Gallbladder or Bile Disorders
What is “bile”?
The ‘bile’ is a greenish-yellow fluid produced by the liver that helps digestion. Through narrow tubular canals (“biliary system” that consists of the organs and ducts (bile ducts, gallbladder, and associated structures)), the bile is collected in the gallbladder, a pear-shaped organ that is located below the right side of the liver.
After each meal, especially with a lot of fat, the gallbladder contracts and sends, through other canals, the bile to the small intestine where the digestion of food takes place i.e. your liver makes a powerful digestive fluid that is called bile. Next, the bile passes to the gallbladder which concentrates and stores it for later use. Bile helps break down the food you eat and the most important role is breaking down fats. The gallbladder that is also known as “bile” is the organ that is removed in the cholecystectomy (or gallbladder removal surgery).
What are the most common problems of the gallbladder?
If the bile remains in the gallbladder for too long then this predisposes the formation of stones, mainly in people over the age of 40, especially in obese women or women who have had more than one pregnancy. These stones – gallstones – are responsible for a number of pathological conditions:
Biliary colic (intermittent duct blockage). The mildest and most common symptom of gallbladder disease is intermittent pain called biliary colic. Typically, a patient experiences a steady gripping or gnawing pain in the upper right abdomen when a gallstone blocks the bile duct, the tube that normally drains bile from the gallbladder to the small intestine. The pain goes away if the stone passes into the small intestine and unblocks the duct. Over-the-counter pain medications can help alleviate discomfort during episodes.
Acute cholecystitis. Acute cholecystitis is inflammation of the gallbladder which causes severe pain in the right upper abdomen and fever.
The recommended treatment for acute cholecystitis usually involves a hospital stay to control the inflammation in your gallbladder. Sometimes, surgical removal of the gallbladder is needed.
Obstructive jaundice. A gallstone passes from the gallbladder into the tube that transfer bile to the small intestine (bile duct), causing pain and intense “yellowing” of the skin’s patient (jaundice). Hospitalization is required until the jaundice subsides and then the bile must be removed. A Magnetic Resonance Cholangiopancreatography (MRCP) of the area is always performed and if the jaundice does not subside then the patient is first subjected to a special examination that is called Endoscopic Reverse Cholangiopancreatography (ERCP) and finally to a surgical removal.
(Gallstone or Biliary) Pancreatitis. In gallstone pancreatitis, (also called biliary pancreatitis,) a gallstone is blocking the pancreatic duct. The blockage causes inflammation to pancreas, which is initially manifested by pain and vomiting. Depending on the case, this condition may be very simple but also very serious and even lead to death. Hospitalization and intensive medical monitoring and care are required.
What are the diagnostic tests for gallbladder disorders?
In addition to the patient’s history and clinical examination, the most useful diagnostic test is ultrasound. Ultrasound is a diagnostic test that gives the most important information about gallbladder diseases. In special cases, Computed Tomography (CT), Magnetic Resonance Cholangiopancreatography (MRCP) and Endoscopic Reverse Cholangiopancreatography (ERCP) can be particularly useful.
What is the treatment of Chololithiasis (Gallstones)?
Gallstones can’t go away on their own. However, if they are too small they can move to the intestine and pancreas. Chololithiasis (commonly gallstones) can be temporarily treated with dietary adjustments, such as reducing fat intake. However, this treatment has limited and short-term success rates. Symptoms will eventually return unless the gallbladder is removed. Surgical removal of the gallbladder is the safest treatment in the majority of cases. Gallbladder surgical removal (cholecystectomy) is one of the most frequently performed surgical procedures. Today, cholecystectomy is almost always performed laparoscopically (with laparoscopic cholecystectomy)
Is gallbladder surgery always performed laparoscopically?
Yes, gallbladder surgery is almost always performed laparoscopically.
Laparoscopic cholecystectomy is now accepted of being safe (depending on the experience of the surgeon) even in cases of severe inflammation of the organ, such as gangrenous gallbladder.
In a very small percentage of patients, conversion to open surgery (open cholecystectomy) is required due to special conditions such as severe adhesions from previous abdominal operations. This percentage ranges from 1-10% depending on the experience of the surgeon in laparoscopic surgery.
Laparoscopic cholecystectomy has become the standard, accepted, and preferred technique for the treatment of gallbladder stones as it has many important advantages such as minimal surgical trauma and blood loss, shorter hospital stay, quick recovery and rapid return to work, minimal postoperative pain, fewer complications compared to trauma, fewer respiratory and cardiovascular complications, etc.
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