburn, and gas.
loss (cancer of the gallbladder).
When To Call Your Doctor
a doctor if you develop severe abdominal pain.
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 formationknown as cholelithiasisis
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.
a high-calorie diet, very rapid weight loss, Crohn disease, cirrhosis,
hemolytic disorders, or intestinal surgery increases the risk
oral contraceptives, or estrogen therapy may provoke the development
of gallstones in women.
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.
are associated with a higher risk of gallbladder cancer.
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.
your doctor before pursuing any diet for rapid weight loss.
is needed. The doctor may press on the upper abdomen to feel
for an enlarged or tender gallbladder.
scans may be performed.
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
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.
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 gallbladders
contents. Complete removal of the gallbladder may be performed
after the patients condition has improved sufficiently.
acid or chenodeoxycholic acidbile acids that dissolve cholesterol
gallstones over a period of months or yearsmay 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.
therapy (extracorporeal shock-wave lithotripsy) has been used
with limited success to shatter some types of gallstones and
chemotherapy may be used to treat cancer of the gallbladder.
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