Gallstones are small, hard deposits that slowly form in the gallbladder, a sac-like organ that lies under the liver on the right side of the abdomen. They are usually composed of bile fluid, which is produced by the liver to aid in the digestion of fat, and cholesterol. In some cases, patients experience symptoms of gallstones without the appearance of the stones; this condition is known as acalculous gallbladder disease.
The most common symptom of gallbladder disease is pain, called biliary colic, which occurs in the upper abdomen, near the rib cage.
- This kind of gallbladder attack is sometimes accompanied by nausea and vomiting.
- The attacks may be triggered by large or fatty meals, often waking patients up during the night.
- They may occur frequently, but not more than once a week.
The symptoms of acute cholecystitis (gallbladder inflammation) are similar to biliary colic but more painful and longer lasting. They include:
- Pain in the upper right or mid abdomen that is severe and constant. It may last for days. Pain frequently increases when drawing a breath.
- Pain may also radiate to the back or occur under the shoulder blades, behind the breastbone or on the left side.
- About a third of patients have fever and chills.
- Nausea and vomiting may occur.
The three approaches to treating gallstones include:
Expectant Management: Wait and See
By and large, patients whose gallbladder disease has not progressed to acute cholecystitis are recommended for expectant management. Exceptions to this recommendation include people disposed to gallbladder cancer, members of ethnic groups particularly at risk for gallstones, or those patients whose gallstones are larger than 3 cm in diameter.
Thirty percent of patients are candidates for dissolving small gallstones using oral medications. However, this process can take up to two years and has largely fallen out of use in favor of laparoscopic gallbladder surgery.
Cholecystectomy: Surgical Removal of the Gallbladder
Candidates for gallbladder removal often have, or have had, one of the following conditions:
- A very severe gallstone attack
- Several less severe gallstone attacks
- Endoscopic sphincterotomy for common bile duct stones
- Cholecystitis: gallbladder inflammation
- Pancreatitis, or inflammation of the pancreas, secondary to gallstones
- High risk for gallbladder cancer
- Chronic acalculous gallbladder disease, also called biliary dyskinesia, in which the gallbladder does not empty well and causes biliary colic even though there are no gallstones present
Surgery for gallstones can usually be performed laparoscopically. Other procedures may be recommended for patients with acalculous gallbladder disease. Each procedure has its risks, but removal of the gallbladder should remove all symptoms of gallbladder disease.