Gall Bladder Disease

The gallbladder (or cholecyst) is a pear-shaped organ that stores about 50 ml of bile (or "gall") until the body needs it for digestion. The gallbladder is about 7-10cm long in humans and is dark green in appearance due to its contents (bile), not its tissue. It is connected to the liver and the duodenum by the biliary tract.

Role in disease

Cholestasis

Cholestasis is the blockage in the supply of bile into the digestive tract. It can be "intrahepatic" (the obstruction is in the liver) or "extrahepatic" (outside the liver). It can lead to jaundice, and is identified by the presence of elevated bilirubin level that is mainly conjugated.

Up to 25% of all people have gallstones (cholelithiasis), composed of cholesterol, lecithin and bile acids. These can cause colicky shooting abdominal pain, usually in relation with the meal, as the gallbladder contracts and gallstones pass through the bile duct. Surgery (cholecystectomy, removal of the gallbladder) is the most common treatment for gallstones. It can be performed laparoscopically, and it is in fact one of the most common procedures done through the laparoscope.

People traditionally considered at an increased risk of cholelithiasis are people who are 5 F's:

• Female
• Fat (obesity)
• Fair (Caucasian, but this is disputed by recent studies)
• Forty (middle-aged)
• Fertile (the risk is increased in pregnancy)

Cholecystitis

Acute or chronic inflammation of the gall bladder causes abdominal pain. 90% of cases of acute cholecystitis are caused by the presence of gallstones.

Choledocholithiasis

When gallstones obstruct the common bile duct, the patient develops jaundice and liver cell damage. It is a medical emergency, requiring endoscopic or surgical treatment.

Gallstone ileus

A rare clinical entity is ileus (bowel obstruction) by a large gallstone, or gallstone ileus. This condition develops in patients with longstanding gallstone disease, in which the gallbladder forms a fistula with the digestive tract. Large stones pass into the bowel, and generally block the gut at the level of Treitz' ligament or the ileocecal valve, two narrow points in the digestive tract. Therapy is surgical.