Anatomy and physiology (What is the gall bladder and what does it do?)
The gall bladder stores the bile that is made in your liver. The purpose of bile, a greenish yellow watery substance,
is to break down the fat in your food into smaller pieces that eventually get absorbed. After a meal, the gall bladder is
stimulated by hormones in your gut to empty the bile into your intestine. The bile drains out of the gallbladder into the
intestine via the cystic duct. Bile can also drain directly from the liver into the hepatic ducts. The hepatic ducts join
the cystic duct to form the common bile duct. Thus, all bile ultimately makes its way to the intestine via the common bile
duct. Bile is made up of 80% cholesterol and 20% bile salts. The bile salts act to dissolve the cholesterol and maintain bile
in liquid form.
Gallstones are solid stones that are formed in your gall bladder. Gallstones are formed either by excess cholesterol
in your body or a low amount of these dissolving bile salts. Most people who have gallstones have no symptoms and are not
even aware that they are present. Gallstone disease is usually manifested as pain after you eat, typically when you have eaten
a fatty meal. As bile is being emptied out of your gall bladder to digest the fat, the stone can begin to flow out with the
bile but not make it past the cystic duct, temporarily blocking it and causing pain. That pain is usually on the right side
where your gall bladder lies, but occasionally the pain can be in the middle of your belly underneath your rib cage or to
the left. The pain typically lasts 30 minutes to 2 hours and is often accompanied by nausea and vomiting. The pain is severe
enough to limit your activities. Shorter, isolated episodes of gallstone attacks are called “biliary colic.” The
pain of biliary colic is relieved when the stone eventually pops back into the gallbladder or gets passed through the duct.
If the stone does not pass, then the gallbladder can become very inflamed. If the pain lasts greater than 4 hours, then gallbladder
inflammation is occurring. This is it is called acute cholecystitis and will generally not get better unless the gall bladder
is removed.
Gallstones can cause other conditions such as pancreatitis, cholangitis, and small bowel obstruction if they migrate
beyond the cystic duct.
There is no known way to prevent formation of gallstones.
Who is at risk?
Populations at risk include obese
people, women, Native Americans, patients with sickle cell disease or other blood disorders.
How is it diagnosed?
Gall stones are detected and diagnosed
by ultrasound. Generally a history of typical symptoms and an ultrasound confirming the presence of gallstones is all that
is needed.
How do I prepare
for surgery?
Patients are usually admitted
the same day of surgery. The night before you will be asked not to eat or drink anything after midnight. This is to ensure
that you have an empty stomach. The surgery is done under general anesthesia meaning you will need to have a breathing tube inserted to help you breathe while you are asleep and paralyzed. Having
an empty stomach helps but does not guarantee that vomiting will be prevented. Vomiting can lead to possible aspiration (breathing
in) of stomach contents into your lungs. Irritation of the lung and possible pneumonia could result from such an aspiration
event.
