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Gallbladder Disease

Disease of Gallbladder

Gallbladder disease is an umbrella term for diseases affecting the gallbladder, which is a pear shaped organ located beneath the liver. Inflammation that causes irritation to the wall of the gallbladder causes its disease to set in.


Presentation

In many instances, individuals with gallbladder diseases often experience no signs and symptoms. In case they do, the following symptoms are experienced [6]:

  • Individuals with gallstones complain of pain in the upper portion of the abdomen, decreased appetite, nausea accompanied by vomiting and development of pain soon after eating.
  • In condition of hydrops, there is severe sepsis along with shock like states.
  • The condition of cholangitis presents with fever, development of jaundice and pain in the upper quadrant region. Sometimes, the condition can also mimic signs and symptoms of cholecystitis
  • Patients suffering from cholecystitis often complain of persistent pain in the epigastric region, fever, nausea accompanied by vomiting and anorexia.
Abdominal Pain
  • Abstract Imaging of the gallbladder has a key role in the examination of patients with abdominal pain-especially pain localized to the right upper quadrant.[ncbi.nlm.nih.gov]
  • Ninety-nine patients with right-sided upper abdominal pain were studied after the intravenous injection of 99Tcm-pyridoxylideneglutamate. In addition, contrast radiology was performed in 87 of these.[ncbi.nlm.nih.gov]
  • Abstract Gallbladder disease (GBD) is a common cause of upper abdominal pain. Prevalence of GBD increases with age, and is more common in women than men.[ncbi.nlm.nih.gov]
  • Symptoms of gallbladder disease include: Abdominal pain after meals Fever Jaundice (yellowing of the skin and whites of the eyes) Right upper quadrant abdominal pain Diagnosis of Gallbladder Disease If your child experiences symptoms of gallbladder disease[rileychildrens.org]
  • Patients with acute cholecystitis will have a persistent right or upper abdominal pain, and fever. This pain can be made worse by movement or coughing. Nausea and vomiting are also common.[healthxchange.sg]
Biliary Colic
  • While cholecystectomy for FGBD appears safe, the outcomes are comparable to cholecystectomy for biliary colic and thus are not without risk. Copyright 2016 Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • DISCUSSION: Biliary colic and acute cholecystitis are best treated with early laparoscopic cholecystectomy.[ncbi.nlm.nih.gov]
  • In the setting of biliary colic, total bilirubin was highly predictive of CBD stones with a positive predictive value of 85%.[ncbi.nlm.nih.gov]
  • Acute cholecystitis or biliary colic may be associated with angina pectoris, arrhythmias, or nonspecific ST-T wave changes on the electrocardiogram. A vagally mediated cardio-biliary reflex is the presumed cause of these changes.[ncbi.nlm.nih.gov]
  • METHODS: Adults admitted to hospital with a first episode of biliary colic or acute cholecystitis were randomized to an early intervention group (36 patients, operation within 72 h of admission) or a conventional group (36, elective cholecystectomy 3[ncbi.nlm.nih.gov]

Workup

In order to diagnose gallbladder disease, a preliminary examination through abdominal examination should be conducted. This would give information about the exact location of pain in the abdomen along with presence of tenderness if any. Following this, various other diagnostic procedures would also be required, which would include [7]:

  • Medical history: A detailed medical history of the patient is gathered in order to obtain a family medical profile. Heredity is one of the major factors for gallbladder disease which would serve as an important clue in the diagnosis.
  • Physical examination: A physical examination of the abdomen is necessary including Murphy’s signs. Such a type of method would shows signs of palpable gallbladder which would suggest gallbladder disease.
  • Imaging studies: Chest and abdomen X-ray would be done to diagnose pneumonia and cholecystitis. Ultrasonography is also indicated to detect presence of gallstones, thickening of the walls and other problems with the gallbladder [8].

Treatment

In gallbladder diseases, wherein there is no presence of stones, but signs of inflammation are evident, antibiotics form the basis of treatment regime. However, when there are recurrent bouts and no signs of improvement are present then surgery is recommended [9].

In many instances it has been seen, that surgical removal of the gallbladder is the best option. Surgical procedures are carried out using 2 methods: either opening up the abdomen or laprocospically. Method involving the latter procedures enables faster recovery and leaves minimal scars as only 3 holes are made to conduct the method. This is the preferred method, when there are no urgent complications that need immediate attention [10].

Prognosis

Prognosis of the condition is favorable with prompt treatment regime. Gallstones can occasionally cause pain if they temporary block the passage of the bile duct. When there is permanent blockage, the condition can turn life threatening indicating immediate removal of the organ [5].

Etiology

Development of gallstones is one of the major types of gallbladder disease, having a high incidence rate. Gallstones form when substances in the bile form hard particles which can be the size of a grain up to that of a golf ball. Women after pregnancy are at an increased risk of developing gallstones. Women who have undergone hormone replacement therapy are also in the risk category. In addition to these, other risk factors that significantly contribute towards gallbladder disease include faulty dietary habits, heredity, obesity and slow intestinal transit [2].

