Gallbladder and Gallstones

by Robert Tallitsch, PhD | July 13, 2023

Video explaining the gallbladder and the creation of gallstones using a real patient case study!

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As is often the case, we may not know one or more of our internal organs is not functioning properly until we encounter symptoms — often painful symptoms — telling us otherwise. Such is the case with cholecystitis-related pain — otherwise known as a gallbladder attack. In this Brain Builder we will discuss the anatomy and function of the gallbladder, followed by the signs, symptoms, and treatment for cholecystitis. 

Anatomy of the Gallbladder

The gallbladder functions as a holder and concentrator of bile — a dark-green fluid produced by the liver. Bile (also referred to as gall) is stored and concentrated within the gallbladder. When released bile flows into the duodenum of the small intestine it aids in the absorption and digestion of lipids.

The gallbladder is found within the right hypochondriac region of the abdomen. It sits between the right and left lobes of the liver, in close relationship to the duodenum and the transverse colon. The fundus of the gallbladder comes in such close contact with the superior portion of the duodenum that it is very commonplace, upon dissection of the abdomen, to note that the duodenum is stained green from bile contained within the gallbladder.

The gallbladder, which typically holds fifty mL of bile, is pear-shaped and subdivided into a fundus, body, and neck. The cystic duct exits from the neck of the gallbladder. Two major ducts exit the hilum of the liver – the right and left hepatic ducts. These two ducts join to form the common hepatic duct. The common hepatic duct then joins with the cystic duct of the gallbladder to form the bile duct (also termed the common bile duct), which empties into the proximal portion of the duodenum. 

Formation of Gallstones

In some individuals, and for unknown reasons, the emptying of the gallbladder either slows or becomes incomplete. As a result, the bile that is retained within the gallbladder thickens. Because of this thickening, some or all of the salts within bile begin to precipitate. This leads to the formation of gallstones - either within the gallbladder, the ducts that drain the gallbladder, or both. There are two main categories of gallstones: pigment gallstones and cholesterol gallstones. Pigment gallstones are formed due to the precipitation of bilirubin, one of the components of bile. These types of stones typically form in individuals with blood disorders, sickle-cell anemia, liver disease, or a bile-duct infection.

Cholesterol gallstones are the most common form of gallstones. These are due to the presence of too much cholesterol within the bile, which increases the incidence of bile salt precipitation and the formation of gallstones.

Symptoms of Cholecystitis

The formation of gallstones does not result in any signs or symptoms for the patient. It isn’t until a gallstone comes lodged within either the cystic duct or bile duct that the patient experiences pain. A partial or total blockage of one of these ducts causes bile to back up and accumulate within the gallbladder. As a result the gallbladder undergoes spasmatic contractions, resulting in extreme pain for the patient. This pain is often accompanied by nausea, vomiting, and diarrhea. It is not uncommon for the patient to also experience referred pain that is either felt in the right shoulder region or perceived as heartburn.

Surgical Removal of the Gallbladder

Removal of the gallbladder (termed cholecystectomy) is a low-risk and commonly performed laparoscopic surgical procedure. Typically, four small incisions are made in the abdomen: one inferior to the umbilicus, one inferior to xiphoid process of the sternum, and two in the right subcostal region. This allows for the insertion of a video camera through one incision, and surgical tools through the remaining three.

The surgeon introduces carbon dioxide into the abdomen of the patient, which allows for better visualization of the abdominal contents. The gallbladder, cystic duct, bile duct, and vasculature supplying and draining the gallbladder are isolated from the inferior surface of the liver. The cystic duct and the cystic artery are dissected free, sectioned, and clamped (or cauterized) closed. The bile duct is retained, allowing bile to flow from the liver into the duodenum. The gallbladder is then removed, and the video camera and surgical instruments are withdrawn and the incisions are sutured closed. If there are no complications the entire surgical procedure is completed within ten minutes.

Most patients recover with few or no complications following gallbladder removal. Although some patients may experience loose stools for a limited period of time following surgery, there are few complications and the patient may resume a normal lifestyle within a few days.

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