Understanding the Gallbladder and Gallstones

The gallbladder is a small, pear-shaped organ located beneath the liver on the right side of the abdomen. It serves as a reservoir for bile, a digestive fluid essential for breaking down fats. While the liver produces approximately 1000 mL of bile per day, the gallbladder has a storage capacity of about 50 mL.

What is Bile?

Bile is a greenish-yellow fluid composed of:

• Cholesterol
• Bilirubin
• Bile salts

Bile travels from the liver through small channels into the common bile duct, which delivers it into the duodenum (the first section of the small intestine), where it aids digestion.

Functions of Bile

• Aids in fat digestion and absorption
• Helps in the excretion of bilirubin, drugs, and toxins

A hormone called cholecystokinin (CCK) stimulates the gallbladder to contract, releasing bile into the intestine. The gallbladder consists of three sections: the fundus, body, and neck.

Gallstones: A Common Problem

What Are Gallstones?

Gallstones are solidified deposits of bile components that form inside the gallbladder. They occur when the gallbladder is malfunctioning or diseased.

Key Facts:

• About 40% of people are affected by gallstones.
• 80% of gallstone carriers remain asymptomatic.
• 1-2% of asymptomatic individuals develop symptoms annually.
• Complications such as cholecystitis, choledocholithiasis, pancreatitis, and cholangitis occur at a rate of 0.1%–0.3% per year.

Gallstones develop due to:

• Excess cholesterol in bile, leading to crystal formation.
• Sluggish bile emptying from the gallbladder.
• Biliary obstruction due to strictures or tumors.

Size & Variation of Gallstones

Gallstones can vary in number and size:

• Some patients may have hundreds of tiny stones.
• Others may develop one large stone up to 5 cm.

Regardless of size, symptomatic gallstones require timely intervention to prevent complications.

Types of Gallstones

Cholesterol Gallstones (Most Common – Yellow/White)

• Form due to excess cholesterol and poor gallbladder contraction.
• Consist primarily of cholesterol but may contain other elements.

Pigment Gallstones (Dark Brown/Black)

• Develop when bile contains too much bilirubin.
• More common in patients with liver disease.

Mixed Pigment Stones

• Contain calcium compounds, cholesterol, and bile.
• Can lead to chronic gallbladder disease.

Causes of Gallstones

There are three main reasons gallstones develop:

1. Excess Cholesterol: The liver produces more cholesterol than bile can dissolve, leading to crystal and stone formation.
2. Excess Bilirubin: Liver diseases, infections, and blood disorders increase bilirubin levels, promoting gallstone formation.
3. Poor Gallbladder Emptying: Stagnant bile thickens over time, creating stones.

Who Is at Risk?

Certain factors increase the likelihood of gallstones:

• Pregnancy (Progesterone slows gallbladder contraction)
• Obesity (Higher cholesterol secretion in bile)
• Genetics (Family history of gallbladder disease)
• Hormone Therapy (Estrogen increases gallstone risk)
• Female Gender (Estrogen alters bile composition)
• Diabetes and Metabolic Syndrome (Impaired gallbladder function)
• Rapid Weight Loss (Can disrupt bile composition)
• Bariatric Surgery and Prolonged Fasting (Bile stasis leads to gallstones)
• Crohn’s Disease and Liver Disorders (Affect bile metabolism)

Symptoms of Gallstones

• Silent Gallstones: Many individuals remain unaware they have gallstones unless symptoms develop.
• Biliary Colic: Pain occurs when a gallstone blocks the bile duct or gallbladder neck.

Common Symptoms Include:

• Sharp pain in the upper right abdomen or beneath the breastbone.
• Pain after consuming greasy food.
• Epigastric pain radiating to the mid-back or right shoulder.
• Nausea, vomiting, and bloating.

Complications of Gallstones

Diabetics Are at Higher Risk
Gallstones in diabetics can cause severe infections due to poor blood circulation, leading to gangrene, sepsis, and organ damage.

Major Complications:

• Cholecystitis (Gallbladder Inflammation) – Severe pain and infection due to bile blockage.
• Choledocholithiasis (Bile Duct Obstruction) – Can result in jaundice and infection.
• Pancreatitis – Occurs when gallstones block the pancreatic duct.
• Gallbladder Cancer – 80% of gallbladder cancer cases involve gallstones.
• Perforated Gallbladder – A rupture leading to life-threatening infection.
• Empyema – Pus formation inside the gallbladder.
• Cholangitis – Infection and inflammation of the bile ducts.
• Gallstone Ileus – Blockage in the intestine caused by gallstones.

Diagnosis of Gallbladder Stones

• Abdominal Ultrasound – Best method for detecting gallstones.
• HIDA Scan, ERCP, MRCP – To evaluate bile duct obstructions.
• Blood Tests (Liver Function, CBC, Procalcitonin, Lipase) – Identify infections and complications.

Treatment Options for Gallstones

• Asymptomatic Gallstones: Usually do not require treatment unless complications arise.
• Symptomatic Gallstones: Require elective laparoscopic surgery for a safer, faster recovery.

Laparoscopic Cholecystectomy (Gold Standard Treatment)

• Minimally invasive with only four small incisions.
• Faster recovery and minimal post-op discomfort.

Advantages of Laparoscopic Gallbladder Surgery

For Surgeons:

• Better visualization of the gallbladder.
• Enhanced precision with a magnified view.

For Patients:

• Minimal pain and faster recovery.
• Same-day discharge for many patients.
• Resume work within a week.
• Less financial burden compared to open surgery.

Early elective surgery is safer and prevents life-threatening complications.

Pre-Surgery and Post-Surgery Instructions

Before Surgery:

• Six to eight hours fasting required.
• Routine blood tests and anesthesia evaluation.
• Stop blood thinners like aspirin and warfarin as advised.

After Surgery:

• Light activities within a day.
• Normal diet within 24 hours.
• Resume work in five to seven days.
• Avoid lifting heavy objects for four to six weeks.
• Complete recovery from open gallbladder surgery may take up to six weeks.