What are Gallstones and Gall Bladder Disease?
The gallbladder is a four-inch sac with a muscular wall that is located under the liver. The gallbladder serves as a reservoir for bile, which is needed in the small intestine for digestion of fat. The small intestine releases a hormone called cholecystokinin, signaling the gallbladder to contract. The force of the contraction propels the bile back through the common bile duct and then into the small intestine, where it emulsifies fatty molecules so that fat and the fat-absorbable vitamins A, D, E, and K can enter the blood stream through the intestinal lining.

Gallstones are formed from bile, a fluid composed mostly of water, bile salts, lecithin, and cholesterol. Bile is first produced by the liver and then secreted through tiny channels within the liver into a duct. From here, bile passes through a larger tube called the common duct, which leads to the small intestines. Then, unless cholecystokinin is released, the bile flows into the gallbladder through the cystic duct and is stored.

What Causes Gallstones?
About three-quarters of the gallstones found in the U.S. population are formed from cholesterol. Cholesterol makes up only five percent of bile; it is not very soluble, however, so in order to remain suspended in fluid, it must be properly balanced with bile salts. If the liver secretes too much cholesterol into the bile, if the bile becomes stagnant because of a defect in the mechanisms that cause the gallbladder to empty, or if other factors are present, supersaturation can occur. Cholesterol may then precipitate out of the bile solution to form gallstones - a condition known as cholelithiasis. The process is very slow and most often painless. Gallstones can range from a few millimeters to several centimeters in diameter.

The other 25% of gallstones are known as pigment gallstones. They are composed of calcium bilirubinate, or calcified bilirubin, the substance formed by the breakdown of hemoglobin in the blood. These black stones often form in the gallbladders of people with hemolytic anemia or cirrhosis.

Symptoms of Gall Bladder Disease
At any point, stones may obstruct the cystic duct, which leads from the gallbladder to the common bile duct, and cause pain (biliary colic), infection and inflammation (cholecystitis), or all of these. About 15% of people with stones in the gallbladder also have stones in the common bile duct (choledocholithiasis), which sometimes pass into the small intestine but also may lodge in the duct and cause distention, infection, or pancreatitis.

What Are the Symptoms of Gallstones and Gall Bladder Disease?
About 80% of people with gallstones never experience any symptoms. Most others remain without symptoms for at least two years after stone formation begins. If symptoms do occur, the chance of developing pain is about 2% per year for the first ten years after stone formation, after which the chance for developing symptoms decrease. On average, symptoms take about eight years to develop. The reason for the decline in incidence after ten years is not known, although some physicians suggest that "younger" stones may cause more symptoms.

Gall Bladder Colic Symptoms

• On and off pain in the upper right portion of the abdomen
• Pain that comes after a fatty meal - sometimes several hours later
• Steady pain along with nausea
• Pain often radiating under the right shoulder

Gall Bladder Inflammation Symptoms
Acute gallbladder inflammation (acute cholecystitis) is a more serious problem than biliary colic. It begins abruptly and subsides gradually.

• Nausea, vomiting and severe pain in the upper right abdomen
• Fever may or may not be present
• Pain when inhaling, or that radiates from the front to the back
• Chronic cholecystitis gives more vague symptoms-gas, nausea, abdominal discomfort around meals
• A yellowing of the skin or whites of eyes caused by a blockage of the bile duct

Diagnosis
A physical exam often reveals tenderness in the right upper area of the abdomen in acute cholecystitis, and sometimes in biliary colic. There is usually no tenderness in chronic cholecystitis. Tests that are needed to determine a treatment plan include:

Gall Bladder Ultrasound
Ultrasound, the diagnostic method most frequently used to detect gallstones, is a simple, rapid, and noninvasive imaging technique. Ultrasound detects gallstones as small as two millimeters in diameter with an accuracy of 90% to 95%. The patient must not eat for six or more hours before the test, which takes only about 15 minutes. During the same procedure, the physician can check the liver, bile ducts, and pancreas and quickly scan the gallbladder wall for thickening (characteristic of cholecystitis).

Gall Bladder Emptying Scan
This procedure is required when the ultrasound is normal. In this procedure, a chemical containing a radioisotope is injected intravenously. This material is excreted into bile and can be seen filling the gallbladder in a normal patient. In acute cholecystitis, however, the dye enters the common bile duct but not the gallbladder, indicating that a gallstone is obstructing the cystic duct. Cholescintigraphy takes 60 to 90 minutes. The scan detects total gallbladder obstruction but cannot identify individual gallstones.

What if I need Surgery?

Every year, about 500,000 people have their gallbladders removed. The gallbladder is not an essential organ, and even today, only surgical removal of the gallbladder (cholecystectomy) guarantees that the patient will not suffer a recurrence of gallstones.