The gallbladder is a pear-shaped organ that is connected to the common hepatic duct which drains bile from the liver. Bile is a yellow-green liquid, composed of water, lecithin, cholesterol, bile salts, and bilirubin. The gallbladder stores and concentrates bile produced by the liver. The bile is then released into the common bile duct and released into the duodenum where it helps with the digestion of fats and certain waste products.

Occasionally stones may develop in the gallbladder or bile duct due to an imbalance of cholesterol, bile salts or bilirubin in the bile. These stones can lead to a blockage of the normal flow of the bile from the gallbladder or bile duct causing severe pain in the upper abdomen. Furthermore, stone formation may produce gallbladder inflammation, a condition known as cholecystitis. Inflammation of the gallbladder without the presence of stone formation is called acalculous cholecystitis and is often caused by prolonged fasting and severe illness amongst other reasons. In rare cases, gallstone formation may be associated with cancer development in the gallbladder and bile ducts.

GALLSTONES

Based on their composition, gallstones can be categorized as cholesterol stones, pigmented stones or mixed stones.

Sometimes gallstones are unnoticeable (asymptomatic) and do not need treatment, however most commonly gallstones produce pain and/or nausea. In these circumstances, the gallbladder is best removed. The surgical removal of the gallbladder (cholecystectomy) usually does not affect the normal functioning of the body. A small proportion of patients develop loose bowel motions after the surgery however this usually settles within 1-2 months and can be improved by avoiding fatty foods for a short period after the surgery.

RISK FACTORS

There are various risk factors that may result in the development of gallstones, including:

• Obesity

• Rapid weight loss
  This increases the fat metabolism of the body causing excessive cholesterol secretion by the liver.

• Prolonged fasting

• Elevated oestrogen levels

  • This occurs during pregnancy and while taking hormone replacement therapy or birth control pills. It is thought to be related to the development of increased cholesterol levels.

• Gender

  • Women are more prone to gallstone formation than men.

• Ethnicity

• Cholesterol-lowering medications

• Sedentary lifestyle with less physical activity

• Conditions: Dyslipidaemia, anaemia, sickle-cell disease, thalassaemia, hereditary spherocytosis, elliptocytosis

SYMPTOMS

Gallstones may not cause any symptoms but when symptoms occur, they usually are sudden and often referred to as a "gallbladder attack".

Typical symptoms include:

• Severe abdominal pain

• Back pain near the shoulder blades

• Nausea and vomiting

• Abdominal bloating and belching

• Intestinal colic

• Stomach upset

DIAGNOSIS

Gallstones and cholecystitis (inflammation of the gallbladder) can be easily diagnosed with an ultrasound scan. Other possible investigations include endoscopic ultrasonography, cholescintigraphy (HIDA scan), CT scan, Endoscopic retrograde cholangiopancreatography (ERCP) or MRI scanning (MRCP).

TREATMENT

Gallbladder surgery is considered the best option for symptomatic gallstone disease. Most people can live a normal life without their gallbladder. Following removal of the gallbladder, the bile ducts become slightly more dilated to accommodate the additional amount of bile required during consumption of a fatty meal.

The operation to remove the gallbladder is called a cholecystectomy and is usually performed laparoscopically (keyhole surgery). In laparoscopic gallbladder surgery, small incisions are made to insert surgical instruments, along with a video camera (laparoscope) that has a light on the end. The laparoscope helps to locate the gallbladder and tiny instruments are used to surgically remove it.

Gallbladder surgery may require an overnight stay in the hospital. During the surgery, an X-ray is taken of the bile duct (Intraoperative cholangiogram) to assess whether there are any stones in the bile duct. If stones are encountered, they may be able to be removed with keyhole surgery during the same operation. If not, additional procedures such as an endoscopic retrograde cholangiopancreatography (ERCP) may be required at that time or as a separate procedure.

An ERCP is a non-surgical procedure performed while you are asleep. During the procedure, a long, flexible tube with a light source at the tip is advanced through the stomach into the duodenum (first part of your small bowel). This allows the surgeon to access the bile duct from below where stones or narrowings can be addressed with special catheters and baskets.

PREVENTATIVE MEASURES

Eating a proper diet may reduce the frequency and severity of gallstone symptoms and includes:

• Low-fat diet

• Increased dietary fibre