Introduction
The gallbladder stores bile, a digestive enzyme liquid, that is constantly produced by the liver. After meals, stomach hormones make the gallbladder contract and squirt the bile down the bile duct and out into the duodenum (upper bowel) to help in digestion of fat and protein in foods. Gallstones are small (few millimetres to a few centimetres) lumps that form in our gallbladders, probably as the result of modern diets. They are very common, affecting 15-20% of the population, but most of these people will have no symptoms. Once gallstones become symptomatic, all guidelines suggest your gallbladder should be removed, as the risks of surgery are less than the risks of developing problems from your gallbladder.
Causes
Gallstones, in westernized countries like Australia, probably form as a result of our diets. Gallbladder polyps result from chronic inflammation in the gallbladder, often associated with gallstones.
Symptoms
Gallstones can cause the following symptoms:
- upper abdominal or chest pain: this is usually upper abdominal on the right or centre, and often spreads through to the back or shoulders.
- nausea / vomiting.
- belching / burping or flatulence / wind.
- intolerance of fatty foods.
- reflux / heartburn.
- jaundice (yellow eyes, black urine, pale stools).
- fever.
Gallstones can cause the following conditions:
- biliary colic: pain from the gallbladder contracting against a blockage caused by gallstones in the neck of the gallbladder.
- cholecystitis: inflammation and infection in the gallbladder, also from gallstone blockage.
- jaundice: gallstones fall out of the gallbladder and get stuck in the lower bile duct, blocking the flow of bile from the liver. Bile backs up in the blood stream, causing yellow eyes and skin and black urine.
- pancreatitis: gallstones stuck in the lower bile duct also block the pancreas duct. This can lead to a long stay in hospital, damage your pancreas permanently (resulting in diabetes and nutritional failure) and have life-threatening complications.
Gallbladder polyps can develop into gallbladder cancer, a universally fatal condition. This is why gallbladder polyps need to be watched very carefully, with a low threshold for gallbladder surgery (cholecystectomy). Guidelines suggest your gallbladder should be removed if you have gallbladder polyps larger than 6mm in diameter.
Tests
Gallstones are diagnosed by a simple and painless ultrasound scan. More advanced testing (MRCP, a type of MRI scan) may occasionally be necessary during treatment for gallstone problems. Bloods tests will also be required (Liver Functions Tests, to look for bile duct blockage and Lipase, to look for pancreatitis).
Diagnosis
Once gallstones or gallbladder polyps are diagnosed, Dr Ben Dodd will take a detailed history of your symptoms. If there is a strong connection between your symptoms and your gallstones or gallbladder polyps, Dr Dodd will recommend laparoscopic cholecystectomy (keyhole removal of your gallbladder).