Overview

 

Cholecystectomy is the removal of the gallbladder. The gallbladder is a small pear-shaped organ located beneath the liver on the right side of the abdomen. It stores bile that is released when you eat, to help digest fatty food.

The gallbladder is connected to the liver and the small intestine by a series of ducts or tubes that carry bile. This is known as the biliary system. Bile is a yellow-brown fluid produced by the liver. In addition to water, bile contains cholesterol, lipids (fat), bile salts and bilirubin (bile pigment that gives bile and stools their color). The liver can produce as much as three cups of bile in one day.

What are gallstones?

Gallstones are pieces of solid material that form in the gallbladder. They are formed by substances in the bile, primarily bile pigments and cholesterol. There are two types of stones. The most common gallstone is a cholesterol stone. They are usually white or yellow and account for about 80% of all gallstones. They are primarily made of cholesterol. The other type of stone is a pigmented stone. They account for the other 20% of gallstones.

Gallstones can vary in size and may be as small as a grain of sand or as large as a golf ball. The gallbladder may develop a single, often large stone, or many (hundreds) of small stones.

What causes gallstones?

 It is believed that gallstone formation is influenced by a number of factors, including:

  • Inherited body chemistry
  • Body weight
  • Gallbladder movement
  • Possibly diet
  • Female gender

Cholesterol gallstones develop when bile contains too much cholesterol and not enough bile salts. Important in gallstone development is how often and how well the gallbladder contracts to empty out bile. If the bile does not completely empty then it can become over concentrated, causing crystals to form, leading to stone formation. Also, important is the presence of proteins in the liver and bile that either can assist or limit cholesterol crystallization into gallstones.

Other factors also play a role in gallstone formation, however it is not clear how. Obesity has been shown to be a major risk factor for gallstones. Also, very low calorie, rapid weight-loss diets and prolonged periods of not eating seem to play a role.

In addition, increased levels of the hormone estrogen as a result of pregnancy, hormone therapy, or the use of birth control pills, may increase cholesterol levels in the bile and also decrease gallbladder movement, resulting in gallstone formation. Gallstones are much more common in women.

There is no clear relationship between diet and gallstones. However, low-fiber, high-cholesterol diets, and diets high in starchy foods have been suggested as contributing to the formation of gallstones.

Pigment stones are usually associated with patients that have certain risk factors such as cirrhosis, biliary tract infections and hereditary blood cell disorders, such as sickle cell anemia.

Who gets gallstones?

More than an estimated 20 million people in the United States have gallstones. Those most likely to develop gallstones are:

  • Women between 20 and 60 years old (more than twice that of men)
  • Men and women over 60 years old
  • Pregnant women or women on estrogen therapy or birth control pills
  • Men and women who are overweight
  • People who go on "crash" diets or who lose weight quickly

Most people with gallstones do not have any symptoms. They are sometimes found on x-rays, sonograms or CT Scans for other illnesses. Surgery is not usually done for gallstones that are not causing symptoms.

What are the symptoms?

Patients refer to the symptoms often as "gallbladder attacks". An attack usually consists of steady, severe pain in the upper abdomen most often under the rib cage on the right side. Attacks can last for 20 or 30 minutes but often last for 2 or 3 hours. Other symptoms associated with an attack are:

  • Pain in the back, especially between the shoulder blades
  • Right shoulder pain
  • Nausea and/or vomiting
  • Bloating
  • Chronic indigestion or "heartburn"

Sometimes gallstones make their way out of the gallbladder and into the cystic duct, the channel that connects the gallbladder to the main duct or tube that carries the bile to the small intestine. If a stone gets into this channel and blocks the flow of bile then cholecystitis, inflammation of the gallbladder, can develop.

Another problem that may occur is when the gallstone gets out of the gallbladder, passes down the cystic duct and becomes lodged in the bile ducts that lead from the liver to the small intestine. This can block the flow of bile from the liver and the gallbladder causing pain and jaundice (yellowing of the skin). Gallstones in this duct can also block the flow of digestive juices from the pancreas that empty into the small intestine, leading to inflammation of the pancreas, known as pancreatitis.

If any of the ducts become blocked for a long period of time it can cause serious damage to the gallbladder, liver, or pancreas. Warning signs include: fever, jaundice, "Coca-Cola colored" or black urine, white bowel movements, severe nausea with vomiting, and severe and steady pain in the right upper abdomen that does not resolve on its own.