Gallbladder: Functions, Gallstones, Symptoms & Treatment

About the Gallbladder

The gallbladder is a small, pear-shaped organ located under the liver (right hypochondrium). Its main functions include:

• Storage of bile and concentrating it 5–10 times.
• Releasing bile into the duodenum during digestion, especially after fatty meals.
• Supporting fat digestion and absorption.

Gallbladder Stones (Gallstones / Cholelithiasis)

Gallstones are solid deposits that form inside the gallbladder, usually from cholesterol, bile pigments, or both.

Causes & Risk Factors

The “classic 4F’s” describe the common risk factors for gallstones:

• Female
• Fat (obesity, high-fat diet)
• Forty (middle age)
• Fertile (pregnancy, estrogen therapy)

Other risk factors: diabetes, rapid weight loss, hemolytic diseases, family history.

Types of Gallstones

1. Cholesterol stones – most common, yellow-green in color, formed due to excess cholesterol.
2. Pigment stones – black (seen in hemolysis, cirrhosis) or brown (infection, bile stasis).
3. Mixed stones – contain cholesterol, calcium salts, and bile pigments.

Clinical Features

• Many gallstones are asymptomatic and discovered incidentally.
• Biliary colic: sudden, severe pain in the right upper abdomen or epigastrium, radiating to the back or shoulder, often after fatty meals.
• Other symptoms: nausea, vomiting, bloating, and indigestion.

Complications of Gallstones

1. Acute Cholecystitis – inflammation of the gallbladder due to duct obstruction.
2. Empyema of Gallbladder – pus collection inside the gallbladder.
3. Gangrene & Perforation – necrosis of the wall leading to peritonitis.
4. Chronic Cholecystitis – recurrent inflammation causing fibrosis and porcelain gallbladder (increased cancer risk).
5. Choledocholithiasis – gallstones in the common bile duct causing jaundice, cholangitis, or pancreatitis.
6. Acute Cholangitis – infection of bile ducts (Charcot’s triad: fever, pain, jaundice).
7. Gallstone Pancreatitis – stone blocks pancreatic duct causing pancreatitis.
8. Gallstone Ileus – intestinal obstruction due to large gallstone.
9. Gallbladder Carcinoma – rare but serious complication, often linked to chronic gallstones.

Diagnosis

• Ultrasound: first-line investigation for stones, wall thickening, fluid.
• CT / MRCP / ERCP: for complications and bile duct stones.
• Blood Tests: liver function, amylase, WBC count.

Management of Gallstones

• Asymptomatic gallstones: usually no treatment needed (except high-risk cases like porcelain gallbladder).
• Symptomatic gallstones or complications:
  • Laparoscopic cholecystectomy (keyhole gallbladder surgery): gold standard treatment.
  • ERCP: for stones in the common bile duct.
• Medical dissolution: ursodeoxycholic acid may be used rarely for patients unfit for surgery.