SPECIALIST IN GALLBLADDER DISEASE

Gall Stones and Other Gallbladder Diseases

The gallbladder is a small organ that stores bile made by the liver and then releases it into the small intestine during the digestion process as bile helps the body break down fat. There are a number of problems that can affect the gallbladder.

Gallstones

This is the most common problem affecting the gallbladder and is caused by the build-up of cholesterol and solidified bile to form small stones. Affecting women more commonly, in 85% of cases they cause no trouble and should be ignored.

Pain is the predominate symptom if problems do occur and this generally occurs after eating. It is felt in the upper abdomen often to the right side and can also be felt in the back. The pain, sometimes severe, generally lasts for over an hour but can last several. Fatty or rich foods are said to be more likely to trigger the pain. Some people report a more constant low grade niggle or pain but this is difficult to explain.

Other gallstone symptoms can also include:

  • nausea and vomiting
  • loss of appetite
  • fever
  • jaundice (yellow skin)
  • dark-coloured urine and pale stools
  • itching skin

Blocked bile duct

This is where a stone has fallen out the gallbladder and blocked the pipe taking bile form the liver to the small bowel. This is painful and maybe associated with yellow jaundice, pale stools and dark urine. The skin may become itchy. Whilst not an emergency it does require timely intervention in a hospital.

If infection takes hold as well then it becomes very serious and is then an emergency. Infection and sepsis is considered if there is a fever. Usually the stone can be removed under sedation by a special endoscopic camera inserted through the mouth.

Cholecystitis

This is a more severe type of gallstone problem where the gallbladder itself has become infected causing constant severe pain, fever, nausea and feeling unwell. The upper abdomen is tender to touch. This is treated with antibiotics and may require hospital admission. Sometimes jaundice accompanies this condition.

Pancreatitis

This is inflammation of the pancreatic gland that sits at the top of the abdomen towards the back. One of its roles is to secrete digestive enzymes in to the small bowel. Pancreatitis occurs if a gallstone blocks the outlet to the pancreas causing severe constant pain in the upper abdomen that is often felt in the back and is worse when moving or lying on your back. It is associated with nausea and feeling very unwell. Sometimes there is a fever.

Acute pancreatitis is a life threatening condition  and needs emergency hospital admission. There are several causes of pancreatitis although gallstones are the commonest. Excessive alcohol intake is the next biggest cause.

Tumours of the bile duct and gallbladder

Cancer of the bile ducts, known as cholangiocarcinoma, is rare. It can originate anywhere in the bile ducts, particularly in those outside of the liver. Being older or suffering from primary sclerosing cholangitis (PSC) are risk factors.

Cancer of the gallbladder is also extremely rare but important as it is very difficult to cure. It may start in a benign polyp. See below.

Gallbladder polyps

Gallbladder polyps are benign tissue growths can develop in the gallbladder but they do not cause symptoms. Although there is some doubt polyps do possibly have potential to develop into gallbladder cancer and whilst this is extremely rare it is a very serious cancer with essentially no cure.

It is therefore recommended that your polyps are monitored using an ultrasound on a annual or biannual basis. If and when they get to certain size removal of the gallbladder may be considered.

Frequently Asked Questions

Mr Stellakis will ask about your symptoms and will carry out a physical examination. He may also request an ultrasound to detect gallstones, fluid around the gallbladder or a thickening of the gallbladder wall. Blood tests may be required and further imaging tests such as CT or MRI scans may be requested. Diagnosing gallstones is very easy but the skill is in deciding whether or not they are the cause of the symptoms. If they are not the cause they should stay where they are. Sometimes other tests are arranged to rule out other causes of the patients symptoms before committing to surgery.

Each of the above gallbladder conditions are treated on their own merits as described above but the definitive treatment is to remove the gallbladder and stones to stop the problems from reoccurring. This is a keyhole operation in most case and is called a laparoscopic cholecystectomy. (hypertext).

It is advisable if you have gallbladder stones with symptoms to remain on a low fat diet whilst awaiting your surgery. This includes good fats such as avocado and olive oil as well as the unhealthy ones like fish and chips, burgers, pizzas and curries.

The gallbladder is not an essential organ and it’s possible to lead a regular life without one. Very occasionally (4% of cases) people develop long term diarrhoea after gallbladder removal. This usually improves with time and can be treated. Once you have had your gallbladder removed you can go back to eating whatever you want with impunity. People often claim that having their gallbladder removed lead to weight gain. Whilst this does happen it is not because the gallbladder is missing. It is caused solely by the patient suddenly re-adopting a high fat diet after they have been abstaining from these tasty foods whilst awaiting surgery.

If you have had an attack of cholecystitis (see above), your surgeon or Mr Stellakis may delay surgery for a few weeks to let the inflammation settle down. If possible to do this is usually a beneficial thing to do. Finally if you have stones in your bile duct tases must be removed endoscopically before your operation the remove the gallbladder.

Gallstones can be dissolved with drugs but take many months to disappear and as soon as you stop the tablets the stones and problems come back. It is only a temporising solution or useful for patients who can not have surgery. The drugs whilst safe do have side effects and are not particularly pleasant to take.

Unfortunately the answer to this question is no. Kidney stones are made predominantly of calcium which makes them hard and brittle. This means when you throw shock waves at them with a special machine (shockwave lithotripsy) the stones crumble, break down and are subsequently passed in the urine. Gallstones have very little calcium and are made up predominantly of cholesterol and bile pigment. This makes the soft and squashy so unnameable to to this form of treatment as they do not shatter when exposed to shockwaves.