Gallbladder & Gallstone disease

Gallstone disease is very common within the western world. Gallbladder removal surgery is one of the most common general surgical procedures performed in our society. 20% of the populations have some degree of gallstones or sludge, although only 1% of that population will manifest with symptoms at a given time.

Gallstones are formed when there is an imbalance between the bile constituents. These are bile salts, lecithin and cholesterol. Diet and genetics are two of the most common reasons for gallstone formation.

Gallstone related symptoms are typically located at the right upper abdomen. They generally manifest as pain. Other symptoms often experienced include nausea, vomiting, intolerance to certain foods (particularly high fat content), heartburn and even bloating.

Gallbladder Pain (Biliary Colic)

Typically if the pain is of a short duration (less than 24 hour) and they disappear completely, they are classified as biliary colic or biliary pain. If the pain becomes continuous beyond 24 hours, it indicates that the gallbladder is now inflamed. Many patients with hindsight will note that there have been tell-tale symptoms before a major episode. These are often the “indigestion” or pain after heavy or oily meals typically in the evenings.

Gallbladder Polyps

As the gallbladder developed from the gastrointestinal tract (embryonic origin), it has the potential to develop polyps similar to the stomach, small bowel and the colon. As the risk of cancer is very small, true polyps of the gallbladder less than 1 cm generally do not require removal. What is important is that patients should not have any symptoms described above. If surveillance is required, serial ultrasounds are required at regular intervals to ensure that there is no change in the size and characteristics of the polyp. Sometimes, it can be difficult and confusing if there were more than 1 polyp to maintain ongoing surveillance. In some cases, the patient can elect to have this treated in a non-urgent setting.

Investigations

Some of these investigations may be required prior to surgery

• Abdominal ultrasound scan
• Blood test especially for the liver and its function
• Other less common investigations include
  
  • HIDA scan – This evaluates the function of the gallbladder
  • MRI-MRCP –  This evaluates the connections of the liver and gallbladder