Epidemiology

Gallbladder disease has become a relatively common phenomenon, affecting about 20 million Americans. The incidence of cholelithiasis is estimated to be about 0.15% to 0.22% amongst the pediatric population [3].

Gallbladder cancer is a rare occurrence in the developed countries. In US, an estimated 5000 cases occur each year. Amongst the developing countries, the incidence of gallbladder cancer is higher in South American Indian and North Indian population.

Sex distribution
Age distribution

Pathophysiology

Anatomically, the gallbladder is a pear shaped organ located beneath the liver. Its major function is to store bile juice, which is essential for digestion of fats in the small intestine. The gallbladder releases the bile through the bile duct. This is a tube like structure that connects the gallbladder and liver to the small intestine.

Gallbladder disease may set in, when there is some kind of physical obstruction that takes place preventing the flow of bile through the duct. As a result of this phenomenon, there is inflammation accompanied by irritation in the wall of the gallbladder. Problems related to the gallbladder get corrected once the organ is removed [4].

Prevention

Diet plays a major role in prevention of gallbladder disease. Individuals who adhere to a balanced diet rich in omega 3 fatty acids, fruits, vegetables and nuts are at a lowered risk of developing gallbladder disease. Foods rich in fat and simple sugars significantly increase the risk of the disease.

Summary

Diseases of the gallbladder are common worldwide. A type of condition, wherein the gallbladder undergoes inflammation is termed as cholecystitis. It occurs when there is development of gallstones that significantly obstruct the bile ducts. This can eventually lead to occurrence of gangrene or necrosis. In addition to cholecystitis, other gallbladder diseases include primary sclerosing cholangitis (PSC), cancer of the gallbladder, biliary enteric fistulas and gallbladder polyps [1].

Patient Information

  • Definition: Gallbladder disease is a condition that affects the functioning of the gallbladder. The primary function of the gallbladder is to store bile that is primarily produced in the liver and used for digestion of fats.
  • Cause: Development of gallstones blocks the bile duct, obstructing its way and paving way for onset of gallbladder disease. Women are at an increased risk of contracting this disease condition than males. Faulty dietary habits and being overweight and obese predisposes an individual to develop gallbladder disease.
  • Symptoms: Several types of gallbladder disease often share similar signs and symptoms. Individuals with cholestatis, suffer from jaundice, dark colored urine, splenomegaly and hepatomegaly. In case of cholelithiasis, individuals suffer from abdominal pain along with pain in the epigastric region. In conditions of cholecystitis, there is fever, followed by pain in upper quadrant region and development of jaundice.
  • Diagnosis: Preliminary physical examination of the abdomen forms the basis of the diagnostic procedure. In addition, a detailed medical history would be carried out to elicit information of family history of the disease. In addition, X-ray of the abdomen and chest would also be required to detect any underlying disease condition. Ultrasonography is also indicated in diagnosis of gallbladder disease.
  • Treatment: Antibiotics form the preliminary treatment regime if there are signs of inflammation and no evidence of gallstones is present. When antibiotics do not work, then surgery is the last resort.

References

Article

  1. Barie PS, Fischer E. Acute acalculous cholecystitis. J Am Coll Surg 1995; 180:232.
  2. Williams CI, Shaffer EA. Gallstone disease: current therapeutic practice. Curr Treat Options Gastroenterol. Mar 2008;11(2):71-7.
  3. Holcomb GW. Gallbladder disease. In: O'Neill JA, Grosfeld JL, Fonkalsrud EW, Coran AG, Caldmone AA, eds. Principles of Pediatric Surgery. Vol 1. 2nd ed. St. Louis, MO: Mosby; 2003:67: 645-651.
  4. Kalloo AN, Kantsevoy SV. Gallstones and biliary disease. Prim Care 2001; 28:591.
  5. Sarmiento RV. Emphysematous cholecystitis. Report of four cases and review of the literature. Arch Surg 1966; 93:1009.
  6. Stringer MD. Informed consent and choice in cholecystectomy. Pediatr Surg Int. Oct 2004;20(10):741-3.
  7. Kalimi R, Gecelter GR, Caplin D, et al. Diagnosis of acute cholecystitis: sensitivity of sonography, cholescintigraphy, and combined sonography-cholescintigraphy. J Am Coll Surg 2001; 193:609.
  8. Barakos JA, Ralls PW, Lapin SA, et al. Cholelithiasis: evaluation with CT. Radiology 1987; 162:415.
  9. Sicklick JK, Camp MS, Lillemoe KD, et al. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg. May 2005;241(5):786-92; discussion 793-5.
  10. Siddiqui S, Newbrough S, Alterman D, Anderson A, Kennedy A Jr. Efficacy of laparoscopic cholecystectomy in the pediatric population. J Pediatr Surg. Jan 2008;43(1):109-13; discussion 113

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Last updated: 2019-07-11 21:19