Pop quiz: Where is your gallbladder and what exactly does it do?
Answer: It’s a small pear- or balloon-shaped organ that sits just below the liver. The gallbladder stores a fluid called bile that the liver produces. The gallbladder then releases bile through the bile duct into the small intestine as food is digested. The most common issue with the gallbladder is the formation of gallstones—which can cause cholecystitis. This inflammation can lead to infection that leads to the need for a cholecystectomy, also referred to as gallbladder surgery or gallbladder removal.
If you’re like most people, you probably had a vague sense that your gallbladder is somewhere in the abdominal area and does something related to the digestive system. But you might not have passed the pop quiz with flying colors. For many of us, the gallbladder is one of those organs we don’t give much thought to … until something goes wrong.
How do Gallstones Form?
Gallstones are the most common condition related to the gallbladder. Gallstones are particles that form when there is an imbalance in the bile. Bile is a fluid that is produced in the liver and is released into the small intestine to help in the process of digesting food, especially fats. Gallstones can occur when there is too much cholesterol or too much bilirubin in the bile. Bilirubin is a yellow/brown substance produced when the liver breaks down old red blood cells. Cholesterol is a waxy or fatty substance that is present in many foods we eat (but is also produced by the liver).
Gallstones can be very small (like a grain of sand) or very large (the size of a golf ball). And an individual can have many gallstones of varying sizes, or just one. Many people have gallstones and don’t know it, because they don’t cause any symptoms or health problems. However, when symptoms do start to appear, they indicate a health issue that needs to be addressed.
One of the first symptoms of gallstones is often a sharp pain on the upper right side of the abdomen. This pain occurs when a gallstone has formed in the gallbladder and moves to block the bile duct. This often happens after a large meal, and the pain can last anywhere from an hour to a few hours. When the gallstone moves out of the bile duct, the pressure decreases and the pain subsides. However, if gallstones get stuck in the bile duct for more than a few hours, infection and swelling can occur, causing permanent damage to the gallbladder and the liver. When these complications are not treated, the blockage can become deadly.
Although gallstones often resolve on their own, the risk of complications is serious. You should talk to your doctor if you suspect gallbladder issues based on any of the following symptoms: nausea and vomiting, fever and chills, abdominal pain, bloating, or indigestion.
If symptoms increase or become severe, visit your closest emergency department or call 911.
Who is at risk?
Gallstones are very common and can impact a wide variety of people. However, there are certain factors that put you at higher risk. Naturally, anyone with a family history of gallstones is more at risk. Age is a top risk factor, as those over 40 are more likely to develop gallstones. Females are also more likely than men to develop gallstones, especially those on hormone replacement therapy or birth control pills. Race also plays a role; within the United States, American Indians and Mexican Americans have high rates of gallstones.
Remember, if you experience any of the following, you should not wait for a doctor’s appointment or a scheduled procedure, but should go to the nearest hospital emergency room.
- You have been experiencing severe abdominal pain and then develop a fever or chills.
- Abdominal pain becomes severe, lasts more than a few hours, and cannot be controlled using over-the-counter pain medication.
- You show symptoms of jaundice including yellow discoloration of your skin or the whites or your eyes, dark-colored urine, or pale-colored stool.
Gallbladder Removal Surgery
Gallstones are typically diagnosed using a combination of symptoms along with other diagnostic procedures. Blood tests can indicate infection or inflammation. Your doctor may choose to use imaging tests such as ultrasound, MRI, or an oral cholecystogram (OCG) which is an x-ray performed using a dye that is put through the biliary system to detect stones.
Based on the results of diagnostic tests and your symptoms, your doctor will recommend treatment. Sometimes no treatment is needed, or medication to dissolve the gallstones will be prescribed. However, since gallstones often recur frequently, and the surgery is low-risk, doctors will often recommend a cholecystectomy to remove the gallbladder completely. Removal of the gallbladder solves the immediate issue and also takes away the risk for future infection and complications that can become life-threatening.
What to Expect from Gallbladder Surgery
There are two basic options for gallbladder removal surgery: laparoscopic surgery and open surgery. The laparoscopic cholecystectomy is less invasive. The surgeon uses small incisions to insert a very small camera and surgical instruments into the abdomen and perform the removal of the gallbladder. While general anesthesia is typically used, laparoscopic cholecystectomy generally takes two hours or less. Patients who undergo a laparoscopic cholecystectomy often go home the same day, although they do require someone else to drive due to the use of general anesthesia and pain medications.
An open cholecystectomy involves the removal of the gallbladder through just one large incision in the abdomen. This procedure is more invasive but may be necessary if you have scarring from an earlier surgery, a bleeding disorder, or any other condition that would make it difficult for the surgeon to see the gallbladder using the laparoscopic procedures. Open surgery for gallbladder removal also requires general anesthesia and typically takes one to two hours. You can expect to stay in the hospital for at least two days, with a total recovery time of six weeks.
Once the gallbladder has been removed, bile flows directly from the liver through the bile duct and into the small intestine where it serves the same digestive function as it did prior to surgery.
Recovery and Outlook
Cholecystectomy or gallbladder removal is a fairly common surgery. It is performed frequently and is considered low risk with a high rate of success. Patients who undergo gallbladder removal are usually able to return to their normal activities within a week or two. However, full recovery that allows for a complete return to your regular lifestyle may take closer to six weeks. Laparoscopic gallbladder removal surgery is less invasive than open surgery and therefore has a quicker and generally less painful recovery period.
As with any surgery, patients should follow all doctor’s instructions carefully in the days following surgery. You may also want to consider some lifestyle and dietary changes. Adjusting your regular diet to include more high fiber foods like beans, whole grains, and raw nuts—plus lots of fruits and vegetables—will help make digestion easier as your body adjusts to the change in bile in your digestive system. You may also need to reduce your intake of processed and high-fat foods. Diarrhea is a common side effect of gallbladder removal surgery, but should be temporary and improve quickly as your digestive system adjusts. Most people are able to live a fully functional and healthy life following gallbladder removal surgery.
Have questions about the gastrointestinal symptoms you are experiencing and the available treatment options? Call today to request an appointment with Dr. Sameer Islam, MD. Early diagnosis and treatment of your condition can improve your health as well as help avoid complications and emergency procedures in the future.