Function of gallbladder and bile juice

  • Bile is a fluid made in the liver
  • Bile contains various substances including bile pigments, bile salts, cholesterol and lecithin.
  • Bile is passed into tiny tubes called bile ducts. The bile ducts join together (like the branches of a tree) to form the main bile duct.
  • Bile constantly drips down the bile ducts, into the main bile duct, and then into the gut after the stomach).
  • The gallbladder lies under the liver on the right upper side of the abdomen.
  • It is like a pouch which comes off the main bile duct and fills with bile. It is a ‘reservoir’ which stores bile.
  • The gallbladder contracts (squeezes) when we eat.
  • This empties the stored bile back into the main bile duct.
  • The bile passes along the remainder of the bile duct into the duodenum (the first part of the gut after the stomach).
  • Bile helps to digest food, particularly fatty foods.

ACUTE CHOLECYSTITIS

The medical term for gallstone formation is cholelithiasis.

  • Cholecystitis is an inflammation of the gallbladder, which can happen suddenly (acute) or over a period (chronic).
  • Most cases are caused by gallstones.
  • When a gallstone becomes stuck in the cystic duct (this is the tube that drains bile out from the gallbladder into the bile duct), bile then builds up in the gallbladder, which becomes stretched (distended).
  • The walls of the gallbladder become inflamed, and in some cases the inflamed gallbladder becomes infected.
  • An infected gallbladder is more prone to lead to complications.
  • The inflammation may settle down with treatment.
  • However, removal of the gallbladder is usually advised to prevent perforated gallbladder., which is a condition when the gallbladder bursts or leaks. It happens in rare cases but it is life threatening.

THE COMMON SYMPTOMS OF CHOLECYSTITIS

Sharp pain in the centre or right upper abdomen .

  • Low grade fever.
  • The pain may radiate (travel) to the back or to the right shoulder and tends to be worse if you breathe in deeply.
  • Jaundice (yellowing colour of the skin), may occur if gallstones are in the common bile duct.
  • You may also develop nausea (feeling sick) and vomiting

HOW IS CHOLECYSTITIS DIAGNOSED?

  • An ultrasound scan is commonly done to clarify the diagnosis
  • It can usually detect gallstones, the thickness of gallbladder and surrounding fluid accumulation if the gallbladder is infected
  • it can assess the degree of dilatation of  bile duct and biliary due to the presence of migrated gallstone causing bile duct obstruction.

WHAT IS THE TREATMENT FOR CHOLECYSTITIS?

  • Usually, you will not be allowed to eat or drink (to rest the gallbladder),
  • You will be given fluids and painkillers.
  • With this initial treatment the gallstone that caused the blockage often falls back into the gallbladder, and the inflammation and symptoms often settle down.
  • If the doctor suspects that the gallbladder has become infected, you will also be given antibiotics directly into a vein through the ‘drip’.
  • The gallbladder will usually be removed by an operation.
  • The operation is often done within a few days of being admitted to hospital.
  • Inform your surgeon if you are taking blood thinners
  • Sometimes the operation is delayed for several weeks until the inflammation has settled.
  • Different techniques to remove the gallbladder may be used depending on various factors.
  • Laproscopic surgery is now the most common way to remove a gallbladder. The medical term for this operation is laparoscopic cholecystomy.
  • Only small cuts are needed in the abdomen with small scars remaining afterwards. The operation is done with the aid of a special telescope that is pushed into the abdomen through one small cut. This allows the surgeon to see the gallbladder. Instruments pushed through another small cut are used to cut out and remove the gallbladder.
  • Some people need a traditional operation to remove the gallbladder, that is called open cholecystectomy which requires abdominal wall incision in difficult gallbladder due to severe scarring or distorted anatomy after long standing inflammation.

Laparoscopic cholecystectomy

WHAT ARE THE POSSIBLE COMPLICATIONS OF CHOLECYSTITIS?

  • In some cases the gallbladder becomes severely infected and even gangrenous.
  • This can lead to blood poisoning (septicaemia), which is very serious and can be life-threatening.
  • Other possible complications include: the gallbladder may perforate (burst), or a fistula (channel) may form between the gallbladder and gut as a result of continued inflammation.

RECOVERY AFTER A GALLBLADDER IS REMOVED

  • You do not need a gallbladder to digest food.
  • Bile still flows from the liver to the gut once the gallbladder is removed.
  • However, there is no longer any storage area for bile between meals.
  • You can usually eat a normal diet without any problems after your gallbladder is removed.
  • However, up to half of people who have had their gallbladder removed have some mild abdominal pain or bloating from time to time.
  • This may be more noticeable after eating a fatty meal.