Gallstone Disease

Gallstone disease results from the accumulation of stones within the gallbladder, known as gallstones which can cause a blockage of the normal bile flow from the gallbladder into the bile duct. The gallbladder is a pear-shaped organ which lies under the liver as a branch of the main bile duct. Bile is a substance produced by the liver that is stored in the gallbladder and used for digestion to help us adequately digest fat and oils that are part of our diet. It is not known why some people develop gallstones while others do not. Most gallstones are formed of cholesterol and bile salts. Certain conditions produce gallstones more frequently than other conditions. Gallstones are particularly common after or during weight loss and after pregnancy. Certain ethnic groups have a very high rate of gallstone disease as can be seen in so many Indian tribes of the Southwest where almost 100% of the women in these groups suffer from gallstone disease.

Symptoms

Most patients with gallstone disease suffer from what is called biliary colic. This refers to pain which occurs in the right side of the abdomen under the right rib cage after meals when a gallbladder contracts and the stones within it are forced into the bile duct system causing a blockage. This pain can last for a few minutes to several hours. If the stone does not dislodge from the bile duct, a condition leading to significant gallbladder inflammation can occur resulting in acute cholecystitis. In this situation the gallbladder becomes infected and the patient suffers from fever, chills and right upper quadrant pain. Patients in this setting usually require surgery to remove the infected gallbladder. Surgery is often recommended for patients who suffer recurrence attacks of biliary colic in an attempt to prevent further complications. Patients can develop jaundice (yellow discoloration of the skin and dark urine) because of gallstones, if the common bile duct is blocked, not allowing bile flow into the intestines. Other symptoms attributable to gallstone disease include indigestion, nausea and some mild abdominal pain, particularly after meals.

Diagnosis and Treatment

Gallstones can be easily diagnosed by an abdominal ultrasound, or sonographic (sound wave test) examination. These tests can determine if gallstones are just within the gallbladder and also help determine if there are any stones blocking the bile duct or causing any swelling of the gallbladder itself. Other tests which can be employed to define gallstone disease include nuclear medicine studies or hepatobiliary scans to see if the gallbladder contracts properly and to ensure that there is no complete blockage of the bile passage to the intestine. Endoscopy is also frequently used to help define the extent of damage from gallstones by using the technique of endoscopic retrograde cholangiopancreatography (ERCP). During ERCP a thin video camera is placed in the mouth and passed into the stomach and then into the small intestine at the point of the bile duct into the intestine. A catheter is then threaded into the bile duct through the intestine and dye is injected into the bile duct system to help define the location of gallstones and potentially the location of any blockages within the gallbladder and bile duct system. Gallstones can frequently be removed from the common bile duct through this technique and limit the extent of surgery. MRCP (magnetic resonance cholangiopancreatography) uses an MRI scan to evaluate the bile and pancreatic ducts. It does not require insertion of a scope but can not perform therapeutic maneuvers, such as, removing stones.  Medication also exists to help dissolve gallstones, but this usually takes several months to be effective and requires long-term use. Medications are usually reserved only for those patients in whom surgery or endoscopy is felt to be too high risk. Most surgical methods of removal of the gallbladder today are done using a laparoscopic technique, known as laparoscopic cholecystectomy. Many patients refer to this technique as a laser surgical technique in which several small incisions are made on the abdominal wall to remove the gallbladder, rather than one large incision. The laparoscopic cholecystectomy technique has been very beneficial to patients by allowing them to recover quicker from surgery and return to work and normal activity at a quicker rate as compared to previous surgical methods.