Learn all about Gallbladder Disease, its symptoms, how to manage it and the precautions you can take, from an expert at Mediclinic Parkview Hospital
19 July 2020| Last updated on 21 July 2020
A Dubai-based expert breaks down gallbladder symptoms, diagnosis, treatment, risk factors, and prevention.
Gallbladder disease can be a highly uncomfortable and potentially dangerous medical condition. But what is the gallbladder and what is its function in your body?
Before experiencing pains, you may not have given this part of your body much thought.
Gallstones and other related gallbladder problems are most common in the age group between 35 to 55 years old. However, one can have this even as a newborn or in old age, with experts seeing the problem present through people in their 80’s and 90’s.
Professor Amir Nisar, Consultant Laparoscopic Surgeon and Head of the Department of Surgery at Mediclinic Parkview Hospital, offered his expertise to help you understand the signs and symptoms of gallbladder problems and how it can be treated in Dubai.
What are gallstones?
Gallstones, medically known as cholelithiasis, are small or large stones present in the gall bladder.
Gallstones can be very small or large, single or multiple. Mostly the gallstones have a smooth surface. The colour can range from pale whitish (cholesterol stones) to dark brown (Bile stones)
Bile, which causes gallstones, is a golden/yellow colour liquid produced in the liver at about 1/2 to 1 liter in a day. It leaves the liver through the tubes (right and left hepatic ducts), most of it enters the small intestine directly, some enters the gall bladder where it is concentrated.
Whenever signals are sent to the gallbladder after eating food, the gallbladder contracts and the bile from the gallbladder flows into the small bowel.
Bile helps to break the fat in food into smaller particles much like dish washing liquids cutting the grease, making it easier for water to wash it away. The digestion of fat in the gut is carried out by enzymes from the gland pancreas.
What is the gallbladder?
The gallbladder is a small pear size organ attached to the lower surface of liver under the ribs on the right side. Its capacity is only 50-70 mls. It is attached to the main tube (common bile duct) connecting the liver to the duodenum (small bowel). Its function is to store some bile.
How are gallstones formed?
There can be many reasons for the formation of gallstones in the gallbladder. Common causes include:
- Infection of gallbladder
- Infection of bile
- Poor contraction or obstruction of gallbladder
- Changes in the constituents of the bile
Pain from gallstones is triggered by eating a fatty meal. Fatty meal causes strong contraction of gall bladder on the stones. It’s like walking on a pebble beach without slippers. At times a stone may become impacted in the outlet (neck) of the gallbladder and a painful sensation will continue for a longer time.
Symptoms of gallstones
Symptoms of gallstones can vary from vague indigestion symptoms to severe pain, fever requiring immediate hospital admission.
Pain from gallstones generally occurs in the right upper abdomen and it radiates to the back between the shoulder blades. Sometimes, the pain from gallstones can just be in the upper abdomen without radiating to the back.
The pain is severe and women may often describe this as worse than labour pain.
Not all gallstones cause symptoms and many remain asymptomatic and one may not be aware of their presence. These come to light when an ultrasound (scan similar to done for pregnancy) is done for symptoms other than pain.
What happens when gallstones form inside the gallbladder?
Gallstones can cause vague symptoms such as nausea, change in taste or mild fever. According to Professor Nisar, you might also experience the following symptoms and complications of gallstones when inside the gallbladder:
Commonly observed in obese women experiencing heartburn, abdominal discomfort, belching and fatty food intolerance.
Pain / Gallstone colic
Medically termed as biliary colic. Its severe, colicky pain is mostly felt in the upper abdomen. Pain can shoot to the back or between the shoulder blades often associated with vomiting, restlessness, and sweating.
Strong pain killers, clinical assessment and sometimes admission in the hospital is required.
Dyskinesia of gallbladder (poorly contracting gallbladder)
Patients can have gallbladder pain even without gallstones. Consulting with a specialist surgical expert will help solve this mystery; which can be debilitating for patients and can take a long time to diagnose.
