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
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
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
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.