The gall bladder is a small, pear-shaped sac that sits under the liver on the right hand side of the abdomen. The liver produces bile and the gallbladder stores it between meals. When you eat the gallbladder squeezes and the bile flows to the first part of the small intestine (duodenum) where it aids in digestion.
Causes of Gallbladder Problems
Gallbladder problems are usually caused by the presence of Gallstones - Cholelithiasis
Other problems include:
Infection or inflammation of the gallbladder (cholecystitis)
Cancer of the gallbladder.
Gallstones are small, hard masses consisting primarily of cholesterol and bile salts that usually form in the gall bladder.
Common symptoms include:
Pain in the upper right abdomen that is severe and constant, and may last several hours or even for days.
Pain may also radiate to the back or occur under the shoulder blades,
Fever, sweating and chills, nausea and vomiting
Abdominal bloating or recurring intolerance of fatty foods
If gallstones move into and block the bile duct, pain and serious complications can occur:
Jaundice - Yellow discolouration of the skin or eyes
Infection of the bile ducts - Cholangitis.
Inflammation of the pancreas - Pancreatitis
Gallstones are usually diagnosed by ultrasound. This is very similar to the scan used in pregnant women to look at their babies. Occasionally the stones can be seen on a plain x-ray or CT scan
Other tests include:
MRI - Magnetic Retrograde Cholangiopancreatography (MRCP): A non-invasive procedure that uses a magnet to examine the gallbladder and biliary ducts.
Endoscopic Retrograde Cholangiopancreatography (ERCP): This is a procedure performed under anaesthetic. The patient swallows a telescope, enabling injection of a special dye that outlines the biliary ducts (pipes). It is used to locate and remove gallstones in the bile duct. It cannot remove gallstones from the gallbladder
HIDA scan: Used to assess the function of the gallbladder. Using a low level radioactive dye it measures the gallbladders ability to contract and push the bile into the small intestine after a meal.
Blood tests to look for signs of infection, liver abnormalities, jaundice or pancreatitis may also be required.
The type of treatment you receive will depend on the particular problem your gallstones are causing. Often Surgery or an ERCP will be the best approach.
It is vital that you discuss the options with your surgeon so you can make an informed decision about how to proceed.
Your surgeon will discuss the various treatment options available with their pros and cons. In patients with symptomatic gallstones who are fit for surgery the best option is usually removal of the gallbladder and gallstones - Cholecystectomy.
Surgery - Cholecystectomy
Surgery to remove the gallbladder (cholecystectomy) is performed under a general anaesthetic. It is usually performed Laparoscopically using small incisions and a telescope. Occasionally it is not possible to complete the operation this way and conversion to an open cholecystectomy is required.
Involves the insertion of a camera through a small incision in the belly button (umbilicus). This allows visualisation of the internal organs on a video monitor. Three smaller incisions are used for insertion of other instruments. Most patients require only 1-2 nights in hospital and are able to return to their normal duties within 1-2 weeks
Involves an 8-12cm incision in the right side of the abdomen, below the ribs. Conversion to open is for safety and to avoid complications. It is required in less than 5% of patients, but is more common if the gallbladder is infected or if there have been infections in the past. Recovery is longer requiring 4-5 nights in hospital and return to normal duties takes 4-5 weeks
Risks you Need to Know About
Infections and bleeding are the most common complications
Bile leak may occur from where the cystic duct is clipped or from where the gallbladder is removed from the liver. It occurs in approximately 1% of patients. Management usually requires a minor operation and or an ERCP
The most serious complication that can occur is a bile duct injury. This is a serious problem and requires a major operation to fix it, Fortunately it is an uncommon problem (1 in 300)
There are other possible risks that are less common. For more information talk with Mr. Cullinan
After your procedure, you will receive IV fluids (drip) until you are able to tolerate food and liquid orally – 6-12 hrs
You will be given regular pain relief, so you remain comfortable
You may have a small drain tube coming out of one of the incisions. This will usually remain in for 24-48 hours
More than likely your sutures will be dissolvable. If not they will need to be removed 7-10 days post-operation.
Remaining mobile, with frequent walks, will aid in your recovery
You will need to organise someone to pick you up from hospital on the day of discharge. Discharge time ~ 9.30am
Wounds - Monitor them for any signs of infection, these include
Increased pain or temperature
Redness and swelling
You should contact the office if you have any concerns
Dressings - They are usually changed before discharge and you should leave them intact for 7 days. They are water resistant so you can shower. If the dressings become mucky or come off early please replace them
It is recommended you eat small light meals for 2-3 weeks after surgery
Avoid heavy lifting or strenuous activity for 2-4 weeks following surgery. Excessive straining can result in a hernia
Pain killers If required take 1-2 Panadol every 4-6 hours. Do not exceed 8 per day. You may have been given a script for stronger pain killers. It is vital you follow the instructions carefully
Driving – You should not drive for 7 days after your surgery. If your recovery is slow or you have had an open operation this will be longer