Infection / Inflammation
Acute Cholecystitis occurs when a gallstone gets lodged in the neck of the gallbladder, causing bile stasis leading to gallbladder inflammation.
Cholecystitis is an acute condition and can cause severe pain, vomiting, nausea, and fever. Strong pain killers, clinical assessment, blood tests, antibiotics and admission in the hospital is required.
Acalculous Cholecystitis (infection of gallbladder without any stones)
This condition is noted in very sick patients and requires the specialist input of an experienced surgeon. What may look like an inflamed gallbladder on a scan be a gangrenous gall bladder.
Blocked gallbladder / Mucocele
It occurs when a stone is completely blocking the gall bladder outlet, cutting off the cystic duct or neck of the gallbladder, but there is no infection. This leads to a distension of the gallbladder and pain.
One notices “white bile” in the gallbladder at surgery. Surgery is required in this situation.
Abscess / Empyema
It’s a completely blocked gall bladder like a mucocele with superadded infection as well. It's like an abscess, where simple antibiotics will not work.
Emergency decompression or removal of gall bladder is required after appropriate assessment by a surgeon in a hospital.
Perforation of gall bladder
Perforation (rupture) in abdominal cavity is a rare condition. Impacted stone, diabetes, or virus can cause an empyema causing gangrene of gallbladder and perforation.
High-grade fever, chills, and pain in the abdomen are common symptoms. Emergency treatment in a hospital with immediate surgery can be lifesaving in this situation.
Fistula formation (leak into another organ)
In case of chronic cholecystitis, a gallstone can erode and leak into the large bowel, leading to Cholecystoduodenal fistula or a Cholecystocolonic fistula.
This can happen silently and may come to attention while having medical tests done for any reason. Generally these can be left alone and observed if it's not giving any symptoms to the patient.
When a stone is impacted in the neck of the gallbladder or the cystic duct (and it's not causing a full blockage of the gallbladder outlet), it can continue getting bigger and can leak into the other parts of your body.
This can lead to pain, infection, jaundice or even sepsis and requires input from a specialist surgeon urgently. This should ideally be dealt with Laparoscopically and may also require an ERCP (Endoscopic Retrograde Cholangio Pancreaticography).
Small bowel Obstruction / Gallstone Ileus
A large gallstone escaping the gall bladder due to Cholecystoduodenal fistula can get impacted in the small bowel and cause a complete blockage. You will then require emergency surgery to relieve the blockage and remove the gallstone from the small bowel.
The likelihood of cancer is not common, but chronic cholecystitis or cholelithiasis can pose an increased risk of gallbladder cancer.
Gallbladder polyps and Porcelain gall bladder are also considered as risk factors for gallbladder cancer.
Complications of gallstones in the Common Bile Duct (CBD)
Though the complications are fewer than of the stones within the gallbladder, these are much more serious and potentially life threatening.
Obstruction to the bile outflow causes obstructive jaundice. The usual symptoms of jaundice include:
- Yellow skin
- Yellow eyes
- Dark colored urine
- Clay-colored stools
You will need to see a surgeon to receive proper and accurate advice and treatment. Generally, one requires ERCP and Laparoscopic Cholecystectomy.
It's the bacterial infection of common bile duct causing abdominal tenderness, chills, fever, and rigors. This is a very scary situation for the patient and requires urgent attention, admission in the hospital and antibiotic treatment with appropriate decompression of the system.
There is no greater or worse complication of gallstones than acute pancreatitis or inflammation of pancreas due to a gallstone blocking the common opening of the CBD with the pancreatic duct.
You will require emergency admission in the hospital and appropriate care, investigations and treatment.
Mild pancreatitis one may get better in a day or two. In moderate cases, a patient may lose the function of her pancreas and become diabetic for life. In some cases of severe pancreatitis, this may even be life threatening.
If you are experiencing any of these symptoms, you must see a doctor immediately.
