Gallbladder Disorders

Cholecystitis: inflammation of gallbladder; chronic or acute; acalculus or calculus

Cholelithiasis: stone (calculus) formation in gallbladder

Cholecystectomy: surgical removal of gallbladder

Anatomy and Physiology of the Gallbladder

  • Primary function: store bile

    • Cholecystokinin (CCK) stimulates gallbladder contraction in response to chyme in the duodenum.

    • Capacity: 30-50 mL

Bile

  • Composition:

    • Bile Salts - 50%

    • Phospholipids - 44%

    • Bilirubin and Cholesterol - 6%

  • Function:

    • Emulsifies lipids and forms micelles which are critical for fat digestion.

Gallstone Formation

  • Types of Stones

  • Cholesterol Stones:

    • Result from decreased bile acid synthesis and increased cholesterol synthesis leading to stone formation.

  • Pigment Stones:

    • Form due to increased bilirubin pigment from infections or conditions such as hemolytic anemia.

    • Can occur with biliary stasis (bile obstruction).

Risk Factors for Gallstones (5 F's)

  • Fat (BMI > 30): Increased cholesterol synthesis by the liver.

  • Female: Estrogen impacts cholesterol levels.

  • Fertile: Women aged 20-40 are at a higher risk due to estrogen.

  • Forty: Risk increases after age 40 for both genders.

  • Fair-skinned: More common in individuals of European descent.

Complications of Gallbladder Disease

  • Possible complications include:

    • Gangrenous cholecystitis

    • Abscess formation

    • Pancreatitis

    • Cholangitis (inflammation of bile duct)

    • Biliary cirrhosis

    • Formation of fistulas or rupture of the gallbladder.

Cholecystitis

Clinical Presentation

  • Continuous right upper quadrant (RUQ) pain

  • Fever and increased inflammatory markers (WBCs)

  • Positive Murphy's sign on physical examination (positive: patient abruptly stops breathing during deep palpation of right upper quadrant due to sharp pain)

  • Imaging findings may include thick-walled and shrunken gallbladder on ultrasound

Diagnostic Techniques

  • Laboratory Tests:

    • Elevated WBC count, inflammatory markers.

  • Imaging:

    • Ultrasound: First-line imaging modality.

    • HIDA scan (Hepatobiliary Iminodiacetic Acid) to evaluate gallbladder function.

Management Options

  • Analgesics for pain relief.

  • Initiate nil by mouth (NPO) with intravenous fluids.

  • Antibiotics to manage any infections.

  • Surgical intervention: Laparoscopic cholecystectomy is common and performed typically on an outpatient basis.