- Nausea and vomiting
- Prolonged abdominal pain lasting more than 4 hours
- Chills and rigors
- Yellowish tinge in the white of the eyes or skin
- Clay-colored stools
- Fatty food intolerance
- Dark-colored urine
Temporary measures of managing gallbladder problems
Exercise and high-fiber, low-fat diet prevents gallstones and may reduce the pain in gallstone patients.
For gallstone patients, this is a temporary treatment option while waiting for a definitive medical intervention, which is necessary to avoid any complication.
Here are some common temporary treatments for gallbladder problems, clarified by Professor Nisar.
1. Medical Treatment
Medical treatment for gallbladder problems was once popular in the 1970s, but it was only suitable for some small stones. This method is not widely used anymore.
Medication was used to dissolve stones and had to be used for many months or a few years. Soon after stopping the medication however, patients would get stone recurrence.
2. Shock Wave Lithotripsy (SWL)
While useful in kidney stone SWL or laser treatments, they are not an option for stones in the gallbladder.
3. Olive oil remedies, mixtures as mentioned on social media
These are not recommended and can be very dangerous if a strong contraction of the gallbladder will expel the stone on the common bile duct, thus causing potential complications like acute pancreatitis, which could be life threatening.
4. Surgical Treatment
Surgical removal is the standard treatment option for gallstones. This can be offered safely in experienced hands and prevents complications and the complete removal of gallstones. Chose a good surgeon working in a decent hospital.
Operation in the form of Laparoscopic Cholecystectomy (key hole operation) is the most commonly performed surgical procedure that involves four small cuts in the abdomen. A laparoscope (a camera with light source) is introduced in the abdomen. The surgeon introduces 3 fine instruments, not much thicker than chopsticks to separate the gallbladder from the adjoining organs and remove it carefully through one of the small incisions.
Laparoscopic Cholecystectomy is a minimally invasive procedure which can done as a one-night stay in the hospital. This can be performed in some patients during the day as well.
Risks of waiting for expert medical treatment
- Acute gallbladder inflammation (cholecystitis)
- Bile duct stone (choledocholithiasis)
- Acute bacterial infection (cholangitis)
- Pancreatic infection (pancreatitis)
- Perforation of gall bladder
- Cholangitis (severe infection)
What are the surgical risk factors?
Laparoscopic Cholecystectomy is a well established procedure for more than 30 years. It is performed under full general anaesthetic. It takes a good surgeon and the team around 15 – 25 minutes to perform a standard Laparoscopic Cholecystectomy.
Prior to this, the operation of removing gallbladder was done with a long open cut just below the right ribcage. Hospital stay used to be 5-7 days after surgery and recovery would take weeks.
Risks of Cholecystectomy open or Laparoscopic are:
- Damage to the neighboring organs such as liver or intestine
- Damage to common bile duct (very serious complication)
- Postoperative infection
- Postoperative pain
No surgery should be taken lightly. When all combined, the above-mentioned risks are quoted as less than 1%. The complications mentioned can be severe, and may require a reoperation.
The complication of damage to the common bile duct is very serious indeed and much more common than generally quoted. Even in the United Kingdom, its incidence is 1:250, which unfortunately is unacceptably too high.
Gold standard treatment for gallstones
In general, laparoscopic cholecystectomy has been the gold standard for gallstone treatment. It has fewer complications, rapid recovery, less post-op pain, early mobilisation, return to driving, and early return-to-work and exercise.
Currently MiniScarLess (MSL) Cholecystectomy is an innovative procedure being offered at Mediclinic Parkview Hospital. It some further benefits over and above the conventional Laparoscopic Cholecystectomy in terms of cosmesis, less post-operative pain, early recovery and return to exercise and work.
Patient experience has been excellent after MiniScarLess (MSL) Cholecystectomy.
Professor Amir Nisar
Consultant Laparoscopic Surgeon and head of the department of surgery, Mediclinic Parkview Hospital, Umm Suqeim Road, Dubai.
Professor Amir has 30 years’ experience of Laparoscopic surgery and he is a teacher and trainer in the United Kingdom, Europe, Middle East and Asia in Gall Bladder disease surgery